PET/CT对乳腺癌术后转移的诊断意义

The roles of PET/CT in the follow-up of patients with breast cancer after surgery

目的部分乳腺癌患者治疗后出现复发和转移。氟代脱氧葡萄糖(fluorodeoxyglucose,18F-FDG)正电子发射断层/计算机断层(positron emission tomography/computed tomography,PET/CT)检查有助于发现早期转移病灶。文中探讨PET/CT在乳腺癌术后随访中的作用。方法 64例乳腺癌术后患者根据组织病理学(4例)、CT或MRI(56例)及临床随访(4例)做出是否转移的诊断。在上述64例患者中选择39个转移灶和22个良性病灶,用PET/CT行双时相检查,测量2次扫描的最大标准摄取值(standard uptake value maximum,SUVmax)及变化。分析PET/CT诊断乳腺癌术后转移的准确性。结果最终诊断38例肿瘤转移,26例未转移。PET/CT检查结果有4例假阳性,4例假阴性,其敏感性为89.5%,特异性为84.6%。双时相检查转移灶SUVmax上升10%以上者达74.4%,而良性病变为SUVmax上升10%以上者为36.4%,两者间差异有统计学意义(P<0.01)。结论 PET/CT可用于诊断乳腺癌术后转移,双时相扫描可用于鉴别转移灶与良性病变。

Objecti.ve Recurrence and metastasis appear in partial patients with breast cancer. The aim of this study is to discuss the role of PET/CT in the follow-up of postoperative patients with breast cancer. Methods PET/CT were performed in 64 patients after breast cancer surgery. The final diagnoses were established by histopathologic confirmation（ n = 4）, CT and/or MRI（ n = 56） and clinical follow-up （n =4）. The maximal standard uptake（SUVmax） of lesions was obtained on images of dual-time-point scan in 39 metastases and 22 benign lesions, their differences were anaylsed. The efficiency and limitation of PET-CT in diagnosing postop- erative metastasis of breast cancer were analysed. Results according to the final diagnosis, 38 patients had tumor metastases and 26 were normal, PET/CT had 4 false positive and 4 false negative, the sensitivity, and specificity of PET/CT were 89.5% , 84.6% respectively. 74.4% metastatic lesions showed an increase of SUVmax in dual-time-point scans, but only 36.4% in benign lesions （P 〈 0.005 ）. Conclusion PET/CT improved significantly the ability to diagnose metastases of breast cancer. Dual-time-point scans were helpful to differentiate metastases from benign lesions.