Accuracy of whole-body fluorine-18-FDG PET for the detection of recurrent or metastatic breast carcinoma.
Accuracy of whole-body fluorine-18-FDG PET for the detection of recurrent or metastatic breast carcinoma.
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发表时间：
1998-03
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通讯作者：
D. Moon;J. Maddahi;D. Silverman;J. Glaspy;M. Phelps;C. Hoh
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作者：
D. Moon;J. Maddahi;D. Silverman;J. Glaspy;M. Phelps;C. Hoh
这项未标记的研究使用18F-氟代脱氧葡萄糖(FDG)对疑似乳腺癌复发或转移的患者进行了全身PET诊断准确性的评估。方法对57例临床怀疑乳腺癌复发的乳腺癌患者进行全身FDG-PET显像。三名独立观察员对全身PET图像进行了从1分(肯定是阴性)到5分(肯定是阳性)的评分，差异由第四名观察员解决。对患者进行长达24个月的临床随访，通过活检、随访成像和其他诊断试验评估PET诊断的准确性。结果在29例患者中，PET扫描显示有41个部位提示复发或转移。有28名患者的38个部位没有显示出恶性疾病的证据。以患者为基础，以4分或5分为阳性，敏感度和特异度分别为93%和79%。阳性预测值为82%，阴性预测值为92%。在病变的基础上，4分或5分被认为是阳性，敏感性为85%，特异性为79%。受试者工作特性分析的面积指数分别为0.91和0.88。为了更准确地确定假阴性和假阳性发现的原因，分析了评分在3分及以下的假阴性病变和评分在4分或更高的假阳性病变。骨转移瘤的假阴性病变比例显著高于其他非骨性恶性肿瘤(p<；0.05)。假阳性病变包括肌肉摄取(n=5)、炎症(n=4)、大血管血池活动(n=2)、肠道摄取(n=1)和不明原因(n=6)。结论FDG-PET全身扫描是诊断乳腺癌复发或转移的有效方法。然而，对骨转移的敏感性似乎低于对其他器官的敏感性。通过更严格地关注患者的准备和对生理性骨骼肌或人工摄取的更好认识，特异性可能会提高。
UNLABELLED This study assessed the diagnostic accuracy of whole-body PET on a patient and lesion basis using 18F-fluorodeoxyglucose (FDG) for the detection of tumor foci in patients with suspected recurrent or metastatic lesions of breast carcinoma. METHODS Whole-body FDG-PET imaging was performed on 57 patients with a previous history of breast carcinoma who were referred for a clinical suspicion of disease recurrence. Whole-body PET images were scored from 1 (definitely negative) to 5 (definitely positive) by three independent observers, and discrepancies were resolved by a fourth observer. Patients were clinically followed for up to 24 mo to assess the accuracy of PET diagnosis by biopsy, follow-up imaging and other diagnostic tests. RESULTS PET scans showed that there were 41 sites indicating recurrent or metastatic disease in 29 patients. There were 38 sites in 28 patients that showed no evidence for malignant disease. On a patient basis, with scores 4 or 5 considered to be positive, sensitivity and specificity were 93% and 79%, respectively. The corresponding positive and negative predictive values were 82% and 92%. On a lesion basis, with scores 4 or 5 considered to be positive, the sensitivity was 85% and specificity 79%. The area index in receiver operating characteristic analysis was 0.91 for patient-based analysis and 0.88 for lesion-based analysis. To determine the cause for false-negative and false-positive findings more precisely, false-negative lesions with scores of 3 or lower and false-positive lesions with scores of 4 or higher were analyzed. Bone metastases had a significantly larger proportion of false-negative lesions than other nonosseous malignant sites (p < 0.05). False-positive lesions were due to muscle uptake (n = 5), inflammation (n = 4), blood pool activity in the great vessels (n = 2), bowel uptake (n = 1) and unknown causes (n = 6). CONCLUSION The whole-body FDG-PET scan is a useful diagnostic test for detecting recurrent or metastatic lesions of breast carcinoma. However, the sensitivity for metastases to bone appears to be lower than that to other organs. Specificity may be improved by more strict attention to patient preparation and better recognition of physiologic skeletal muscle or artifactual uptakes.