18FDG PET/CT 对新诊断乳腺癌患者临床管理、成本效益和辐射暴露的影响。
Impact of 18FDG PET/CT on Clinical Management, Cost Effectiveness, and Radiation Exposure in Newly Diagnosed Breast Cancer Patients.
机构信息
Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.
Department of Hem-Oncology, University of Oklahoma, OH, USA.
出版信息
Asian Pac J Cancer Prev. 2024 Oct 1;25(10):3577-3581. doi: 10.31557/APJCP.2024.25.10.3577.
BACKGROUND
For the initial staging of breast cancer (BC), 18FDG PET/CT is recommended by professional guidelines in stage III (except T3N1) and inflammatory BC (T4d) and optional when conventional imaging is equivocal or suspicious. However, growing evidence also supports its role in the staging of intermediate-risk groups (IIA, IIB, T3N1 of IA). This study aimed to compare the impact of 18FDG PET/CT with conventional imaging (CT-chest+abdomen+pelvis and bone scan; CT-CAP+BS) in staging, cost-effectiveness, and radiation exposure in the initial staging of BC.
MATERIAL AND METHOD
A retrospective study (April 2020 2024) included 115 biopsy-proven BC patients who had CT-CAP+BS and 18FDG PET/CT for initial staging. Data were analyzed to see the impact of 18FDG PET/CT on change in staging, cost-effectiveness, and radiation exposure compared to CA-CAP+BS.
RESULTS
Out of 115 patients (113 female and 02 male), 110 had unilateral and 5 had bilateral BC (Invasive Ductal Ca. 107; Non-IDC: 08) with non-significant laterality. The overall upstaging rate for regional nodal and/or distant metastases was 36% (24/66; excluded 49 with stage IV). The overall upstaging rate due to unsuspected higher nodal metastases was 20% (predominantly stage IIA, and IIB). Upstaging rate to stage IV was seen in 17% (11/66; predominantly in IIIA-C). The overall concordance (no change in staging) was seen in 64% (42/66) while no downstaging was found in any patient. In patients with stage-IV disease (n = 49), 18FDG PET/CT identified a higher number of hypermetabolic lesions in 18 (37%), lesser in 07 (14%), and similar in 24 (49%) cases. The estimated cost in Pak rupees for CT-CAP+BS and PET/CT was 139000 and 106000 respectively. The mean effective dose imparted by 18FDG PET/CT was 8.85 mSv compared to the reported 26.6 mSv by CT-CAP+BS.
CONCLUSION
We conclude that in the initial staging of BC, 18FDG PET/CT compared with CT-CAP+BS has a significant impact on decision-making by upstaging the disease in stage II and III and detecting more metastatic lesions in stage-IV disease. Furthermore, 18FDG PET/CT is more cost-effective and imparts significantly lower radiation exposure as compared with CT+CAP+BS. These findings support the inclusion of 18FDG PET/CT in the initial staging of stage II-IV BC.
背景
对于乳腺癌（BC）的初始分期，专业指南建议在 III 期（T3N1 除外）和炎症性 BC（T4d）中进行 18FDG PET/CT，在常规影像学检查不确定或可疑时可选择进行。然而，越来越多的证据也支持其在中危组（IIA、IIB、IA 的 T3N1）分期中的作用。本研究旨在比较 18FDG PET/CT 与常规影像学（胸部+腹部+骨盆 CT 和骨扫描；CT-CAP+BS）在分期、成本效益和辐射暴露方面在 BC 初始分期中的影响。
材料和方法
一项回顾性研究（2020 年 4 月至 2024 年）纳入了 115 例经活检证实的 BC 患者，这些患者均接受了 CT-CAP+BS 和 18FDG PET/CT 进行初始分期。分析数据以了解 18FDG PET/CT 对分期改变、成本效益和辐射暴露的影响，与 CA-CAP+BS 相比。
结果
在 115 例患者（113 例女性和 02 例男性）中，110 例为单侧 BC，5 例为双侧 BC（浸润性导管癌 107 例；非 IDC：08 例），无明显侧别。区域淋巴结和/或远处转移的总体升级率为 36%（66 例中的 24 例；排除 49 例 IV 期患者）。由于意外出现更高的淋巴结转移而导致的总体升级率为 20%（主要为 IIA 和 IIB 期）。在 17%（66 例中的 11 例）患者中观察到 IV 期升级，主要在 IIIA-C 期。总体一致性（分期无变化）为 64%（42/66），而无任何患者降期。在 49 例 IV 期疾病患者中，18FDG PET/CT 在 18 例（37%）患者中发现更多高代谢病变，在 07 例（14%）患者中发现较少，在 24 例（49%）患者中发现相似。巴基斯坦卢比的 CT-CAP+BS 和 PET/CT 估计费用分别为 139000 卢比和 106000 卢比。18FDG PET/CT 所赋予的平均有效剂量为 8.85mSv，而 CT-CAP+BS 报告的有效剂量为 26.6mSv。
结论
我们的结论是，在 BC 的初始分期中，与 CT-CAP+BS 相比，18FDG PET/CT 在 II 期和 III 期疾病的决策中具有显著影响，并在 IV 期疾病中检测到更多的转移病变。此外，与 CT+CAP+BS 相比，18FDG PET/CT 更具成本效益，并且辐射暴露显著降低。这些发现支持将 18FDG PET/CT 纳入 II-IV 期 BC 的初始分期。
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