摘要
目的探讨18F-FDG PET/CT评估乳腺癌新辅助化疗疗效的价值。方法34例初治乳腺癌患者,采用标准CAF方案化疗2~4个周期,平均3.64周期,于治疗前、第一周期及第二周期化疗结束时共行84例次PET/CT检查,比较最大标准摄取值(m axim al standard uptake value,SUVm ax)的变化。化疗结束后行手术,以病理结果作为PET/CT预测疗效的金标准,分为大体残留病变(gross residual d isease,GRD)和微小残留病变(m in im al residual d isease,MRD)两组。采用第一周期化疗后SUVm ax是否降到基础值的52%作为评估MRD和GRD的标准。结果第一周期化疗结束后GRD组和MRD组的SUVm ax变化差异有显著性,SUVm ax比值预测病理反应的准确性为89.0%,预测GRD组和MRD组特异性分别为83.0%和90.0%。结论18F-FDG PET/CT在第一周期化疗结束后即可准确鉴别出化疗有效的病例,从而避免对新辅助化疗无效者的过度治疗,支持有效者继续化疗。
Objective To study the predictive value of response to neoadjuvant chemotherapy in breast cancer using ^18 F-fluorodeoxyglucose （FDG） positron emission tomography （PET）. Methods 2-4 （ average 3.64） standard chemotherapy regimens with CAF were given to 34 patients with primary breast cancer. Maximal standard uptake values （ SUVmax ） of breast acquired after the first and second courses of chemotherapy was compared with the baseline scan. Operation was given after neoadjuvant chemotherapy. Histopathologic response was classified as gross residual disease （ GRD ） or minimal residual disease （MRD） served as the gold standard. After the first course, standardized uptake value decreased below 55% of the baseline scan using normal distribution. This was the threshold between GRD group and MRD group. Results Significant differences in tracer uptake between nonresponding tumors （GRD） and responding lesions （MRD） were observed after the first course of chemotherapy. And histopathologic response could be predicted with an accuracy of 89.0% by a standardized uptake value decrease below 52% of the baseline scan. The specificity of GRD and MRD is 83.0% and 90.0% respectively. Conclusion ^18 FDG-PET differentiates responders from nonresponders early in the course of therapy. This may help improve patient management by avoiding ineffective chemotherapy and supporting the decision to continue dose-intensive preoperative chemotherapy in responding patients.
出处
《中国肿瘤临床与康复》
2006年第3期215-218,共4页
Chinese Journal of Clinical Oncology and Rehabilitation
