99mTc-3PRGD2 SPECT to monitor early response to neoadjuvant chemotherapy in stage II and III breast cancer
99mTc-3PRGD2 SPECT to monitor early response to neoadjuvant chemotherapy in stage II and III breast cancer
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DOI：
10.1007/s00259-015-3062-1
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发表时间：
2015-08-01
影响因子：
9.1
通讯作者：
Ma, Qingjie
中科院分区：
文献类型：
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作者：
Ji, Bin;Chen, Bin;Ma, Qingjie
目的监测乳腺癌患者新辅助化疗（NCT）的疗效对优化治疗方案具有重要意义。Tc-99m-3PRGD（2）SPECT是一种新发展的评价肿瘤血管状态的显像方法。方法33例Ⅱ、Ⅲ期乳腺癌患者分别于术前、术后第1、2个周期接受~（99）Tc-3PRGD（2）SPECT显像。4例患者在基线时Tc-99m-3PRGD（2）摄取极低，未纳入后续研究。将肿瘤与非肿瘤（T/N）比值的变化与使用残留癌症负荷系统分类的病理肿瘤反应进行比较。使用受试者操作者特征分析比较NCT第一个周期结束和第二个周期结束之间识别应答者的把握度。评价了乳腺癌亚型对Tc-99m-3PRGD（2）摄取的影响。结果经4个周期NCT后手术治疗，病理结果显示18例有效率，15例无效率。在基线时Tc-99m-3PRGD（2）摄取清晰可见的患者中，第一个周期NCT后Tc-99m-3PRGD（2）SPECT的灵敏度、特异性和阴性预测值分别为86.7%、85.7%和86.7%，第二个周期后分别为92.9%、93.3%和93.3%。HER-2阳性组的T/N比值和T/N比值变化均显著高于其他亚型（P <0.05）。结论Tc99m3PRGD（2）SPECT显像可用于判断Ⅱ、Ⅲ期乳腺癌患者，尤其是HER-2阳性乳腺癌患者NCT后的病理学反应。
Purpose Monitoring of response to neoadjuvant chemotherapy (NCT) is important for optimal management of patients with breast cancer. Tc-99m-3PRGD(2) SPECT is a newly developed imaging modality for evaluating tumor vascular status. In this study, we investigated the application of Tc-99m-3PRGD(2) SPECT in evaluating therapy response to NCT in patients with stage II or III breast cancer.Methods Thirty-three patients were scheduled to undergo Tc-99m-3PRGD(2) SPECT at baseline, after the first and second cycle of NCT. Four patients had extremely low Tc-99m-3PRGD(2) uptake at baseline, and were not included in the subsequent studies. Changes in tumor to nontumor (T/N) ratio were compared with pathological tumor responses classified using the residual cancer burden system. Receiver operator characteristic analysis was used to compare the power to identify responders between the end of the first and the end of the second cycle of NCT. The impact of breast cancer subtype on Tc-99m-3PRGD(2) uptake was evaluated. The correlation between Tc-99m-3PRGD(2) uptake and pathological tumor response was also evaluated in each breast cancer subtype.Results Surgery was performed after four cycles of NCT and pathological analysis revealed 18 responders and 15 nonresponders. In patients with clearly visible Tc-99m-3PRGD(2) uptake at baseline, the sensitivity, specificity, and negative predictive value of Tc-99m-3PRGD(2) SPECT were 86.7 %, 85.7 % and 86.7 % after the first cycle of NCT, and 92.9 %, 93.3 % and 93.3 % after the second cycle, respectively. Among these patients, the HER-2-positive group demonstrated both higher T/N ratios and a greater change in T/N ratio than patients with other breast cancer subtypes (P < 0.05). A strong correlation was found between changes in T/N ratio and pathological tumor response in the HER-2-positive group (P < 0.03).Conclusion Tc-99m-3PRGD(2) SPECT seems to be useful for determining the pathological tumor response in patients with stage II or III breast cancer undergoing NCT, especially those with the HER-2-positive subtype.