ADC值联合^(18)F-FDG PET/CT最大标准摄取值对乳腺癌新辅助化疗疗效的预测价值  

The predictive value of ADC value combined with SUVmax of^(18)F-FDG PET/CT for the response of neoadjuvant chemotherapy in breast cancer

作　　者：张玉[1] 袁权[1] 汤增辉[3] 高春芳 张雪原 ZHANG Yu;YUAN Quan;TANG Zeng-hui(Biomedical Engineering Experimental Training Center,Wannan Medical College,Anhui 241002,China)

机构地区：[1]皖南医学院生物医学工程实验实训中心,安徽241002 [2]皖南医学院弋矶山医院医学影像中心,安徽241001 [3]皖南医学院弋矶山医院医务处,安徽241001

出　　处：《放射学实践》2022年第5期550-555,共6页Radiologic Practice

基　　金：2019教育部高教司协同育人项目(201901013009)。

摘　　要：目的:探讨磁共振扩散加权成像(DWI)表观扩散系数(ADC)值及^(18)F-脱氧葡萄糖(^(18)F-FDG)正电子发射计算机断层扫描(PET/CT)最大标准摄取值(SUVmax)对乳腺癌新辅助化疗疗效的预测价值。方法:纳入2017年1月至2019年6月首次接受全程新辅助化疗并进行肿块切除术的132例女性乳腺癌患者作为研究对象。化疗前,所有患者均进行MRI和PET/CT检查,分别记录ADC值和SUVmax值。依据Miller and Payne分级标准对病理学反应进行分级,分为病理完全缓解(pCR)组和非pCR组。结果:新辅助化疗后,共有40例(30.30%)患者达到pCR(pCR组),92例(69.70%)患者为非pCR(非pCR组);有无淋巴结转移、Ki-67表达状态及分子亚型在两组间的分布差异有统计学意义(P<0.05)。pCR组的ADC值为(0.82±0.11)×10^(-3)mm^(2)/s,显著低于非PCR组的(0.94±0.12)×10^(-3)mm^(2)/s,差异有统计学意义(t=-5.580,P<0.001);pCR组的SUVmax值为(8.54±0.86)g/mL,显著高于非PCR组的(6.94±1.32)g/mL,差异有统计学意义(t=8.325,P<0.001)。对于Luminal A型乳腺癌,pCR组化疗前的ADC值显著低于非pCR组,SUVmax值显著高于非pCR组,差异均有统计学意义(P<0.05);对于Luminal B型乳腺癌,pCR组化疗前的ADC值显著低于非pCR组,差异有统计学意义(P<0.05)。ADC值、SUVmax值单独及联合预测化疗后非pCR的曲线下面积(AUC)分别为0.731(0.641~0.821)、0.880(0.817~0.944)、0.921(0.870~0.972),敏感度分别为57.5%、85.0%、87.5%,特异度分别为80.4%、77.2%、89.1%。ADC值联合SUVmax值预测Luminal A型患者化疗后非pCR的AUC为0.921(0.828~1.000),敏感度和特异度分别为87.0%和85.7%。结论:ADC值联合SUV max值对乳腺癌新辅助化疗后的疗效具有较高的预测效能。Objective:To investigate the predictive value of apparent diffusion coefficient(ADC)and maximum standard uptake value(SUVmax)of ^(18)F-deoxyglucose(^(18)F-FDG)positron emission computed tomography(PET/CT)for the response of neoadjuvant chemotherapy in breast cancer.Methods:A total of 132 female breast cancer patients who firstly received full neoadjuvant chemotherapy and underwent lumpectomy from January 2017 to June 2019 were included in the study.Before chemotherapy,MRI and PET/CT were performed in all patients,and ADC value and SUVmax value were recorded respectively.Pathological responses were classified into pathological complete response(PCR)group and non-PCR group according to Miller and Payne grading criteria.Results:After neoadjuvant chemotherapy,a total of 40 patients(30.30%)reached pCR,and 92 patients(69.70%)were classified into non-PCR group.There were statistically significant differences in lymph node metastasis,expression status of Ki-67 and distribution of molecular subtypes between the two groups(P<0.05).The ADC value of pCR group was(0.82±0.11)×10^(-3)mm^(2)/s,which was significantly lower than that of non-PCR group(0.94±0.12)×10^(-3)mm^(2)/s(t=-5.580,P<0.001).The SUVmax value of pCR group was(8.54±0.86)g/mL,which was significantly higher than that of non-PCR group(6.94±1.32)g/mL(t=8.325,P<0.001).For Luminal A type breast cancer,ADC value in pCR group was significantly lower than that in non-PCR group before chemotherapy,and SUVmax value was significantly higher than that in non-PCR group(P<0.05).For Luminal B type breast cancer,the ADC value of pCR group before chemotherapy was significantly lower than that of non-PCR group(P<0.05).The AUCs of ADC value,SUVmax value and combination of the two factors in predicting the non-PCR after chemotherapy were 0.731(0.641~0.821),0.880(0.817~0.944)and 0.921(0.870~0.972),respectively,the sensitivities were 57.5%,85.0%,87.5%,and the specificities were 80.4%,77.2%,89.1%,respectively.The ADC value combined with SUVmax value obtained an AUC of 0.921(0.828

关 键 词：乳腺癌 疗效评估 磁共振成像 表观扩散系数 正电子发射计算机体层成像 最大标准摄取值 

分 类 号：R737.9[医药卫生—肿瘤] R814.42[医药卫生—临床医学]