99mTc-Glu-c(RGDyK)-Bombesin SPECT Can Reduce Unnecessary Biopsy of Masses That Are BI-RADS Category 4 on Ultrasonography
99mTc-Glu-c(RGDyK)-Bombesin SPECT Can Reduce Unnecessary Biopsy of Masses That Are BI-RADS Category 4 on Ultrasonography
复制标题
99mTc-Glu-c(RGDyK)-Bombesin SPECT 可以减少超声检查中 BI-RADS 4 类肿块的不必要活检。
DOI：
10.2967/jnumed.115.168773
复制
发表时间：
2016-08-01
影响因子：
9.3
通讯作者：
Ma, Qingjie
中科院分区：
文献类型：
--
作者：
Ji, Tiefeng;Gao, Shi;Ma, Qingjie
根据乳腺成像报告和数据系统（BI-RADS），超声检查为4类的肿块可能是恶性肿瘤，建议进行活检。本研究探讨了Tc-99 m-Glu-c（RGDyK）-蛙皮素（Tc-99 m-RGD-bombesin）在减少这些肿块不必要活检中的价值。方法：90名超声检查为BI-RADS 4级肿块的女性入选本研究，使用Tc-99 m-RGD-蛙皮素进行乳腺SPECT。使用定性视觉和半定量分析独立解释图像。最后的诊断是基于手术切除或经皮穿刺活检标本的组织病理学检查。对样品的级分进行化学分析以评价整合素α（V）β（3）和胃泌素释放肽受体（GRPR）的表达。受体阳性组进一步分为3个亚组（GRPR（+）/α（V）β（+）（3）、GRPR（+）/α（V）β（-）（3）和α（V）β（+）（3）/GRPR（-））。结果：94例（恶性22例，良性72例）经病理证实。在定性分析中，20例恶性肿块显示高Tc-99 m-RGD-蛙皮素积聚，48例良性肿块显示无Tc-99 m-RGD-蛙皮素积聚。定性分析的最佳截止值为2分。半定量分析显示，20例恶性肿块和16例良性肿块的肿瘤与正常组织的比值（T/N）相对较高。最佳临界值为T/N为2.26。恶性肿块的平均T/N高于良性肿块（3.17 +/- 0.86 vs. 1.89 +/- 0.71，P 0.05）。定性和半定量分析的受试者工作特征曲线下面积分别为0.788和0.865，总体诊断性能在这些分析之间没有显著差异（P>0.05）。结论：99 m-Tc-RGD-蛙皮素SPECT显像对BI-RADS 4类肿块的良恶性鉴别具有较高的特异性。进一步研究这种测试的临床乳腺癌的应用似乎是必要的。
Masses that, on ultrasonography, are category 4 according to the Breast Imaging Reporting and Data System (BI-RADS) represent possible malignancy, and a biopsy is recommended. This study explored the value of Tc-99m-Glu-c(RGDyK)-bombesin (Tc-99m-RGD-bombesin) in reducing unnecessary biopsy of these masses. Methods: Ninety women with a BI-RADS 4 mass on ultrasonography were enrolled in this study to undergo breast SPECT using Tc-99m-RGD-bombesin. The images were independently interpreted using qualitative visual and semiquantitative analyses. The final diagnosis was based on histopathologic examination of surgically excised or percutaneous biopsy specimens. Fractions of the samples were immunohistochemically analyzed to evaluate expression of integrin alpha(V)beta(3) and gastrin-releasing peptide receptor (GRPR). The receptor-positive group was further divided into 3 subgroups (GRPR(+)/alpha(V)beta(+)(3), GRPR(+)/alpha(V)beta(-)(3), and alpha(V)beta(+)(3)/GRPR(-)). Results: Ninety-four masses (22 malignant and 72 benign) were confirmed by histopathologic examination. On qualitative analysis, 20 of the malignant masses showed high Tc-99m-RGD-bombesin accumulation and 48 of the benign masses showed no Tc-99m-RGD-bombesin accumulation. The optimal cutoff for qualitative analysis was a score of 2. Semiquantitative analysis revealed that 20 of the malignant masses and 16 of the benign masses had a relatively high tumor-to-normal-tissue ratio (T/N). The optimal cutoff was a T/N of 2.26. The mean T/N was higher for malignant masses than for benign masses (3.17 +/- 0.86 vs. 1.89 +/- 0.71, P0.05). The areas under the receiver-operating-characteristic curves for the qualitative and semi-quantitative analyses were 0.788 and 0.865, respectively, and the overall diagnostic performance did not significantly differ between these analyses (P>0.05). Conclusion: Tc-99m-RGD-bombesin SPECT can differentiate benign from malignant BI-RADS 4 masses with high specificity. Further study of the application of this test to clinical breast cancer appears warranted.