^(18)F-FES PET/CT检查对乳腺癌诊断及疗效评估的价值分析

Value analysis of ^(18)F-FES PET/CT examination in breast cancer diagnosis and curative effect evaluation

目的探讨以16α-[18F]-17β-雌二醇(18F-FES)为显像剂的PET/CT检查在乳腺癌诊断及疗效评估中的应用价值。方法选择乳腺癌患者13例(乳腺癌组),雌激素受体(ER)阳性11例,其中5例接受内分泌治疗(口服他莫昔芬)、6例未接受内分泌治疗;乳腺良性结节患者3例(良性结节组),ER均阳性;另选女性健康志愿者1例。健康志愿者仅行18F-FES PET/CT检查,观察代谢分布;乳腺癌组及良性结节组分别行18F-FES、氟代脱氧葡萄糖(18F-FDG)PET/CT全身检查,分析病灶数及18F-FES、18F-FDG最大标准化摄取值(SUVmax)。结果18F-FES在健康志愿者体内被肝脏摄取并代谢,经胆道、肠道排泄。乳腺癌组及良性结节组18F-FES PET/CT显像结果提示ER阳性12例,经病理证实分别为乳腺癌9例、乳腺良性结节3例;ER阴性4例,经病理证实均为乳腺癌患者。两组18FFDG PET/CT显像结果提示ER阳性12例,经病理证实均为乳腺癌患者;ER阴性4例,经病理证实分别为乳腺癌1例和乳腺良性结节3例。6例ER阳性且未经内分泌治疗的乳腺癌患者18F-FES的SUVmax高于18F-FDG(P<0.01)。5例ER阳性经内分泌治疗的乳腺癌患者中18F-FES、18F-FDG的SUVmax比较差异无统计学意义(P>0.05)。2例ER阴性的乳腺癌患者未见18F-FES摄取,而18F-FDG显示阳性病灶。3例ER阳性的乳腺良性结节患者PET/CT显像可见18F-FES摄取而18F-FDG未见明显摄取。结论以18F-FES为显像剂的PET/CT可用于乳腺癌的诊断及疗效评估,结合18F-FDG PET/CT显像效果更佳。

Objective To explore the value of using 16α-[18F]-17β-estradiol（18F-FES） as photographic developer of PET / CT imaging in diagnosis and treatment for breast cancer. Methods All cases who were recruited to the study were female. Thirteen cases of patients with breast cancer were enrolled in the breast cancer group,and 3 cases of benign breast nodules were enrolled in the benign nodules group. For the breast cancer group,there were 11 cases with estrogen receptor（ ER）-positive,and the other 2 cases were ER-negative. Among the 11 cases with ER-positive,5 cases accepted endocrine therapy（ tamoxifen）,and the other 6 cases had not. For benign nodules group,3 cases were ER-positive. One healthy volunteer was recruited to observe the distribution and features of18F-FES PET / CT imaging in vivo. The breast cancer group and benign nodules group respectively received18F-FES and18F-FDG PET / CT examination,and the assessment parameters were analyzed,which contained the number of lesions,SUVmax and ER expression. Results In vivo,18F-FES went through liver-intestine excretion.18F-FES PET / CT imaging results suggested that in the breast cancer group and benign nodules group,there were 12 ER-positive cases. After confirmed by pathology,there were 9 breast cancer cases and 3 benign breast lesions. Meanwhile,the imaging results suggested that there were 4 ER-negative cases,and all were breast cancer patients which were confirmed by pathology. The two group18F-FDG PET / CT imaging results suggested that there were 12 positive cases,and all were breast cancer patients confirmed by pathology; on the other hand,the imaging results suggested that there were 4 negative cases. After confirmed by pathology,there was one case of breast cancer and 3 cases had benign breast lesions. For the 6 breast cancer cases with ER-positive and without endocrine therapy,the SUVmax of18F-FES was higher than that of18F-FDG,and there was statistical difference（ P 〈 0. 01）. However,among the 5 breast cancer patients with ER-positive and accepted endocrine therapy,there was no statistical difference（ P 〉 0. 05） between18F-FES and18F-FDG uptake. The 2 ER-negative breast cancer cases showed18F-FES negative uptake and18F-FDG positive focus in PET / CT imaging. The 3 benign breast cases showed18F-FES positive uptake and18F-FDG negative uptake in PET / CT imaging. Conclusions18F-FES PET / CT imaging can be used for clinical diagnosis and therapeutic evaluation of breast cancer. It is necessary to combine with18F-FDG to make a better effect.