18F-FDG PET/CT对原发性乳腺癌诊断和淋巴结分期的临床价值

目的评价18F-脱氧葡萄糖(18F-FDG)PET/CT对原发性乳腺癌诊断和淋巴结分期的临床价值。方法临床拟诊为乳腺癌的27例女性患者,手术前分别行乳腺钼靶X线和18F-FDG PET/CT检查。全部患者均行手术治疗,共切除32个病灶。23例患者接受了腋淋巴结廓清术,并行病理学诊断。结果32个病灶中,25个为乳腺癌病灶,7个为良性病变。18F-FDG PET/CT诊断的敏感度为80.0%,特异度为71.4%。T1期病灶8个,PET/CT诊断阳性6个;T2期病灶14个,PET/CT诊断阳性12个;T3期病灶2个,PET/CT均诊断阳性。对区域淋巴结转移,PET/CT诊断的敏感度为60.0%,特异度为84.6%,诊断准确度为73.9%。结论对于怀疑多中心乳癌、病期较晚、需要全面评价区域淋巴结状态或疑有远处转移的患者,PET/CT具有优势,对乳腺癌的分期有重要帮助,但尚不适宜于作为乳腺癌的常规检查。

Performance of 18F-FDG PET/CT in the detection of primary breast cancer and staging of the regional lymph nodes

Objective To evaluate the performance of 18F-FDG PET/CT in the detection of primary breast cancer, and the staging of regional lymph nodes. Methods Twenty four females with highly suspected breast cancer, underwent PET/CT imaging of the breast preoperatively. All the patients received no treatment at admission. Three nuclear medicine physicians analyzed the image and made the diagnosis. 32 breast lesions were evaluated by histology, revealing 25 breast carcinomas and 7 benign pathological changes. 23 patients had histological diagnosis of the breast tumor and regional lymph nodes. Results 20 of 25 breast carcinomas were successfully diagnosed by FDG-PET/CT. The sensitivity was 80% and specificity was 71.4%. No Tis breast carcinoma was detected. 75. 0% of T1 breast carcinomas were detected, and with 85. 7% of stage T2, 100.0% of T3. 10 patients were proved to have lymph node metastasis, and PET/CT got a sensitivity of 60.0%. As to a suspicious distant metastasis, PET/CT convinced the diagnosis. Conclusion As a noninvasive technique, FDG PET/CT appears to be a useful method in staging patient with breast cancer, especially in cases in which the lesion is hard to predict by routine examination. But the accuracy of FDG PET/CT seems to be not high enough to identify patients who might avoid axillary lymph nodes dissection. In the detection of breast lesions, PET/CT doesn't seem to have a high sensitivity, especially in early stage breast cancers. The high cost and the space resolution limit its use as a routine diagnostic method of breast cancer.