原发乳腺弥漫性大B细胞淋巴瘤的^(18)F-FDG PET/CT影像学分析及其价值

Analysis and evaluation of ^(18)F-FDG PET/CT imaging in primary breast diffuse large B cell lymphoma

目的探究^(18)F-FDG PET/CT在原发乳腺淋巴瘤(PBL)诊疗中的价值。方法回顾性分析2015年7月至2021年10月间无锡市锡山人民医院和江南大学附属医院诊治的6例原发乳腺弥漫性大B细胞淋巴瘤(PB-DLBCL)患者(均为女性,年龄46~79岁)的临床资料及^(18)F-FDG PET/CT影像资料。6例患者共行10次^(18)F-FDG PET/CT显像,分别用于化疗前基线评估(6例共6次)、治疗反应评估(2例共3次)、复发监测(1例共1次)。^(18)F-FDG PET/CT图像分析采用视觉分析和半定量分析(SUV_(max)),疗效评估采用Deauville评分法。结果6例患者均经病理诊断为PB-DLBCL(3例为穿刺病理,3例为术后病理)。6例患者化疗前均行^(18)F-FDG PET/CT显像辅助诊断并评估分期,其中3例穿刺病理确诊患者基线^(18)F-FDG PET/CT显像示单侧乳腺肿块FDG摄取异常增高,SUV_(max)分别为23.0、52.9、33.6;另3例术后患者基线^(18)F-FDG PET/CT显像示术区片状稍高密度影,FDG摄取轻度弥漫性增高,SUV_(max)分别为3.4、2.2、2.0。有1例患者(病例2)基线PET/CT示左侧乳腺巨大肿块伴左侧腋窝淋巴结累及,化疗4程后PET/CT显像示双侧乳腺新增多处结节状摄取增高灶(Deauville评分4分),随后更换方案化疗3程,治疗结束后PET/CT显像结果阴性(Deauville评分1分)。另有1例患者(病例4)术前常规影像检查仅发现右乳病灶及右腋窝淋巴结,术后PET/CT提示左乳病灶,治疗后PET/CT显像提示病灶代谢完全缓解(Deauville评分1分),随访7个月余后再次行PET/CT评估发现肿瘤复发(Deauville评分5分)。结论^(18)F-FDG PET/CT显像在PB-DLBCL患者诊疗的各阶段(诊断和初始分期、治疗反应评估及复发监测)中可以更好地进行全身评价并发挥重要作用。

Objective To evaluate the value of ^(18)F-FDG PET/CT in the diagnosis and treatment of primary breast lymphoma(PBL).Methods Clinical data and ^(18)F-FDG PET/CT imaging data of 6 patients(all females,age 46-79 years)with pathologically diagnosed primary breast diffuse large B cell lymphoma(PB-DLBCL)in Xishan People′s Hospital of Wuxi City and Affiliated Hospital of Jiangnan University from July 2015 to October 2021 were analyzed retrospectively.A total of 10^(18)F-FDG PET/CT scans were done for primary staging(6 scans of 6 patients),evaluation of treatment response(3 scans of 2 patients),and recurrence detection(1 scan of 1 patient).^(18)F-FDG PET/CT image analysis was performed qualitatively(visually)and semi-quantitatively(SUVmax).Treatment response was evaluated by Deauville scores.Results All 6 patients were diagnosed pathologically as PB-DLBCL(3 patients by core needle biopsy,3 patients by biopsy after lumpectomy).All 6 patients were staged using baseline ^(18)F-FDG PET/CT before chemotherapy.For 3 patients diagnosed by core needle biopsy,baseline ^(18)F-FDG PET/CT showed unilateral breast lesion with high FDG uptake(SUVmax:23.0,52.9,and 33.6).For 3 postoperative patients,baseline ^(18)F-FDG PET/CT showed flocculent soft tissue density in the operative area with low FDG uptake(SUVmax:3.4,2.2 and 2.0).Patient No.2 showed a large left breast mass with left axillary lymph node involvement by baseline PET/CT,and multiple nodular uptakes in bilateral breast(Deauville score of 4)after 4 courses of chemotherapy and negative result(Deauville score of 1)after 3 courses of new chemotherapy regimens by PET/CT.Patient No.4 showed right breast lesion and right axillary lymph nodes by routine preoperative imaging examination,but left breast lesion by postoperative PET/CT.According to the results of ^(18)F-FDG PET/CT,patient No.4 was with complete response(Deauville score of 1)after treatment,but recurrence(Deauville score of 5)occurred after 7 months follow-up.Conclusion ^(18)F-FDG PET/CT can play an important role in every step of management(diagnosis and staging,treatment response evaluation and detection of recurrence)in patients with PB-DLBCL.