F-FDG PET和F-FES PET对1-2级雌激素受体阳性乳腺癌分期的诊断准确性
The Diagnostic Accuracy of F-FDG PET and F-FES PET for Staging Grade 1-2 Estrogen Receptor-Positive Breast Cancer.
作者信息
Knip Jelijn J, Iqbal Ramsha, Bonjer Emma C, Mammatas Lemonitsa H, van Zweeden Annette A, Perin Paola, Teunissen Jaap J M, Diepenhorst Gwen M P, Schijf Laura J, Bakker Sandra D, Schoenmakers Noortje, van der Velde Susanne, Barbé Ellis, Duvivier Katya, Konings Inge R, Zwezerijnen Gerben J C, Windhorst Albert D, Boellaard Ronald, Oprea-Lager Daniela E, Menke-van der Houven van Oordt C Willemien
机构信息
From the Departments of Medical Oncology (J.J.K., R.I., E.C.B., I.R.K., C.W.M.v.d.H.v.O.), Surgery (G.M.P.D., S.v.d.V.), Radiology and Nuclear Medicine (L.J.S., K.D., G.J.C.Z., A.D.W., R.B., D.E.O.L.), and Pathology (E.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Department of Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands (J.J.K., R.I., I.R.K., G.J.C.Z., R.B., D.E.O.L., C.W.M.v.d.H.v.O.); Departments of Medical Oncology (L.H.M.) and Nuclear Medicine (J.J.M.T.), Reinier de Graaf Gasthuis, Delft, the Netherlands; Department of Medical Oncology, Ziekenhuis Amstelland, Amstelveen, the Netherlands (A.A.v.Z., P.P.); Department of Surgery, Flevoziekenhuis, Almere, the Netherlands (G.M.P.D.); Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands (L.J.S.); Department of Medical Oncology, Zaans Medisch Centrum, Zaandam, the Netherlands (S.D.B.); and Department of Medical Oncology, Dijklander Ziekenhuis, Hoorn, the Netherlands (N.S.).
出版信息
Radiology. 2025 Mar;314(3):e241850. doi: 10.1148/radiol.241850.
Background According to current guidelines, staging of patients with locally advanced breast cancer and local-regional recurrent breast cancer is preferably performed with PET using 2-fluorine 18-fluoro-2-deoxy-d-glucose (F-FDG). However, F-FDG PET might underperform in low-grade estrogen receptor (ER)-positive breast cancer. Alternatively, 16α-F-fluoro-17β-estradiol (F-FES) has emerged as a powerful tracer for in vivo visualization of ER-positive lesions. Purpose To assess whether F-FES PET improves staging of grade 1 or 2 ER-positive breast cancer compared with F-FDG PET. Materials and Methods Patients with clinical stage II/III or local-regional recurrent, grade 1 or 2, ER-positive breast cancer were included between December 2018 and January 2021 in this prospective multicenter pilot study. All participants underwent an F-FES PET examination in addition to standard staging with conventional imaging and F-FDG PET. Both PET scans were independently assessed. The disease stage was determined independently based on conventional imaging and F-FDG PET or F-FES PET. Relevant lesions suspected of malignancy were verified histopathologically, after which a final stage was determined. Results A total of 41 female participants (median age, 56 years [IQR, 48-71 years]) with 44 breast tumors were included. Overall, 29 of 41 participants (71%) were correctly staged at F-FDG PET compared with 34 of 41 (83%) at F-FES PET ( = .18). Seven of 10 and nine of 10 cases of lobular breast cancer were correctly staged at F-FDG and F-FES PET, respectively (70% vs 90%; = .38) and seven of 12 and 11 of 12 cases of grade 1 tumors, respectively (58% vs 92%; = .06). Regional lymph nodes were incorrectly staged at F-FDG PET in six of 44 cases (14%), whereas all cases were correctly staged at F-FES PET ( = .02). Both imaging methods had a sensitivity of 100% (95% CI: 59, 100) and a specificity of 91% (95% CI: 76, 98) for the detection of metastatic disease. Conclusion In this prospective pilot study, there was no evidence of a difference in diagnostic accuracy of F-FES PET and F-FDG PET in staging patients with grade 1 or 2 ER-positive breast cancer. Clinical trial registration no. NCT03726931 Published under a CC BY 4.0 license See also the editorial by Fowler in this issue.
背景
根据当前指南，局部晚期乳腺癌和局部区域复发性乳腺癌患者的分期最好使用2-氟-18-氟-2-脱氧-d-葡萄糖（F-FDG）进行PET检查。然而，F-FDG PET在低级别雌激素受体（ER）阳性乳腺癌中可能表现不佳。另外，16α-F-氟-17β-雌二醇（F-FES）已成为用于ER阳性病变体内可视化的有效示踪剂。目的：评估与F-FDG PET相比，F-FES PET是否能改善1级或2级ER阳性乳腺癌的分期。材料与方法：2018年12月至2021年1月期间，本前瞻性多中心试点研究纳入了临床分期为II/III期或局部区域复发、1级或2级、ER阳性乳腺癌患者。所有参与者除了接受常规成像和F-FDG PET的标准分期外，还接受了F-FES PET检查。两种PET扫描均由独立人员进行评估。疾病分期根据常规成像和F-FDG PET或F-FES PET独立确定。对怀疑为恶性的相关病变进行组织病理学验证，然后确定最终分期。结果：共纳入41名女性参与者（中位年龄56岁[四分位间距，48 - 71岁]），有44个乳腺肿瘤。总体而言，41名参与者中29名（71%）在F-FDG PET检查时分期正确，而在F-FES PET检查时为41名中的34名（83%）（P = 0.18）。小叶乳腺癌10例中有7例在F-FDG PET检查时分期正确，10例中有9例在F-FES PET检查时分期正确（70%对90%；P = 0.38）；1级肿瘤12例中有7例和12例中有11例分别在F-FDG和F-FES PET检查时分期正确（58%对92%；P = 0.06）。44例中有6例（14%）区域淋巴结在F-FDG PET检查时分期错误，而所有病例在F-FES PET检查时分期均正确（P = 0.02）。两种成像方法检测转移疾病的敏感性均为100%（95%CI：59，100），特异性均为为91%（95%CI：76，98）。结论：在这项前瞻性试点研究中，没有证据表明F-FES PET和F-FDG PET在1级或2级ER阳性乳腺癌患者分期的诊断准确性上存在差异。临床试验注册号：NCT03726931 根据知识共享署名4.0许可发布 另见本期Fowler的社论。
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