Comparisons between glucose analogue 2-deoxy-2-(^(18)F)fluoro-D-glucose and ^(18)F-sodium fluoride positron emission tomography/computed tomography in breast cancer patients with bone lesions

AIM: To compare 2-deoxy-2-(18F)fluoro-D-glucose(18F-FDG) and 18F-sodium (18F-NaF) positron emission tomography/computed tomography (PET/CT) accuracy in breast cancer patients with clinically/radiologically suspected or known bone metastases.METHODS: A total of 45 consecutive patients with breast cancer and the presence or clinical/biochemical or radiological suspicion of bone metastatic disease underwent 18F-FDG and 18F-fluoride PET/CT. Imaging results were compared with histopathology when available, or clinical and radiological follow-up of at least 1 year. For each technique we calculated: Sensitivity (Se), specificity (Sp), overall accuracy, positive and negative predictive values, error rate, and Youden’s index. McNemar’s χ2 test was used to test the difference in sensitivity and specificity between the two diagnostic methods. All analyses were computed on a patient basis, and then on a lesion basis, with consideration ofthe density of independent lesions on the co-registered CT (sclerotic, lytic, mixed, no-lesions) and the divergent site of disease (skull, spine, ribs, extremities, pelvis). The impact of adding 18F-NaF PET/CT to the work-up of patients was also measured in terms of change in their management due to 18F-NaF PET/CT findings.RESULTS: The two imaging methods of 18F-FDG and 18F-fluoride PET/CT were significantly different at the patient-based analysis: Accuracy was 86.7% and 84.4%, respectively (McNemar’s χ2 = 6.23, df = 1, P = 0.01). Overall, 244 bone lesions were detected in our analysis. The overall accuracy of the two methods was significantly different at lesion-based analysis (McNemar’s χ2 = 93.4, df = 1, P < 0.0001). In the lesion density-based and site-based analysis, 18F-FDG PET/CT provided more accurate results in the detection of CT-negative metastasis (P < 0.002) and vertebral localizations (P < 0.002); 18F-NaF PET/CT was more accurate in detecting sclerotic (P < 0.005) and rib lesions (P < 0.04). 18F-NaF PET/CT led to a change of management in 3 of the 45 patients (6.6%) by revealing findings that were not detected at 18F-FDG PET/CT.CONCLUSION: 18F-FDG PET/CT is a reliable imaging tool in the detection of bone metastasis in most cases, with a diagnostic accuracy that is slightly, but significantly, superior to that of 18F-NaF PET/CT in the general population of breast cancer patients. However, the extremely high sensitivity of 18F-fluoride PET/CT can exploit its diagnostic potential in specific clinical settings (i.e., small CT-evident sclerotic lesions, high clinical suspicious of relapse, and negative 18F-FDG PET and conventional imaging).

微钙化在乳腺疾病超声诊断中的价值

目的评价微钙化在超声诊断乳腺疾病的价值。方法收集乳腺微钙化(经钼靶摄影证实)病变患者68例,根据微钙化的钼靶摄影表现将其分为≥10 mm和<10 mm 2组;簇状分布、沿导管分布和散在分布3组。分析不同组别微钙化的超声检出率及超声对乳腺病变诊断的敏感性和特异性。结果微钙化的超声检出率为61.7%,其中恶性病变的微钙化超声检出率为84.2%,良性病变的超声检出率为33.3%。微钙化簇≥10 mm组的超声检出率为84.8%,<10 mm组检出率为40.0%;呈簇状和沿导管分布的微钙化超声检出率为72.5%,散在分布的检出率为29.4%;乳腺恶性病变超声诊断的敏感性和特异性分别为92.1%、76.7%。结论超声检查可有效识别乳腺病变内的微钙化,特别是恶性病变,其对乳腺病变的诊断与鉴别诊断具有重要临床应用价值。

乳腺微小病灶立体定位切除活检的临床应用

目的:探讨乳腺微小病灶经B超、钼靶定位切除活检的临床应用价值。方法:分别对55例、40例临床触诊阴性的乳腺微小病灶进行B超、钼靶定位切除活检。结果:发现乳腺纤维腺瘤35例(36.84%),乳腺增生29例(30.53%),乳管内乳头状瘤7例(7.37%),慢性乳腺炎5例(5.26%),轻度不典型增生4例,中度不典型增生2例,乳腺癌19例(20.00%),其中0期乳腺癌4例,I期乳腺癌5例,II乳腺癌10例。结论:利用B超及钼靶X线引导下金属导丝定位切除乳腺微小病灶病检具有重要的临床应用价值。

超声引导下乳腺微小病灶内置入定位针的临床应用

目的探讨超声引导定位针对乳腺微小病灶定位手术切除的应用价值。方法经乳腺超声和钼靶筛查后,发现临床触诊不清的乳腺病灶33个,行超声引导下置入定位针,定位手术切除,并将标本送病理检查。结果 33个乳腺微小病灶超声引导下置入定位针定位准确率为97.0%,所定位的微小病灶均一次性切除。结论超声引导下置入定位针技术定位准确率高,安全,操作简单、方便,为早期乳腺癌和癌前病变的诊断和治疗提供了一种有效的方法。

乳腺微小实性病变超声诊断与分析

目的探讨超声声像图特征及超声在微小乳癌中的早期诊断价值。方法回顾性分析病理证实的76例乳腺微小实性病变声像图特征。结果乳腺微小实性病变声像图在边界、后方透声、纵横比、有无钙化方面有统计学差异,恶性病变血流特征明显。结论典型良性微小实性病变诊断较易,部分与恶性病变鉴别困难,超声提示有恶性倾向者宜早期手术。超声对乳腺微小实性病变具有较高的鉴别与诊断价值。