18F-16α-氟雌二醇正电子发射计算机断层显像在晚期雌激素受体阳性乳腺癌诊疗中的初步应用

Preliminary application of 18F-FES PET/CT in the diagnosis and treatment of advanced ER positive breast cancer

目的探讨^18F-16α-氟雌二醇(^18F-FES)正电子发射计算机断层显像(PET/CT)评估晚期乳腺癌患者雌激素受体(ER)状态及预测内分泌疗效的应用价值。方法选取2012年1月至2017年12月间福建省立医院收治的13例晚期乳腺癌患者,对患者行^18F-FDG及^18F-FES PET/CT显像,对ER+(ER阳性)者行内分泌治疗一个月后再次复查FES PET/CT显像,分析穿刺病灶基线FES最大标准化摄取值(SUVmax)与免疫组化ER表达的相关性,分析病灶基线FES SUVmax值与治疗疗效的关系。结果13例患者,8例ER+,FES SUVmax(3.45±2.10),5例ER-,SUVmax为(0.88±0.19),以FES SUVmax>1.5为ER阳性,则FES SUVmax诊断乳腺癌病灶ER阳性的敏感度为75.0%,特异度100.0%,阳性预测值100.0%,阴性预测值71.0%,2例假阴性患者均为ER低表达(1%和5%);6例ER+患者进行内分泌治疗,PR病例基线FES SUVmax明显高于SD病例,差异有统计学意义(P<0.05)。结论乳腺癌病灶FES的摄取值与免疫组织化学ER的检测结果具有良好的相关性,病灶基线FES摄取值可预测内分泌治疗的疗效,为晚期乳腺癌个体化治疗提供新的思路。

Objective To explore the value of fluorine(F)-1816 alpha-fluoroestradiol(^18F-FES) positron emission tomography/computed tomography(PET/CT)in assessing the status of hormone receptors in patients with advanced breast cancer and predicting the efficacy of endocrine therapy.Methods ^18F-fluorodeoxyglucose(FDG)and ^18F-FES PET/CT double imaging were performed on 13 patients with advanced breast cancer who admitted to Fujian Provincial Hospital from January 2012 to December 2017.^18F-FES PET/CT imaging was performed again at 1 month after the endocrine therapy in estrogen receptor(ER)-positive patients.The relationship between the baseline maximum standard uptake values(SUVmax)for FES SUVmax and the expression of immunohistochemical ER was analyzed,and the relationship between the baseline FES SUVmax value and the therapeutic efficacy was analyzed.Results In the 13 patients,positive expression of ER was found in 8 patients and FES SUVmax was 3.45±2.10.Negative expression of ER was found in 5 patients and FES SUVmax was 0.88±0.19.When FES SUVmax>1.5 was considered as ER positive,the sensitivity,specificity,and positive and negative predictive value of ^18F-FES SUVmax for the diagnosis of ER positive breast cancer lesions was 75%,100%,100% and 71%,respectively.Low expression of ER was observed in 2 patients with false negative expression of ER(1% and 5%).Endocrine therapy was given to 6 patients with ER positive breast cancer.Conclusion FES was strongly associated with the results of immunohistochemical ER in breast cancer.The baseline FES value may predict the efficacy of endocrine therapy and provide new ideas for individualized treatment of advanced breast cancer.