18F-FDG PET/CT as a staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques
18F-FDG PET/CT as a staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques
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DOI：
10.1007/s10549-011-1767-9
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发表时间：
2012-01-01
影响因子：
3.8
通讯作者：
Olmos, Renato A. Valdes
中科院分区：
文献类型：
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作者：
Koolen, Bas B.;Peeters, Marie-Jeanne T. F. D. Vrancken;Olmos, Renato A. Valdes
本研究的目的是调查 18F-氟脱氧葡萄糖 (18F-FDG) 正电子发射断层扫描/计算机断层扫描 (PET/CT) 在排除 II 期和 III 期乳腺癌患者新辅助化疗 (NAC) 治疗前的远处转移方面是否优于传统成像技术。其次，我们评估了假阳性结果的临床重要性。 154 名计划接受 NAC 的 II 期或 III 期乳腺癌患者接受了 18F-FDG PET/CT 扫描和常规成像，包括骨闪烁扫描、肝脏超声和胸部 X 光检查。通过活检和组织病理学和/或额外成像证实分期检查时可疑的额外病变。 PET/CT 扫描后 6 个月内检测到的转移被认为是隐匿性转移的证据，但因分期检查而漏掉。通过 PET/CT 在 25 名患者中发现了另外 42 个远处病变，并在 154 名患者中的 20 名（13%）得到了证实。 PET/CT 对另外 8 个病灶 (19%) 呈假阳性，并在 154 名患者中对 5 名 (3%) 患者的转移性疾病的存在进行了错误分类。 20 名患者中有 16 名（80%）仅通过 PET/CT 发现了额外病变，导致 154 名患者中有 13 名（8%）改变了治疗方法。在 129 名 PET/CT 分期为阴性的患者中，在 9 个月的随访期间没有出现转移。 PET/CT 检测 II 期或 III 期乳腺癌患者额外远处病灶的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 100%、96%、80%、100% 和 97%。 FDG PET/CT 在检测未经治疗的 II 期或 III 期乳腺癌患者的远处转移方面优于传统成像技术，并且假阳性率较低。 PET/CT 对于 NAC 之前的乳腺癌分期可能具有附加价值。
The aim of the present study was to investigate if 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) outperforms conventional imaging techniques for excluding distant metastases prior to neoadjuvant chemotherapy (NAC) treatment in patients with stage II and III breast cancer. Second, we assessed the clinical importance of false positive findings. One hundred and fifty four patients with stage II or III breast cancer, scheduled to receive NAC, underwent an 18F-FDG PET/CT scan and conventional imaging, consisting of bone scintigraphy, ultrasound of the liver, and chest radiography. Suspect additional lesions at staging examination were confirmed by biopsy and histopathology and/or additional imaging. Metastases that were detected within 6 months after the PET/CT scan were considered evidence of occult metastasis, missed by staging examination. Forty-two additional distant lesions were seen in 25 patients with PET/CT and could be confirmed in 20 (13%) of 154 patients. PET/CT was false positive for 8 additional lesions (19%) and misclassified the presence of metastatic disease in 5 (3%) of 154 patients. In 16 (80%) of 20 patients, additional lesions were exclusively seen with PET/CT, leading to a change in treatment in 13 (8%) of 154 patients. In 129 patients with a negative staging PET/CT, no metastases developed during the follow-up of 9.0 months. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT in the detection of additional distant lesions in patients with stage II or III breast cancer are 100, 96, 80, 100, and 97%, respectively. FDG PET/CT is superior to conventional imaging techniques in the detection of distant metastases in patients with untreated stage II or III breast cancer and is associated with a low false positive rate. PET/CT may be of additional value in the staging of breast cancer prior to NAC.