PET/CT对乳腺癌术后肺结节病的诊断分析

PET/CT diagnosis of pulmonary sarcoidosis after breast cancer surgery

目的通过正电子发射计算机断层显像(PET/CT)的影像表现分析,以加强对乳腺癌术后结节病的认识,提高诊断及鉴别诊断能力。方法收集2010年—2023年在复旦大学附属华山医院及江苏省中医院经病理证实的28例乳腺癌术后的结节病患者临床资料及PET/CT影像资料,回顾性分析其临床特点及PET/CT表现。结果28例患者诊断为结节病时的中位年龄49岁(38~75岁),距离乳腺癌术后的中位时间为4年(1.5~7.8年)。乳腺癌术后病理均为浸润性乳腺癌,Ⅰ~Ⅱ期26例,Ⅲ期2例,其中12例行乳腺癌根治术,16例行保乳手术。所有病例诊断为结节病前均未发生复发和转移,均为乳腺癌术后定期复查发现,无明确临床症状。PET/CT表现为双肺多发结节18例(64.2%),支气管血管束增粗12例(42.6%),纵隔淋巴结肿大且放射性摄取增高28例(100%),双侧肺门淋巴结肿大且放射性摄取增高26例(92.9%),一侧肺门淋巴结肿大且放射性摄取增高2例(7.1%),腋窝淋巴结肿大且放射性摄取增高9例(32.1%),内乳淋巴结肿大且放射性摄取增高2例(7.1%)。10例表现椎旁胸膜的结节状增厚,放射性摄取增高(35.7%),均未见胸腔积液。胸外淋巴结且放射性摄取增高16例(57.1%),肝脏局限性放射性摄取增高1例(3.6%)。结论乳腺癌术后结节病常模拟乳腺癌的淋巴结转移及肺转移的表现,充分认识结节病的PET/CT表现,尤其是胸外病变的识别,有利于提高结节病的诊断及与转移瘤的鉴别诊断能力。

Objective To evaluate the diagnostic efficiency of 18F-fluorodeoxyglucose(FDG)positron emission tomography/computed tomography(PET/CT)in sarcoidosis after breast cancer surgery.Methods Clinical and FDG PET/CT data of 28 patients with pathologically confirmed sarcoidosis after breast cancer surgery in our hospital from 2010 to 2023 were retrospectively analyzed.Results The median age of the 28 patients at diagnosis of sarcoidosis was 49 years(38-75 years)and the median time from radical mastectomy(12)and breast-conserving surgery(16)for invasive breast cancer(26 stageⅠ-Ⅱ,2 stageⅢ)was 4 years(1.5-7.8 years).All patients were asymptomatic.No tumor recurrence or metastasis occurred before sarcoidosis was diagnosed on routine follow-up.PET/CT manifestations were FDG-avid mediastinal(28,100%),bilateral hilar(26,92.9%),unilateral hilar(2,7.1%),axillary(9,32.1%),internal mammary(2,7.1%),and/or external thoracic(16,57.1%)lymphadenopathy,multiple pulmonary nodules(18,64.2%),paratracheal thickening(12,42.6%),nodular thickening of paravertebral pleura(10,35.7%).No pleural effusion was observed.Increased localized hepatic uptake was seen in 1 patient(3.6%).Conclusion Sarcoidosis can mimic lymph node and lung metastasis after breast cancer surgery.PET/CT manifestations of extra-thoracic lesions can help to distinguish sarcoidosis from metastatic lesions.