Bonnin David, Ladoire Sylvain, Briot Nathalie, Bertaut Aurélie, Drouet Clément, Cochet Alexandre, Alberini Jean-Louis
Department of Nuclear Medicine, Georges Francois Leclerc Research Cancer Center, 21079 Dijon, France.
Department of Medical Oncology, Georges Francois Leclerc Research Cancer Center; 21000 Dijon, France.
J Clin Med. 2023 Apr 17;12(8):2916. doi: 10.3390/jcm12082916.
Invasive lobular carcinoma accounts for 10 to 15% of all breast cancers. The first objective of this retrospective study was to assess the diagnostic performance of FDG-PET/CT scanning in women previously treated for invasive lobular carcinoma with suspected first recurrence. The secondary objectives were to evaluate the impact of PET/CT in a change in treatment and its prognostic value on specific survival.
Patients in whom a PET/CT scan was performed from January 2011 to July 2019 in our Cancer Research Center were enrolled. Recurrence was suspected based on clinical symptoms, abnormal findings on conventional imaging, and/or elevated tumor markers. The diagnosis of recurrence was established by the oncologist after integration of all clinical, biological, histological, imaging, and follow-up data. Prognostic factors of recurrence as predicted by PET were determined using univariate logistic regression. KI67, mitotic index, or grade of mitosis were tested. Survival curves were compared using the log-rank test. Sixty-four patients (mean age: 60.3; SD = 12.4 years) were enrolled. The average time from initial diagnosis of the primary tumor to suspicion of recurrence was 5.2 ± 4.1 years. Forty-eight patients (75%) were judged to have recurrence by the oncologist: 7 local and 41 metastatic, with mainly bone ( = 24), lymph node ( = 14) and liver ( = 10) metastases.
Sensitivity, specificity, and positive and negative predictive values of PET/CT to predict recurrence were, respectively: 87%, 87%, 95%, and 70%. SUVmax at recurrence sites was generally high (mean: 6.4; SD = 2.9). False negative PET/CT results occurred with local ( = 2), peritoneal ( = 2), meningeal ( = 1), or bladder ( = 1) recurrences. In 40 patients with available histopathological data from suspected sites of recurrence, 30 PET/CT were true positive. In four patients, primary lung ( = 1) or gastric ( = 1) tumors or lymphomas ( = 2) were found. The detection of a recurrence resulted in a change in treatment in 44/48 patients (92%). No association between recurrence predicted by PET and biological biomarkers was found. Median specific survival appears shorter in patients with metastatic recurrence versus patients with local or no recurrence on PET/CT ( = 0.067).
FDG-PET/CT is an effective and reliable tool for the detection of invasive lobular carcinoma recurrence, although certain recurrence sites specific to this histological type can impair its diagnostic performance.
浸润性小叶癌占所有乳腺癌的10%至15%。这项回顾性研究的首要目的是评估氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）对曾接受浸润性小叶癌治疗且疑似首次复发的女性患者的诊断效能。次要目的是评估PET/CT对治疗改变的影响及其对特定生存期的预后价值。
纳入2011年1月至2019年7月在我们癌症研究中心接受PET/CT扫描的患者。基于临床症状、传统影像学检查的异常发现和/或肿瘤标志物升高怀疑复发。肿瘤学家在整合所有临床、生物学、组织学、影像学和随访数据后确定复发诊断。使用单因素逻辑回归确定PET预测复发的预后因素。检测了Ki67、有丝分裂指数或有丝分裂分级。使用对数秩检验比较生存曲线。共纳入64例患者（平均年龄：60.3岁；标准差=12.4岁）。从原发性肿瘤初始诊断到怀疑复发的平均时间为5.2±4.1年。肿瘤学家判定48例患者（75%）复发：7例为局部复发，41例为转移复发，主要转移部位为骨（=24）、淋巴结（=14）和肝（=10）。
PET/CT预测复发的敏感性、特异性、阳性预测值和阴性预测值分别为：87%、87%、95%和70%。复发部位的最大标准化摄取值（SUVmax）通常较高（平均值：6.4；标准差=2.9）。PET/CT假阴性结果出现在局部复发（=2）、腹膜复发（=2）、脑膜复发（=1）或膀胱复发（=1）的情况中。在40例有疑似复发部位可用组织病理学数据的患者中，30例PET/CT结果为真阳性。在4例患者中，发现了原发性肺癌（=1）或胃癌（=1）肿瘤或淋巴瘤（=2）。44/48例患者（92%）因检测到复发而导致治疗改变。未发现PET预测的复发与生物学标志物之间存在关联。PET/CT显示有转移复发的患者的特定生存期的中位数似乎比局部复发或无复发的患者短（=0.067）。
FDG-PET/CT是检测浸润性小叶癌复发的有效且可靠的工具，尽管这种组织学类型特有的某些复发部位可能会影响其诊断效能。
