Gunster Jetske L B, Schrijver A Marjolein, van Duijnhoven Frederieke H, Stokkel Marcel P M, Marijnen Corrie A M, Scholten Astrid N
Department of Radiation Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
Breast. 2025 Jun;81:104475. doi: 10.1016/j.breast.2025.104475. Epub 2025 Apr 8.
This study evaluates the clinical impact of routine FDG-PET/CT on locoregional treatment in a large cohort of breast cancer patients scheduled for preoperative systemic therapy (PST).
Patients scheduled for PST were identified from a retrospective database between 2011 and 2020 at our hospital. All patients underwent staging by FDG-PET/CT prior to PST. The rate of regional upstaging by FDG-PET/CT compared to initial locoregional staging was assessed, as well as its implications on surgical and radiotherapeutic management. Logistic regression analysis was used to evaluate the correlation between clinical characteristics and regional upstaging by FDG-PET/CT.
Among 1228 eligible patients, FDG-PET/CT detected additional regional lymph node involvement in 145 patients (12 %). This resulted in treatment modifications for 140 patients (11 %), including changes to the axillary surgical approach in 27 patients (2 %), and adjustments to the postoperative radiation therapy plans in 115 patients (9 %). The majority of these modifications occurred in patients initially staged as cN1(1-3) (92/140). Clinical T stage was significantly associated with regional upstaging by FDG-PET/CT.
FDG-PET/CT staging before PST frequently identifies additional regional lymph node involvement, significantly altering locoregional treatment strategies in the majority.
本研究评估了常规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）对一大群计划接受术前全身治疗（PST）的乳腺癌患者局部区域治疗的临床影响。
从我院2011年至2020年的回顾性数据库中识别出计划接受PST的患者。所有患者在PST前均接受FDG-PET/CT分期。评估FDG-PET/CT相对于初始局部区域分期的区域分期上调率，及其对手术和放射治疗管理的影响。采用逻辑回归分析评估临床特征与FDG-PET/CT区域分期上调之间的相关性。
在1228例符合条件的患者中，FDG-PET/CT检测到145例患者（12%）有额外的区域淋巴结受累。这导致140例患者（11%）的治疗方案发生改变，包括27例患者（2%）腋窝手术方式的改变，以及115例患者（9%）术后放疗计划的调整。这些改变大多发生在最初分期为cN1(1-3)的患者中（92/140）。临床T分期与FDG-PET/CT区域分期上调显著相关。
PST前的FDG-PET/CT分期经常发现额外的区域淋巴结受累，显著改变了大多数患者的局部区域治疗策略。
