Feasibility of FDG PET/CT to monitor the response of axillary lymph node metastases to neoadjuvant chemotherapy in breast cancer patients.
Feasibility of FDG PET/CT to monitor the response of axillary lymph node metastases to neoadjuvant chemotherapy in breast cancer patients.
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DOI：
10.1007/s00259-009-1343-2
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发表时间：
2010-06
影响因子：
9.1
通讯作者：
Peeters, Marie-Jeanne T. F. D. Vrancken
中科院分区：
文献类型：
--
作者：
Straver, Marieke E.;Aukema, Tjeerd S.;Olmos, Renato A. Valdes;Rutgers, Emiel J. T.;Gilhuijs, Kenneth G. A.;Schot, Margaret E.;Vogel, Wouter V.;Peeters, Marie-Jeanne T. F. D. Vrancken
本研究的目的是评估18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/CT在新辅助化疗开始前可视化淋巴结转移的准确性，并确定可视化足够突出以监测腋窝反应的频率。38例浸润性乳腺癌>3 cm和/或淋巴结转移患者在新辅助化疗前接受FDG PET/CT检查。将FDG PET/CT的结果与超声细针穿刺（FNA）细胞学或前哨淋巴结活检的结果进行比较。适合腋窝缓解监测的患者定义为最大标准化摄取值（SUVmax）≥ 2.5或最强淋巴结中肿瘤与背景比值≥5。FDG PET/CT诊断腋窝淋巴结转移的敏感性和特异性分别为97%和100%。原发灶与相关最强淋巴结转移灶的SUVmax无差异。此外，与原发性肿瘤相比，淋巴结中的平均肿瘤与背景比率高90%（p = 0.006）。93%的患者在淋巴结中有足够的吸收，有资格进行随后的腋窝反应监测。在乳腺癌的不同亚型之间观察到代谢活性的相当大的差异。雌激素受体（ER）阳性、三阴性和人表皮生长因子受体2（HER 2）阳性肿瘤淋巴结转移的平均SUVmax分别为6.6、11.6和6.6。淋巴结转移可视化的高准确性以及基线时足够高的SUVmax和肿瘤与背景比表明，使用FDG PET/CT监测腋窝反应是可行的，尤其是在三阴性肿瘤中。
The aim of this study was to assess the accuracy of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT to visualize lymph node metastases before the start of neoadjuvant chemotherapy and to determine how often the visualization is sufficiently prominent to allow monitoring of the axillary response. Thirty-eight patients with invasive breast cancer of >3 cm and/or lymph node metastasis underwent FDG PET/CT before neoadjuvant chemotherapy. The results of the FDG PET/CT were compared with those from ultrasonography with fine-needle aspiration (FNA) cytology or sentinel node biopsy. Patients suitable for response monitoring of the axilla were defined as having either a maximum standardized uptake value (SUVmax) ≥ 2.5 or a tumour to background ratio ≥5 in the most intense lymph node. The sensitivity and specificity of FDG PET/CT in detecting axillary involvement were 97 and 100%, respectively. No difference existed between the SUVmax of the primary tumour and that from the related most intense lymph node metastasis. Moreover, the mean tumour to background ratio was 90% higher in the lymph nodes compared to the primary tumour (p = 0.006). Ninety-three per cent of the patients had sufficient uptake in the lymph nodes to qualify for subsequent response monitoring of the axilla. A considerable distinction in metabolic activity was observed between the different subtypes of breast cancer. The mean SUVmax in lymph node metastases of oestrogen receptor (ER)-positive, triple-negative and human epidermal growth factor receptor 2 (HER2)-positive tumours was 6.6, 11.6 and 6.6, respectively. The high accuracy in visualizing lymph node metastases and the sufficiently high SUVmax and tumour to background ratio at baseline suggest that it is feasible to monitor the axillary response with FDG PET/CT, especially in triple-negative tumours.
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