Fujii H, Nakamura K, Kubo A, Enomoto K, Ikeda T, Kubota T, Matsuzaki S W, Kitajima M
Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
Ann Nucl Med. 1998 Dec;12(6):307-12. doi: 10.1007/BF03164919.
The chemosensitivity of breast cancer is important for its management, but it is difficult to evaluate preoperatively. Tc-99m hexakis-2-methoxyisobutylisonitrile (MIBI) scintimammography has been reported to indicate the expression of P-glycoprotein, which is one factor concerned with multidrug resistance. We developed a chemosensitivity assay by using surgical specimens to investigate whether 99mTc-MIBI scintimammography findings before the operation are related to chemosensitivity according to our assay. Fifteen patients with primary breast cancer were enrolled into the study. Early and delayed images were obtained at 10 and 120 minutes after intravenous injection of 99mTc-MIBI, respectively. Regions of interest were placed on the tumors and the contralateral healthy breasts in each patient to estimate 99mTc-MIBI uptake in the tumor, and retention indices were then calculated to assess the washout of 99mTc-MIBI. Chemosensitivity assay was performed by incubating surgical specimens with anticancer agents such as doxorubicin, epirubicin, pinorubicin, mitomycin C, cisplatin and 5-fluorouracil. 99mTc-MIBI washout on scintimammography was successfully related to inhibition ratios on chemosensitivity tests when compared with 99mTc-MIBI uptake by the tumor. In particular, high correlation coefficients were obtained between the retention index of 99mTc-MIBI and the inhibition ratios of doxorubicin (r = 0.75), epirubicin (r = 0.60) and pinorubicin (r = 0.62), but poor correlation was found for mitomycin C (r = 0.44) and cisplatin (r = 0.31). Our results indicate that the retention index of 99mTc-MIBI is closely correlated to chemosensitivity to anthracyclines, suggesting that double-phase scintimammography allows preoperative prediction of chemosensitivity of breast cancer.
乳腺癌的化疗敏感性对其治疗至关重要，但术前评估较为困难。据报道，锝-99m六甲基-2-甲氧基异丁基异腈（MIBI）乳腺闪烁显像可显示P-糖蛋白的表达，而P-糖蛋白是与多药耐药相关的一个因素。我们通过使用手术标本开发了一种化疗敏感性检测方法，以研究术前99mTc-MIBI乳腺闪烁显像结果是否与我们检测方法的化疗敏感性相关。15例原发性乳腺癌患者纳入本研究。分别在静脉注射99mTc-MIBI后10分钟和120分钟获得早期和延迟图像。在每位患者的肿瘤及对侧健康乳腺上放置感兴趣区，以估计肿瘤对99mTc-MIBI的摄取，然后计算滞留指数以评估99mTc-MIBI的洗脱情况。通过将手术标本与阿霉素、表柔比星、吡柔比星、丝裂霉素C、顺铂和5-氟尿嘧啶等抗癌药物孵育来进行化疗敏感性检测。与肿瘤对99mTc-MIBI的摄取相比，乳腺闪烁显像上99mTc-MIBI的洗脱与化疗敏感性试验中的抑制率成功相关。特别是，99mTc-MIBI的滞留指数与阿霉素（r = 0.75）、表柔比星（r = 0.60）和吡柔比星（r = 0.62）的抑制率之间获得了较高的相关系数，但丝裂霉素C（r = 0.44）和顺铂（r = 0.31）的相关性较差。我们的结果表明，99mTc-MIBI的滞留指数与对蒽环类药物的化疗敏感性密切相关，提示双相乳腺闪烁显像可实现乳腺癌化疗敏感性的术前预测。
