乳腺癌新辅助化疗后残留肿瘤^(99)Tc^m-MIBI摄取与预后因素的关系  

Correlation between residual tumor uptake of ^(99)Tc^m-sestamibi and prognostic factors after neoadjuvant chemotherapy for breast cancer

作　　者：关晏星[1] 雷秋模 熊秋云 曹亚丽 欧阳军[1] 瞿伟 杨晓青[1] 张青[1] 张庆[1] 江美英[1] 楼捷[1] 潘志敏[1] 

机构地区：[1]南昌大学第一附属医院核医学科,江西南昌330006 [2]南昌市第三医院乳腺外科,江西南昌330006

出　　处：《中国医学影像技术》2007年第6期921-924,共4页Chinese Journal of Medical Imaging Technology

基　　金：江西省科技厅计划项目资助(200110300102)

摘　　要：目的探讨乳腺癌新辅助化疗后残留肿瘤99Tcm-MIBI显像估计患者预后因素的价值。方法50例乳腺癌患者接受术前化疗(环磷酰胺+氨甲喋呤+5氟尿嘧啶3个疗程或环磷酰胺+表阿毒素+5氟尿嘧啶2个疗程),均进行99Tcm-MIBI早期和延迟乳腺显像,利用感兴趣区技术测定肿瘤部位(T)与对侧正常乳腺组织(N)早期、晚期放射性摄取比值(T/N(e)、T/N(d),计算滞留指数(RI)。手术切除乳腺癌组织和腋窝淋巴结做病理分析,尺量切除下肿瘤的最大长径。分析99Tcm-MIBI摄取与病理化疗反应程度、残留腋淋巴结转移数、残余肿瘤大小的关系。结果残余乳腺癌99Tcm-MIBI的T/N(e)及RI在病理反应Ⅰ级组明显高于Ⅱ级和Ⅲ级组,T/N(e)在Ⅱ级组明显高于Ⅲ级组(P均<0.05)。T/N(e)在残余肿块最大长径≤2cm组明显低于>2~5.9cm组和≥6cm(P均<0.05)。T/N(e)及RI在残留转移腋淋巴结数≥4个组明显高于1~3个组(P<0.05)。99Tcm-MIBI早期摄取低且滞留少,提示患者预后良好,反之,预后不良。结论新辅助化疗后残留肿瘤99Tcm-MIBI显像有助于评估患者预后因素,为术后制定化疗方案提供参考。Objective To evaluate the value of ^99Tc^m-methoxyisobutylisonitrile （MIBI） imaging in predicting prognosis of patients with the breast cancer after neoadjuvant chemotherapy. Methods Fifty patients with breast carcinoma underwent the neoajuvant chemotherapy （three courses of treatment： Cyclophosphamide ＋ Methotrexate ＋ 5-Fluorouracil, or two courses of treatment： Cyclophosphamide ＋ Epirubicin ＋ 5 Fluorouracil）. After chemotherapy, early and delayed imagings were performed. And T/N uptake ratios in early and delayed imaging and retention index （RI） were measured and calculated on each case. The cancer tissue and axillary lymph nodes were surgically removed, and were determined by pathological essay. The largest diameters of residual tumors were measured. The correlation between ^99 Tc^m-MIBI uptake of residual tumor and pathologic chemotherapy response, residual axillary lymph nodes metastases and tumors size were analysed. Results The early T/N ratios and RI were significantly increasing in tumors with I grade chemotherapy response than those of Ⅱ and Ⅲ grade （P〈0.05）. The early T/N ratio was significantly increasing in tumors with Ⅱ grade chemotherapy response than that of Ⅲ grade （P〈0.01）. The early T/N ratios were significantly decreasing in tumors with diameter ≤2 cm than those of 〉2-5.9 cm and ≥6 cm （P〈0. 05）. The early T/N ratios and retention index were significantly higher in the patients with ≥4 lymph nods of metastasis than that with 1～3 （P〈0.05）. The decreased early uptake and retention of ^99Tc^m- MIBI predicted the well prognosis of patients. The high early uptake and retention rate predicted poor prognosis of patients. Con- elusion ^99Tc^m-MIBI imaging after neoadjuvant chemotherapy may be valuable in predicting prognosis factors of patients with breast cancer.

关 键 词：乳腺肿瘤 新辅助化疗 甲氧基异丁基异腈 预后 

分 类 号：R814.42[医药卫生—影像医学与核医学] R737.9[医药卫生—放射医学]