Implications of standardized uptake value measurements of the primary lesions in proven cases of breast carcinoma with different degree of disease burden at diagnosis: Does 2-Deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography predict tumor biology?
Implications of standardized uptake value measurements of the primary lesions in proven cases of breast carcinoma with different degree of disease burden at diagnosis: Does 2-Deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography predict tumor biology?
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DOI：
10.1007/s11307-007-0121-4
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发表时间：
2008-01-01
影响因子：
3.1
通讯作者：
Alavi, Abass
中科院分区：
文献类型：
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作者：
Basu, Sandip;Mavi, Ayse;Alavi, Abass
目的：通过2-脱氧-2-[F-18]氟-D-葡萄糖-正电子发射断层扫描（FDG-PET）成像确定的肿瘤糖酵解活性是肿瘤生物学的重要标志物，并提供了有关疾病不同阶段大多数恶性肿瘤行为的关键信息。本研究的目的是确定在确诊的乳腺癌病例中，不同疾病负荷的原发性乳腺病变的FDG摄取程度是否不同。在这项前瞻性研究招募的250名患者中，174例新诊断的乳腺癌患者在不同的疾病阶段接受了双时间点FDG-考虑将任何治疗或手术干预前的PET纳入本分析。这些患者前瞻性地接受了多模态成像技术，如磁共振成像（MRI）、超声检查、数字乳腺X线摄影、计算机断层扫描（CT）和双时间点FDG-PET，作为美国国立卫生研究院资助的用于表征原发性乳腺病变和局部区域分期的项目的组成部分。选择在感兴趣区域（ROI）中具有最大FDG摄取的切片用于第一时间点和第二时间点图像，以定量测量示踪剂的代谢活性（分别为SUVmax 1和SUVmax 2）。此外，SUVmax的百分比变化（% Δ SUVmax）之间的SUVmax 1和SUVmax2calculated.Results：患者人群（n=174）被分为三组，本研究的目的。64例原发性和转移性腋窝淋巴结病患者（指定为I组）和18例腋窝和远处转移患者（指定为II组）符合本分析的入选标准。第三组（III组）包括92名患者，在淋巴结或远处部位均无任何转移。I组（n=64）患者早期和延迟FDG-PET的平均SUVmax 1、SUVmax 2和% Δ SUVmax如下：原发性病变分别为4.8 ± 3.9、5.3 ± 4.5和9.4 ± 12.8%，腋窝病变分别为3 ± 2.6、3 ± 2.7和1.1 ± 21.3%。在II组患者（n=18）中，原发性病变的SUVmax 1、SUVmax 2和%Delta SUVmax的平均值分别为7.7 +/- 6.2、8.9 +/- 7.1和15.7 +/-10.8%。腋窝病灶的相应数字分别为3.5 +/- 3.1、3.7 +/- 3.1和6.3 +/-20.9%，远处转移病灶的相应数字分别为3 +/- 1.4、3.1 +/- 1.2和8.5 +/-21.2%。第III组患者（n=92）原发病灶的平均SUVmax 1、SUVmax 2和%Delta SUVmax分别为2.9 +/- 2.7、3.4 +/- 2.4和4.5 +/-4.2%。这三组原发性病变中三个参数的单因素方差分析在平均SUV最大值1（p=0.01）和SUV最大值2（p=0.01）方面具有统计学显著性。这些数值在第II组的原发性病变中最高（腋窝和远处转移），其次是I组（仅转移性腋窝淋巴结病）和III组（没有任何转移的患者），并且可能与II组中更具侵袭性的肿瘤生物学有关。这些发现提供的证据表明，在诊断时具有不同疾病负担的病变中，腋窝和远处转移的病例中FDG摄取最高，其次是腋窝转移，然后是无转移性疾病。这些提供了对肿瘤生物学的体内洞察，因为FDG摄取被认为是肿瘤生物学的替代标志物。
Objectives: Tumor glycolytic activity as determined by 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) imaging is an important marker of tumor biology and provides critical information about the behavior of most malignancies at different stages of the disease. This study was undertaken to determine whether the degree of FDG uptake differs between the primary breast lesions with varying disease burden at diagnosis in proven cases of breast carcinoma.Materials and Methods: Among 250 patients enrolled for this prospective study, 174 patients with newly diagnosed breast carcinoma at different disease stages who had undergone dual time point FDG-PET before any therapeutic or surgical interventions were considered for inclusion in this analysis. These patients prospectively underwent multimodality imaging techniques, such as magnetic resonance imaging (MRI), ultrasonography, digital mammography, computed tomography (CT), and dual time point FDG-PET, as a component of a National Institutes of Health-funded project for characterizing primary breast lesions and local-regional staging. The slice with maximum FDG uptake in the region of interest (ROI) was chosen for the first time point and the second time point images for quantitative measurement of the metabolic activity of the tracer (SUVmax1 and SUVmax2, respectively). Furthermore, the percent change in SUVmax (%Delta SUVmax) between SUVmax1 and SUVmax2 was calculated.Results: The patient population (n=174) were divided into three groups for the purposes of this study. Sixty-four patients with primary and metastatic axillary lymphadenopathy (designated as group I) and 18 patients with both axillary and distant metastases (designated as group II) met the inclusion criteria for this analysis. The third group (group III) comprised of a population of 92 patients without any metastasis either at the lymph nodes or at distant sites. The mean SUVmax1, SUVmax2, and the %Delta SUVmax in the early and delayed FDG-PET in group I (n=64) patients were as follows: primary lesion 4.8 +/- 3.9, 5.3 +/- 4.5, and 9.4 +/- 12.8%, respectively, and axillary lesions 3 +/- 2.6, 3 +/- 2.7, and 1.1 +/- 21.3%, respectively. Among the group II patients (n=18), the mean values of the primary lesion with regard to the SUVmax1, SUVmax2, and the %Delta SUVmax were 7.7 +/- 6.2, 8.9 +/- 7.1, and 15.7 +/- 10.8%, respectively. The corresponding figures for the axillary lesions were 3.5 +/- 3.1, 3.7 +/- 3.1, and 6.3 +/- 20.9%, respectively, and those for the distant metastatic lesions were 3 +/- 1.4, 3.1 +/- 1.2, and 8.5 +/- 21.2%, respectively. The mean SUVmax1, SUVmax2, and the %Delta SUVmax of the primary lesion of group III patients (n=92) without any metastasis were 2.9 +/- 2.7, 3.4 +/- 2.4, and 4.5 +/- 4.2%, respectively. Unifactorial ANOVA of the three parameters among the primary lesions of these three groups were statistically significant with regard to the mean SUVmax1 (p=0.01) and SUVmax2 (p=0.01). These values in the primary lesions were highest in group II (those with both axillary and distant metastases), followed by group I (those with only metastatic axillary adenopathy) and group III (patients without any metastasis), and could be related to the more aggressive tumor biology in group II.Conclusion: The findings provide evidence that among the lesions with varying disease burden at diagnosis, the FDG uptake is highest in cases with both axillary and distant metastasis, followed by those with axillary metastasis and then by those with no metastatic disease. These provide in vivo insight into tumor biology as FDG uptake is regarded as a surrogate marker of the same.