Bassa P, Kim E E, Inoue T, Wong F C, Korkmaz M, Yang D J, Wong W H, Hicks K W, Buzdar A U, Podoloff D A
Department of Nuclear Medicine, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
J Nucl Med. 1996 Jun;37(6):931-8.
We retrospectively investigated the value of PET with fluorine-18 fluorodeoxyglucose (FDG) for preoperative chemotherapy response in patients with locally advanced breast cancer.
FDG-PET studies were performed on 16 consecutive patients. All patients had PET studies before chemotherapy, 13 patients between the end of the first cycle and at the midpoint of chemotherapy, and 14 patients before surgery. Visual diagnoses and the standardized uptake values (SUV) of PET scans were compared with pathology findings at surgery and with the results of mammography, ultrasonography (US) or both, which were performed before chemotherapy and before local surgery for residual disease. Each patient's clinical course was monitored for up to 3 yr.
Sensitivity for detection of pathologically proven primary lesions was 100%, 62.5% and 87.5% with FDG-PET, mammography and US, respectively; and sensitivity for detection of initial nodal involvement was 77%, 70% and 87.5%, respectively. Sensitivity for detection of residual primary tumor was 75%, 71.4% and 87.5%, respectively; and sensitivity for detection of residual nodal involvement was 41.6%, 71.4% and 66.6%, respectively. The mean SUV value of primary lesions was 9.4 (range 2.0-20.7, n = 16), with only two lesions showing an SUV below 3. Clinical improvement of primary lesions was seen in all patients; improvement with smaller size and less FDG uptake was visible as early as the second study in 11 patients (69%). Mean SUV values obtained at the second and third studies decreased significantly from those obtained in the first study. In four patients, the disease recurred after breast surgery with high SUV values. The mammograms and sonograms obtained before surgery showed a decrease in the diameter of 6 and 12 primary lesions of the 13 and 14 patients examined, respectively.
FDG-PET is valuable for monitoring the effects of preoperative chemotherapy in patients with locally advanced breast cancer with better sensitivity for primary tumor and better specificity for nodal metastasis in comparison with ultrasonography.
我们回顾性研究了18F-氟脱氧葡萄糖（FDG）PET对局部晚期乳腺癌患者术前化疗反应的价值。
对16例连续患者进行了FDG-PET研究。所有患者在化疗前均进行了PET检查，13例患者在第一个周期结束至化疗中期进行了PET检查，14例患者在手术前进行了PET检查。将PET扫描的视觉诊断和标准化摄取值（SUV）与手术病理结果以及化疗前和局部手术前针对残留疾病进行的乳房X线摄影、超声检查（US）或两者的结果进行比较。对每位患者的临床病程进行了长达3年的监测。
FDG-PET、乳房X线摄影和US检测经病理证实的原发性病变的敏感性分别为100%、62.5%和87.5%；检测初始淋巴结受累的敏感性分别为77%、70%和87.5%。检测残留原发性肿瘤的敏感性分别为75%、71.4%和87.5%；检测残留淋巴结受累的敏感性分别为41.6%、71.4%和66.6%。原发性病变的平均SUV值为9.4（范围2.0 - 20.7，n = 16），只有两个病变的SUV低于3。所有患者的原发性病变均有临床改善；早在第二次检查时，11例患者（69%）可见病变尺寸变小且FDG摄取减少。第二次和第三次检查获得的平均SUV值与第一次检查相比显著降低。4例患者在乳房手术后疾病复发，SUV值较高。手术前获得的乳房X线照片和超声图显示，接受检查的13例和14例患者中，原发性病变的直径分别有6例和12例减小。
FDG-PET对于监测局部晚期乳腺癌患者术前化疗的效果具有重要价值，与超声检查相比，对原发性肿瘤具有更高的敏感性，对淋巴结转移具有更高的特异性。
