乳腺癌摄取^18F-氟脱氧葡萄糖与Ki-67的相关性研究

Research on correlation between fluorine-18-fluorodeoxyglucose uptake in PET-CT and tumor proliferation assessed by Ki-67 in breast cancer

目的本研究旨在评价乳腺癌摄取^18F-氟脱氧葡萄糖（^18F-FDG）与肿瘤增殖指标Ki-67标记指数的相关性。方法30例乳腺癌患者在术前行^18F-FDG—PET—CT成像。在PET图像上，勾画出肿瘤病灶的感兴趣区（ROI），测定标准摄取值（SUV），半定量评价乳腺癌摄取^18F-FDG的强度。患者接受手术治疗后，对肿瘤标本进行病理组织学分析，包括肿瘤大小、组织学分型和组织学分级。选取有代表性的病理切片，采用免疫组织化学的方法检测Ki-67标记指数。检验标准摄取值与Ki-67标记指数、标准摄取值和Ki-67标记指数与组织学分级的相关性。结果肿瘤大小0．8—7．5cm，平均2．8cm；标准摄取值1．16—14．10，平均4．9±2．8；Ki-67标记指数3％～90％，平均35％±22％。标准摄取值分别与Ki-67标记指数（r=0．650，P=0．001）、组织学分级（x^2=7．72，P=0．02）有统计学意义，乳腺癌SUV与其组织学分级的相关性有统计学意义（x^2=13．43，P=0．001）。结论作为一种非侵袭性的影像学检查方法，^18F-FDG PET—CT有助于预测乳腺癌在活体情况下的增殖状态，有助于筛选出能从新辅助化疗获益的增殖力高、预后差的乳腺癌，为局部晚期或转移性乳腺癌化疗反应的早期评价提供一种备选的检查方法。

Objective To evaluate whether fluorine- 18- fluorodeoxyglucose （^18F- FDG ） uptake of breast cancer correlates with proliferation assessed by Ki-67 immunohistochemistry. Methods Thirty patients with breast cancer underwent ^18F-FDG PET-CT imaging before primary therapy. PET-CT images of the breast were quantified for assessment of tumor FDG uptake with the standardized uptake value（SUV） ,were calculated in regions of interesting （ROI） drawn exactly around tumor. After all patients underwent surgery, tumor specimens were assessed for histologic examination by pathologist, including size of tumor, histologic classification, histologic grade. Representative tumor sections were stained with immunohistochemistry for Ki-67 labelled index. Statistical analysis examined differences among SUV, Ki-67 and histologic grade. Results The tumors ranged from 0. 8 cm to 7.5 cm,with a medium size of 2. 8 cm. The SUV varied from 1.16 to 14. 10,95% confidence interval：3.85 -5.95. The Ki-67 expression varied from 3% to 90% ,95% confidence interval：27% -43%. The correlation were found between Ki-67 index and SUV （ r = 0. 650, r^2 = 0. 406, P = 0. 001 ） , histologic grade （X^2 =13.43, P =0.001） ,also between SUV and histologic grade （X^2 =7.72, P =0.02）. Conclusion ^18F- FDG PET-CT may be used to noninvasively predict breast cancer proliferation in vivo, can identify rapidly growth of breast cancer with poor prognosis that could benefit from preoperative chemotherapy, possibly provides an alternative method in the early evaluation of response to chemotherapy for patients with locally advanced or metastatic breast cancer.