18F-FDG PET/CT早期预测乳腺癌新辅助化疗病理完全缓解的价值  

Early prediction value of 18F-FDG PET/CT for pathological complete reaction in breast cancer patients following neoadjuvant chemotherapy

作　　者：鲁胜男[1] 冯彦林[1] 李雯[1] 王颖[1] 冼伟均[1] 杨明[1] LU Sheng-nan;FENG Yan-lin;LI Wen;WANG Ying;XIAN Wei-jun;YANG Ming(Department of Nuclear Medicine, The First People's Hospital of Foshan, Foshan Guangdong 528000, China)

机构地区：[1]佛山市第一人民医院核医学科

出　　处：《中国临床医学影像杂志》2019年第5期313-317,共5页Journal of China Clinic Medical Imaging

基　　金：广东省医学科学技术研究基金项目(A2018450)

摘　　要：目的:探讨乳腺癌病灶18F-脱氧葡萄糖正电子发射计算机断层扫描(18F-FDG PET/CT)最大标准摄取值(SUVmax)早期变化能否预测新辅助化疗(NAC)病理完全缓解(pCR)。方法:61例初治乳腺癌患者在NAC前、NAC第1疗程结束后及NAC第2疗程结束后行18F-FDG PET/CT检查,并计算病灶的SUVmax的变化率(ΔSUVmax1%、ΔSUVmax2%)。手术后病理评价是否达到pCR,利用受试者工作特性曲线(ROC曲线)评估ΔSUVmax1%、ΔSUVmax2%预测pCR的效能。结果:pCR组ΔSUVmax1%、ΔSUVmax2%下降率均大于非pCR组,差异有统计学意义(P均=0.001)。根据ROC曲线得到ΔSUVmax1%最佳预测pCR阈值为40.5%(敏感度为85.7%,特异性为67.7%);ΔSUVmax2%最佳预测pCR阈值为56.5%(敏感度为84.6%,特异性为57.1%);ΔSUVmax1%、ΔSUVmax2%ROC曲线下面积分别为0.867、0.820(P分别为0.003、0.001),两者预测pCR的效能差异无统计学意义(P=0.845)。Luminal型乳腺癌pCR组的ΔSUVmax1%、ΔSUVmax2%与非pCR组比较差异有显著性(P分别为0.041、0.005);非Luminal型乳腺癌pCR组的ΔSUVmax1%与非pCR组比较差异有显著性(P=0.012),而在第2疗程结束后pCR组与非p CR组的ΔSUVmax2%比较差异无统计学意义(P=0.100)。结论:18F-FDG PET/CT显像在乳腺癌NAC早期(第1疗程、第2疗程结束后)即可预测pCR,指导个体化治疗;对于非Luminal型乳腺癌只有ΔSUVmax1%可以预测pCR。Objective: To discuss whether early change in maximum standard uptake value (SUVmax) of ^18F-flurodeoxy glucose using positron emission tomography with computed tomography(^18F-FDG PET/CT) can predict pathologic complete response (pCR) of primary breast to neoadjuvant chemotherapy (NAC). Methods: 61 women with primary breast cancer underwent ^18FFDG PET/CT scanning at baseline, after the first and second course of NAC. The changes of SUVmax were calulated(△SUVmax1% and △SUVmax2%). Surgery was performed for all patients for pCR evaluation. Receiver operating characteristic(ROC) curves were used to assess the pCR predicting ability of △SUVmax1% and △SUVmax2%. Results: The pCR group had a greater decline in SUVmax, than the non-pCR group (all P=0.001) after the first and second course of NAC. Under the ROC curves, the best prediction effect of △SUVmax1% was 40.5%(sensitivity 85.7%, specificity 67.7%), the best prediction effect of △SUVmax2% was 56.5%(sensitivity 84.6%, specificity 57.1%), respectively. The respective area under the ROC curves (AUC) for △SUVmax1% and △SUVmax2% in the prediction of pCR were 0.867 and 0.820 (P=0.003,0.001), but the differences of AUCs between △SUVmax1% and △SUVmax2% were not significant in predicting pCR.△SUVmax1% and △SUVmax2% were significantly useful for differentiating pCR from non-pCR in Luminal subtype(P=0.041, 0.005). For non-Luminal subtype,△SUVmax1% of pCR group was significantly different from that in non-pCR group(P=0.012), but △SUVmax2% was not significantly different between the two groups(P=0.100). Conclusion: Early changes in SUVmax of 18F-FDG PET/CT scanning after first or second cycles of NAC could predict pCR in breast cancer effectively and guide clinical individualized treatment. Only △SUVmax1% was efficiently predictive of pCR in non-Luminal subtype.

关 键 词：乳腺肿瘤 体层摄影术 螺旋计算机 正电子发射断层显像术 

分 类 号：R737.9[医药卫生—肿瘤] R817.4[医药卫生—临床医学]