^(99)Tc^(m)-3PRGD_(2) SPECT显像对乳腺癌新辅助化疗后病理完全缓解的预测价值及与^(18)F-FDG PET/CT的对比研究

Prediction of pathological complete response to neoadjuvant chemotherapy in breast cancer using ^(99)Tc^(m)-3PRGD_(2) imaging in comparison to^(18)F-FDG imaging

目的:探讨^(99)Tc^(m)-联肼尼克酰胺-3聚乙二醇-精氨酸-甘氨酸-天冬氨酸环肽二聚体(3PRGD_(2))显像对乳腺癌患者新辅助化疗(NAC)病理完全缓解(pCR)的预测价值,并将其与^(18)F-FDG显像比较。方法:前瞻性纳入2017年10月至2019年10月间在福建医科大学附属第一医院和福建医科大学附属协和医院确诊并拟行术前NAC的Ⅱ、Ⅲ期乳腺癌患者41例[年龄:(61.5±7.8)岁],在患者NAC治疗前、第1周期化疗后和第4周期化疗后分别同步进行^(99)Tc^(m)-3PRGD_(2)和^(18)F-FDG显像,计算肿瘤/本底比值(T/B;^(99)Tc^(m)-3PRGD_(2))和SUV max(^(18)F-FDG)。以化疗前显像为基线,分别计算化疗第1周期和第4周期后显像T/B和SUV max的变化值(ΔT/B 1、ΔT/B 2和ΔSUV_(max1)、ΔSUV_(max2))。NAC治疗结束后行常规手术治疗,以手术病理结果为判断是否达pCR的"金标准"。通过ROC曲线分析获得AUC,分析治疗前后乳腺癌原发灶及腋窝淋巴结(ALN)转移灶摄取值变化对pCR的预测价值;不同AUC的比较采用Delong检验。结果:41例患者中有13例(31.7%)达到pCR。乳腺癌原发灶ΔT/B 1和ΔT/B 2预测pCR的AUC分别为0.827(P=0.001)和0.687(P=0.057),ΔSUV_(max1)和ΔSUV_(max2)预测pCR的AUC分别为0.859(P<0.001)和0.713(P=0.030);2种显像在化疗早期摄取变化ΔT/B 1和ΔSUV_(max1)的AUC差异无统计学意义(z=0.33,P=0.740)。ALN转移灶ΔT/B 1和ΔT/B 2预测pCR的AUC分别为0.859(P=0.002)和0.778(P=0.014),ΔSUV_(max1)和ΔSUV_(max2)预测pCR的AUC分别为0.572(P=0.523)和0.802(P=0.007);化疗早期^(99)Tc^(m)-3PRGD_(2)摄取变化(ΔT/B 1)的AUC高于^(18)F-FDG摄取变化(ΔSUV_(max1))的AUC(z=2.10,P=0.035)。结论:乳腺癌患者在NAC后,乳腺癌原发灶和ALN转移灶对^(99)Tc^(m)-3PRGD_(2)摄取的早期变化可用于预测pCR,其中ALN转移灶^(99)Tc^(m)-3PRGD_(2)显像的早期变化对pCR的预测效能可能较^(18)F-FDG显像更高。

Objective To evaluate the value of ^(99)Tc^(m)-hydrazinonicotinamide-(poly-(ethylene glycol))4-E((poly-(ethylene glycol))4-c((Arg-Gly-Asp)fK))2(3PRGD_(2))imaging on predicting pathological complete response(pCR)outcomes to neoadjuvant chemotherapy(NAC)in patients with breast cancer and to compare it with^(18)F-FDG imaging.Methods From October 2017 to October 2019,41 patients(age:(61.5±7.8)years)who were diagnosed with stageⅡandⅢbreast cancer and planned to receive preoperative NAC in the First Affiliated Hospital of Fujian Medical University and Xiehe Affiliated Hospital of Fujian Medical University were prospectively enrolled.All patients underwent both ^(99)Tc^(m)-3PRGD_(2) and^(18)F-FDG imaging before NAC(baseline),and after the first and the fourth NAC cycle.The tumor/background ratio(T/B;^(99)Tc^(m)-3PRGD_(2))and SUVmax(^(18)F-FDG)in breast tumors and axillary lymph node(ALN)metastases were separately calculated.The relative T/B changes(ΔT/B1,ΔT/B2)and SUVmax changes(ΔSUV_(max1),ΔSUV_(max2))after the first and the fourth NAC cycle compared to baseline were obtained.Patients underwent surgery after NAC and the pathology was used as the gold standard to determine whether patient achieved pCR.The predictive performance ofΔT/B andΔSUVmax regarding the identification of pCR or non-pCR was evaluated by using ROC analysis and the AUCs were compared by Delong test.Results Of 41 patients,13(31.7%)were achieved pCR after NAC.For breast tumors,the AUCs ofΔT/B1,ΔT/B2,ΔSUV_(max1) andΔSUV_(max2) were 0.827(P=0.001),0.687(P=0.057),0.859(P<0.001)and 0.713(P=0.030)respectively,and the AUCs ofΔT/B1 andΔSUV_(max1) had no significant difference(z=0.33,P=0.740).For ALN metastases,the AUCs ofΔT/B1,ΔT/B2,ΔSUV_(max1) andΔSUV_(max2) were 0.859(P=0.002),0.778(P=0.014),0.572(P=0.523)and 0.802(P=0.007)respectively,and the AUC ofΔT/B1 was significantly higher than that ofΔSUV_(max1)(z=2.10,P=0.035).Conclusion The early relative changes of breast tumors and ALN metastases in ^(99)Tc^(m)-3PRGD_(2) imaging during NAC can offer predictive information for pCR to NAC in patients with breast cancer,and early relative changes of ALN metastases in ^(99)Tc^(m)-3PRGD_(2) imaging may have a higher predictive value for pCR than^(18)F-FDG imaging.