目的：探讨应用18F-FDG PET/CT显像MTV、TLG、SUVmax、SUVmean及SUVpeak对乳腺癌的诊断价值。资料与方法：回顾性分析2011年12月—2015年8月我院确诊为乳腺癌的患者48例，术前行18F-FDG PET/CT检查，通过测定MTV、TLG及SUVmax、SUVpeak及SUVmean，采用t检验、单因素方差分析及Spearman相关性分析，评价上述代谢指标同乳腺癌原发灶大小、转移情况及病理免疫组化及相关受体之间的关系。结果：较高T级别肿瘤各代谢指标值较高，各代谢指标在T2~T4与T0~T1级别两者中差异均具有统计学意义（P＜0.05），有淋巴结或脏器转移（N1~N3及M1）的癌灶的各代谢值高于无转移（N0及M0）肿瘤，其中MTV及TLG值显著，具有统计学意义（P<0.05），Ki67及p53指数与各代谢值均无相关性，但Ki67高表达肿瘤较之低表达者代谢水平较高，差异无统计学意义（P>0.05），各代谢指标值与乳腺癌相关受体ER、PR及HER-2的表达与否差异无统计学意义。结论：5者的组合能比较全面评估乳腺癌恶性程度及侵袭力，MTV及TLG是其中较好的指标。
Abstract
Objective: The aim of this study was to observe the value of different metabolic parameters(MTV, TLG, SUVmax, SUVmean and SUVpeak) in breast cancer. Materials and Methods: Forty-eight patients of breast cancer underwent PET/CT imaging before operation consecutively from December 2011 to August 2015, maximum, peak and mean standardized uptake values(SUVmax, SUVpeak and SUVmean), metabolic tumor volume(MTV) and total lesion glycolysis(TLG) in the primary tumor were calculated and compared with sizes, metastatic situation, immunohistochemical characterization and oestrogen receptor(ER), progesterone receptor(PR), HER-2 status, being analyzed with T-text, ANOVA, spearman analysis. Results: Most of metabolic parameters were higher in high T-grade lesions, significant correlation was found between all metabolic parameters in T2~T4 and T0~T1, all the parameters were higher in M1/N1~N3 than lesions compared with M0/N0, significant correlation was found only for TLG and MTV(P＜0.05). TLG and MTV were higher in the cancers with Ki67≥14％, however there was no correlation between the Ki67 or p53 expression and all the parameters. No significant correlation was found between all metabolic parameters and ER, PR or HER-2 status. Conclusion: Metabolic tumor volume, total lesion glycolysis and SUV combined detection can be used as an evaluation index for judging the malignant degree and invasiveness, MTV and TLG are the better index.
关键词
乳腺肿瘤 /
正电子发射断层显像术 /
体层摄影术 /
螺旋计算机
Key words
Breast neoplasms /
Positron-emission tomography /
Tomography, spiral computed
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Chen W, Zheng R, Zhang S, et al. Report of incidence and mortality in China cancer registries, 2009[J]. Chin J Cancer Res, 2013, 25(1): 10-21.
[2]Kumar R, Halanaik D, Malhotra A. Clinical applications of positron emission tomography-computed tomography in oncology[J]. Indian J Cancer, 2010, 47(2): 100-119.
[3]Moon SH, Cho SH, Park LC, et al. Metabolic response evaluated by 18F-FDG PET/CT as a potential screening tool in identifying a subgroup of patients with advanced non-small cell lung cancer for immediate maintenance therapy after first-line chemotherapy[J]. Eur J Nucl Med Mol Imaging, 2013, 40(7): 1005-1013.
[4]Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011[J]. Ann Oncol, 2011, 22(8): 1736-1747.
[5]Groheux D, Giacchetti S, Moretti JL, et al. Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer[J]. Eur J Nucl Med Mol Imaging, 2011, 38(3): 426-435.
[6]Osborne JR, Port E, Gonen M, et al. 18F-FDG PET of locally invasive breast cancer and association of estrogen receptor status with standardized uptake value: microarray and immunohistochemical analysis[J]. J Nucl Med, 2010, 51(4): 543-550.
[7]Heudel P, Cimarelli S, Montella A, et al. Value of PET-FDG in primary breast cancer based on histopathological and immunohistochemical prognostic factors[J]. Int J Clin Oncol, 2010, 15(6): 588-593.
[8]Kim BS, Sung SH. Usefulness of 18F-FDG uptake with clinicopathologic and immunohistochemical prognostic factors in breast cancer[J]. Ann Nucl Med, 2012, 26(2): 175-183.
[9]Sanli Y, Kuyumcu S, Ozkan ZG, et al. Increased FDG uptake in breast cancer is associated with prognostic factors[J]. Ann Nucl Med, 2012, 26(4): 345-350.
[10]Ueda S, Tsuda H, Asakawa H, et al. Clinicopathological and prognostic relevance of uptake level using 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging(18F-FDG PET/CT) in primary breast cancer[J]. Jpn J Clin Oncol, 2008, 38(4): 250-258.
[11]全国围绝经期妇女健康调查协作组. 绝经年龄及其有关因素分析[J]. 江苏医药，1990，16（5）：242-245.
[12]Kumar R, Chauhan A, Zhuang H, et al. Clinicopathologic factors associated with false negative FDG-PET in primary breast cancer[J]. Breast Cancer Res Treat, 2006, 98(3): 267-274.
[13]Kajary K, Tokes T, Dank M, et al. Correlation of the value of 18F-FDG uptake, described by SUVmax, SUVavg, metabolic tumour volume and total lesion glycolysis, to clinicopathological prognostic factors and biological subtypes in breast cancer[J]. Nucl Med Commun, 2015, 36(1): 28-37.
[14]Buck A, Schirrmeister H, Kuhn T, et al. FDG uptake in breast cancer: correlation with biological and clinical prognostic parameters[J]. Eur J Nucl Med Mol Imaging, 2002, 29(10): 1317-1323.
[15]Tchou J, Sonnad SS, Bergey MR, et al. Degree of tumor FDG uptake correlates with proliferation index in triple negative breast cancer[J]. Mol Imaging Biol, 2010, 12(6): 657-662.
[16]Tokes T, Somlai K, Szekely B, et al. The role of FDG-PET-CT in the evaluation of primary systemic therapy in breast cancer: links between metabolic and pathological remission[J]. Orv Hetil, 2012, 153(49): 1958-1964.
[17]Midulla C, De lorio P. Immunohistochemical expression of P53, nm23 H1, Ki67 and DNA ploidy: correlation with lymph node status and other clinical pathologic parameters in breast cancer[J]. Anticancer Res, 1999, 19(5): 4033-4037.
[18]Linjawi A, Kontogiannea M, Halwani F, et al. Prognostic significance of p53, bcl-2, and Bax expression in early breast cancer[J]. J Am Coll Surg, 2004, 198(1): 83-90.
[19]毛杰，海健，舒海平，等. 联合检测多基因在乳腺癌组织中的表达及其临床意义[J]. 中国普通外科杂志，2005，14（4）：265-268.
[20]Palmieri D, Bronder JL, Herring JM, et al. Her-2 overexpression increases the metastatic outgrowth of breast cancer cells in the brain[J]. Cancer Res, 2007, 67(9): 4190-4198.
[21]胡伟国. Her-2的研究进展与乳腺癌[J]. 肿瘤学杂志，2002，8（6）：347-349.
