[1]张亶,章斌,邓胜明,等.18F-FDG PET/CT在乳腺癌术后随访中的价值[J].国际放射医学核医学杂志,2017,41(3):159-165.[doi:10.3760/cma.j.issn.1673-4114.2017.03.001]
　Zhang Dan,Zhang Bin,Deng Shengming,et al.Clinical value of 18F-FDG PET/CT in follow-up of postoperative breast cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2017,41(3):159-165.[doi:10.3760/cma.j.issn.1673-4114.2017.03.001]
点击复制

18F-FDG PET/CT在乳腺癌术后随访中的价值(/HTML)
分享到：

《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
41
期数:
2017年第3期
页码:
159-165
栏目:
论著
出版日期:
2017-05-25

文章信息/Info

Title:
Clinical value of 18F-FDG PET/CT in follow-up of postoperative breast cancer
作者:
张亶;  章斌;  邓胜明;  吴翼伟
215000, 苏州大学附属第一医院核医学科
Author(s):
Zhang Dan;  Zhang Bin;  Deng Shengming;  Wu Yiwei
Department of Nuclear Medicine, the First Affiliated Hospital of Soochow University, Suzhou 215000, China
关键词:
乳腺肿瘤; 正电子发射断层显像术; 体层摄影术; X线计算机; 预后; 肿瘤转移; 肿瘤复发
Keywords:
Breast neoplasms; Positron-emission tomography; Tomography;  X-ray computed; Prognosis; Neoplasm metastasis; Neoplasm recurrence
DOI:
10.3760/cma.j.issn.1673-4114.2017.03.001
摘要:
目的 研究18F-FDG PET/CT在乳腺癌术后复发转移中的诊断价值以及在治疗决策改变和预后中的价值。方法 回顾性分析2007年7月至2016年9月行18F-FDG PET/CT检查的59例女性乳腺癌术后患者，分析PET/CT对真阳性患者临床治疗策略的影响，并对真阳性组和真阴性组患者进行Kaplan-Meier生存分析。在PET/CT显像真阳性组中，按照患者年龄、雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体2（HER2）及乳腺癌亚型进行分组，组间SUVmax的比较采用t检验。结果 在59例乳腺癌术后患者中，18F-FDG PET/CT诊断乳腺癌术后复发转移的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为100%、87.5%、94.9%、92.1%、100%。PET/CT真阳性组与真阴性组患者平均随访时间分别为（58.33±37.69）个月和（47.40±25.99）个月，中位数生存时间分别为3.58年和4.16年，PET/CT真阴性患者的总生存时间（OS）和无进展生存时间（PFS）长于真阳性患者，且差异有统计学意义（χ2=10.274和17.187，均P<0.01）。35例PET/CT真阳性患者中，25例分期上调，30例检查后治疗策略改变。乳腺癌复发转移灶的SUVmax在年龄、ER、PR、HER2及亚型分组间的差异无统计学意义（t=0.808、0.225、0.355、-0.426和-1.076，均P>0.05）。结论 18F-FDG PET/CT显像在诊断乳腺癌术后复发转移中有较高的灵敏度和准确率，能及时修正乳腺癌术后复发转移患者的临床再分期，以及指导临床治疗策略的改变，在乳腺癌的术后随访中具有较高的临床应用价值。
Abstract:
Objective To evaluate the clinical value of 18F-FDG PET/CT imaging in detecting the recurrence and metastasis, therapeutic strategy, and prognosis of postoperative breast cancer patients. Methods From July 2007 to September 2016, 59 patients with postoperative breast cancer were retrospectively studied. The influence of PET/CT imaging results on the choice of therapeutic strategy was analyzed. Kaplan-Meier survival analysis was conducted based on the true-positive and true-negative groups of patients. Comparison of SUVmax according to the age, estrogen receptor(ER), progesterone receptor (PR), human epidermal growth factor receptor-2(HER2), and subtypes of the patients in the PET/CT imaging true-positive group was performed using t-test. Results The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT were 100%, 87.5%, 94.9%, 92.1%, and 100%, respectively. No statistically significant difference in the SUVmax for breast cancer recurrence and metastasis was observed between the two groups of patients according to age, ER, PR, HER2, and subtypes of breast cancer(t=0.808, 0.225, 0.355, -0.426 and -1.076, all P>0.05). The true-positive and true-negative groups were followed for a median period of 58.33±37.69 and 47.40±25.99 months, and their median survival times were 3.58 and 4.16 years, respectively. The two groups significantly differed in the overall survival and progression-free survival times (Kaplan-Meier survival analysis, χ2=10.274, P<0.01; χ2=17.187, P<0.01). Clinical restaging was raised in 25 true-positive patients after PET/CT imaging, and the therapeutic strategy was changed in 30 true-positive patients. Conclusions PET/CT imaging is highly sensitive and accurate in diagnosing the recurrence and metastasis of postoperative breast cancer and allows clinical restaging in a timely manner. It helps in choosing the appropriate clinical therapeutic strategy, thereby improving the prognosis of patients. Compared with the true-positive patients, the true-negative patients who underwent PET/CT imaging had a better prognosis. Therefore, PET/CT imaging has a high clinical value in the follow-up of postoperative breast cancer patients.

参考文献/References:

[1] Yang L, Parkin DM, Ferlay J, et al. Estimates of cancer incidence in China for 2000 and projections for 2005[J]. Cancer Epidemiol Biomarkers Prev, 2005, 14(1):243-250.
[2] Mayer EL, Burstein HJ. Chemotherapy for metastatic breast cancer[J]. Hematol Oncol Clin North Am, 2007, 21(2):257-272. DOI:10. 1016/j.hoc.2007.03.001.
[3] Berman AT, Thukral AD, Hwang WT, et al. Incidence and patterns of distant metastases for patients with early-stage breast cancer after breast conservation treatment[J]. Clin Breast Cancer, 2013, 13(2):88-94. DOI:10.1016/j.clbc.2012.11.001.
[4] Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer:hightlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013[J]. Ann Oncol, 2013, 24(9):2206-2223. DOI:10.1093/annonc/mdt303.
[5] Slamon DJ, Leyland-Jones B, Shak S, et al. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2[J]. N Engl J Med, 2001, 344(11):783-792. DOI:10.1056/NEJM200103153441101.
[6] Blackwell KL, Burstein HJ, Storniolo AM, et al. Randomized study of Lapatinib alone or in combination with trastuzumab in women with ErbB2-positive, trastuzumab-refractory metastatic breast cancer[J]. J Clin Oncol, 2010, 28(7):1124-1130. DOI:10.1200/JCO. 2008.21.4437.
[7] Mavi A, Cermik TF, Urhan M, et al. The effects of estrogen, progesterone, and C-erbB-2 receptor states on 18F-FDG uptake of primary breast cancer lesions[J]. J Nucl Med, 2007, 48(8):1266-1272. DOI:10.2967/jnumed.106.037440.
[8] 陈道宝, 杨红健. 乳腺癌ER与FES-PET[J]. 中国肿瘤, 2008, 17(7):588-592. DOI:10.3969/j.issn.1004-0242.2008.07.013. Chen DB, Yang HJ. Estrogen receptor and fluoroestradiol-positron emission tomography in breast cancer[J]. Chin Cancer, 2008, 17(7):588-592.
[9] Montagna E, Bagnardi V, Rotmensz N, et al. Breast cancer subtypes and outcome after local and regional relapse[J]. Ann Oncol, 2012, 23(2):324-331. DOI:10.1093/annonc/mdr129.
[10] Niikura N, Liu J, Hayashi N, et al. Loss of human epidermal growth factor receptor 2(HER2) expression in metastatic sites of HER2-overexpressing primary breast tumors[J]. J Chin Oncol, 2012, 30(6):593-599. DOI:10.1200/JCO.2010.33.8889.
[11] Zangheri B, Messa C, Picchio M, et al. PET/CT and breast cancer[J]. Eur J Nucl Med Mol Imaging, 2004, 31 supple1:S135-142. DOI:10.1007/s00259-004-1536-7.
[12] Cermik TF, Mavi A, Basu S, et al. Impact of FDG PET on the pre-operative staging of newly diagnosed breast cancer[J]. Eur J Nucl Med Mol Imaging, 2008, 35(3):475-483. DOI:10.1007/s00259-007-0580-5.
[13] 陈建伟, 王杰, 刘标, 等. PET/CT与胸部诊断CT在乳腺癌术后随访中的比较[J]. 南京医科大学学报:自然科学版, 2010, 30(2):195-198, 213. Chen JW, Wang J, Liu B, et al. Impact of 18F-FDG PET/CT compared with diagnostic CT on following-up breast cancer after surgery[J]. Acta Univ Med Nanjing(Natural Science), 2010, 30(2):195-198, 213.
[14] Murakami R, Kumita S, Yoshida T, et al. FDG-PET/CT in the diag-nosis of recurrent breast cancer[J]. Acta Radiol, 2012, 53(1):12-16. DOI:10.1258/ar.2011.110245.
[15] 刘晓强, 周海中, 杜鹃. 乳腺癌患者术前18F-FDG PET/CT显像肿瘤代谢体积测定的预后价值[J]. 实用临床医药杂志, 2014, 18(21):55-59. DOI:10.7619/jcmp.201421016. Liu XQ, Zhou HZ, Du J. Prognositc value of metabolic tumor volume measured by 18F-FDG PET/CT imaging in preoperative breast cancer patients[J]. J Clin Med Prac, 2014, 18(21):55-59.
[16] Maffione AM, Lopci E, Bluemel C, et al. Diagnostic accuracy and impact on management of 18F-FDG PET and PET/CT in colorectal liver metastasis:a meta-analysis and systematic review[J]. Eur J Nucl Med Mol Imaging, 2015, 42(1):152-163. DOI:10.1007/s00259-014-2930-4.

相似文献/References:

[1]何燕,苏晋,郑晓霞,等.P-糖蛋白抑制剂在PET显像中的应用研究[J].国际放射医学核医学杂志,2016,40(1):1.[doi:10.3760/cma.j.issn.1673-4114.2016.01.001]
　He Yan,Su Jin,ZhengXiaoxia,et al.Developing P-glycoprotein inhibitor marked by PET[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):1.[doi:10.3760/cma.j.issn.1673-4114.2016.01.001]
[2]许飞,刘建军,黄钢,等.PET乏氧显像在预测肿瘤乏氧及指导临床治疗中的应用进展[J].国际放射医学核医学杂志,2016,40(1):35.[doi:10.3760/cma.j.issn.1673-4114.2016.01.008]
　Xu Fei,Liu Jianjun,Huang Gang,et al.The application of hypoxia imaging with PET in predicting tumor hypoxia and guiding clinical therapy[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):35.[doi:10.3760/cma.j.issn.1673-4114.2016.01.008]
[3]胡伟,赵军.小胶质细胞在AD炎性机制中的作用及其常见PET显像剂的应用进展[J].国际放射医学核医学杂志,2016,40(1):44.[doi:10.3760/cma.j.issn.1673-4114.2016.01.009]
　Hu Wei,Zhao Jun.Microglia’s Alzheimer disease inflammatory mechanisms and progress of its common application in PET imaging agents[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):44.[doi:10.3760/cma.j.issn.1673-4114.2016.01.009]
[4]张莹莹,王振光,孔艳.PET/CT显像在肺间质纤维化中的应用进展[J].国际放射医学核医学杂志,2016,40(1):55.[doi:10.3760/cma.j.issn.1673-4114.2016.01.011]
　Zhang Yingying,Wang Zhenguang,Kong Yan.Application advancement on PET/CT in pulmonary interstitial fibrosis[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):55.[doi:10.3760/cma.j.issn.1673-4114.2016.01.011]
[5]李海峰,张晓军,李云钢,等.国产模块LOOP环改良法合成11C-蛋氨酸[J].国际放射医学核医学杂志,2016,40(2):106.[doi:10.3760/cma.j.issn.1673-4114.2016.02.004]
　Li Haifeng,Zhang Xiaojun,Li Yungang,et al.Synthesis of 11C-methionine on home-made module by the improved LOOP method[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):106.[doi:10.3760/cma.j.issn.1673-4114.2016.02.004]
[6]杨雷,袁卫红,王家平,等.99Tcm-MIBI显像与钼靶X线对乳腺癌诊断的比较研究[J].国际放射医学核医学杂志,2016,40(2):111.[doi:10.3760/cma.j.issn.1673-4114.2016.02.005]
　Yang Lei,Yuan Weihong,Wang Jiaping,et al.Diagnostic value of technetium 99Tcm sestamibi and X-ray mammography in breast cancer: a comparison study[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):111.[doi:10.3760/cma.j.issn.1673-4114.2016.02.005]
[7]史文杰,孟召伟,谭建.基于Deauville标准探讨18F-FDG PET/CT在霍奇金淋巴瘤复发诊断中的应用价值[J].国际放射医学核医学杂志,2016,40(2):120.[doi:10.3760/cma.j.issn.1673-4114.2016.02.007]
　Shi Wenjie,Meng Zhaowei,Tan Jian.Value of 18F-FDG PET/CT on diagnosis of Hodgkin lymphoma recurrence using Deauville criterion[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):120.[doi:10.3760/cma.j.issn.1673-4114.2016.02.007]
[8]马乐,张万春,李晓敏.乳腺癌前哨淋巴结核素显像新进展[J].国际放射医学核医学杂志,2016,40(2):145.[doi:10.3760/cma.j.issn.1673-4114.2016.02.012]
　Ma Le,Zhang Wanchun,Li Xiaomin.Evolution of radionuclide imaging of sentinel node lymphscintigraphy in breast cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):145.[doi:10.3760/cma.j.issn.1673-4114.2016.02.012]
[9]李海峰,张晓军,张锦明.多巴胺转运蛋白显像剂11C-β-CFT在帕金森病中的应用研究[J].国际放射医学核医学杂志,2016,40(3):218.[doi:10.3760/cma.j.issn.1673-4114.2016.03.011]
　Li Haifeng,Zhang Xiaojun,Zhang Jinming.Review of the use of dopamine transporter imaging agent 11C-β-CFT for diagnosing Parkinson disease[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):218.[doi:10.3760/cma.j.issn.1673-4114.2016.03.011]
[10]尤阳,轩昂,张杰,等.淋巴瘤患者大脑静息葡萄糖代谢改变[J].国际放射医学核医学杂志,2016,40(4):255.[doi:10.3760/cma.j.issn.1673-4114.2016.04.003]
　You Yang,Xuan Ang,Zhang Jie,et al.Changes in resting-state brain glucose metabolism in patients with lymphoma[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(3):255.[doi:10.3760/cma.j.issn.1673-4114.2016.04.003]
[11]胡鸿,唐刚华,聂大红.乳腺癌分子显像研究进展[J].国际放射医学核医学杂志,2015,39(1):91.[doi:10.3760/cma.j.issn.1673-4114.2015.01.019]
　Hu Hong,Tang Ganghua,Nie Dahong.Progress on molecular imaging of breast cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(3):91.[doi:10.3760/cma.j.issn.1673-4114.2015.01.019]
[12]李雯,冯彦林.18F-FDG PET/CT评估三阴性乳腺癌新辅助化疗疗效的研究进展[J].国际放射医学核医学杂志,2014,38(3):197.[doi:10.3760/cma.j.issn.1673-4114.2014.03.013]
　Li Wen,Feng Yanlin.Advances of assessment with 18F-FDG PET/CT in triple-negative breast cancer during neoadjuvant chemotherapy[J].International Journal of Radiation Medicine and Nuclear Medicine,2014,38(3):197.[doi:10.3760/cma.j.issn.1673-4114.2014.03.013]
[13]胡梦裳,章斌.PET/CT显像在乳腺癌疗效评价及预后中的作用[J].国际放射医学核医学杂志,2014,38(5):332.[doi:10.3760/cma.j.issn.1673-4114.2014.05.013]
　Hu Meng-shang,Zhang Bin.The role of PET/CT imaging in the evaluation of the efficacy and prognosis of breast cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2014,38(3):332.[doi:10.3760/cma.j.issn.1673-4114.2014.05.013]
[14]董佳佳,章斌.多种影像学方法评价乳腺癌新辅助化疗疗效的价值比较[J].国际放射医学核医学杂志,2014,38(6):427.[doi:10.3760/cma.j.issn.1673-4114.2014.06.018]
　Dong Jia-jia,Zhang Bin.Comparision on the values of different image modalities in monitoring the response to neoadjuvant chemotherapy in breast cancer patients[J].International Journal of Radiation Medicine and Nuclear Medicine,2014,38(3):427.[doi:10.3760/cma.j.issn.1673-4114.2014.06.018]
[15]袁建伟,杨劼,贺小红,等.乳腺癌18F-FDG PET/CT和3.0T MRI联合显像评分与Ki-67表达水平的相关性分析[J].国际放射医学核医学杂志,2013,37(2):84.[doi:10.3760/cma.j.issn.1673-4114.2013.02.006]
　YUAN Jian-wei,YANG Jie,HE Xiao-hong,et al.Correlation between combined imaging modalities of 18F-FDG PET/CT and 3.0T MRI and expression of Ki-67 in breast cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2013,37(3):84.[doi:10.3760/cma.j.issn.1673-4114.2013.02.006]
[16]袁建伟,杨劼,贺小红,等.18F-FDG PET/CT与3.0T MRI联合显像在乳腺癌原发病灶诊断中的价值[J].国际放射医学核医学杂志,2013,37(4):199.[doi:10.3760/cma.j.issn.1673-4114.2013.04.003]
　YUAN Jian-wei,YANG Jie,HE Xiao-hong,et al.Diagnosis value of 18F-FDG PET/CT and 3.0T MRI combined imaging in detecting the primary focus of breast cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2013,37(3):199.[doi:10.3760/cma.j.issn.1673-4114.2013.04.003]
[17]林美福,陈文新,周硕,等.18F-FES PET/CT显像在雌激素受体阳性乳腺癌诊疗中的初步应用[J].国际放射医学核医学杂志,2013,37(4):216.[doi:10.3760/cma.j.issn.1673-4114.2013.04.007]
　LIN Mei-fu,CHEN Wen-xin,ZHOU Shuo,et al.Application of 18F-FES PET/CT in diagnosis and endocrine therapy of patients with estrogen receptorpositive breast cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2013,37(3):216.[doi:10.3760/cma.j.issn.1673-4114.2013.04.007]
[18]夏晓天,张永学.影像学检查在乳腺癌的诊断及疗效评估中的应用价值[J].国际放射医学核医学杂志,2010,34(4):242.[doi:10.3760/cma.j.issn.1673-4114.2010.04.014]
　XIA Xiao-tian,ZHANG Yong-xue.The value of imaging examinations in diagnosis and curative effect evaluation of breast cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2010,34(3):242.[doi:10.3760/cma.j.issn.1673-4114.2010.04.014]
[19]鲁胜男,冯彦林.乳腺癌新辅助化疗过程中18F-FDG PET-CT与化疗前Ki-67、COX-2表达的相关性研究[J].国际放射医学核医学杂志,2011,35(4):238.[doi:10.3760/cma.j.issn.1673-4114.2011.04.011]
　LU Sheng-nan,FENG Yan-lin.The correlation analysis between 18F-FDG PET-CT in breast cancer with neoadjuvant chemotherapy and the expression of Ki-67 and COX-2 before neoadjuvant chemotherapy[J].International Journal of Radiation Medicine and Nuclear Medicine,2011,35(3):238.[doi:10.3760/cma.j.issn.1673-4114.2011.04.011]

备注/Memo

备注/Memo:
收稿日期:2017-02-27。
基金项目:国家自然科学基金青年项目（81601522）；江苏省自然科学基金青年项目（BK2016-0348）；江苏省青年医学人才项目（QNRC2016749）；苏州市“科教兴卫”青年科技项目（kjxw2015-004）
通讯作者:吴翼伟,Email:wuyiwei3988@gmail.com
更新日期/Last Update: 2017-06-28