新辅助化疗前18F-FDG PET/CT检查评价II-III期乳腺癌术后放疗价值

目的： 评价新辅助化疗（NAC）前18F-FDG PET/CT检查提高乳腺癌术后危险分组并对术后放疗的指导价值。 方法： 2009年7月至2013年5月一共收集乳腺癌患者309例，纳入研究224例。所有患者在NAC前行体部18F-FDG PET/CT检查，后行NAC后，结合淋巴结传统诊断方法B超、B超介导下穿刺活检，根据NCCN2013指南，将患者进行肿瘤复发的风险性分组：低风险组（T1N0、T2N0）、中风险组（T0N1、T1N1、T2N1、T3N0）和高风险组（T3N1、T4、TxN2、TxN3）。根据治疗前PET/CT检查，计算同侧腋窝4个及4个以上淋巴结即petN2（4+）或者乳内淋巴结或者锁骨区淋巴结即隐匿淋巴结（ petN3），采用配对卡方检验，评价化疗前PET/CT检查提高危险分组的价值。 结果： 18F-FDG PET/CT在35 例低风险组患者中发现petN3患者4 例（占11.4%）；在123例中风险组患者中， 18F-FDG PET/CT发现petN2（4+）患者20 例， petN3患者16 例，一共提高分级31例（占25.2%）；在66例高风险组的患者中，新发现petN3患者9例（占13.6%）；在低风险组和中风险组一共提高35例（占22.2%）复发风险分级。根据配对卡方检验和一致性检验， 18F-FDG PET/CT检查与传统检查危险性评估存在一致性，其中Kappa=0.748，小于0.75，认为一致性中等；配对卡方P=0.000，根据数据显示，PET/CT检查较传统方法将肿瘤复发风险性分组提高。 结论：NAC前18F-FDG PET/CT检查对患者的复发风险进行较好的评价，减少因NAC低估乳腺癌复发风险性而耽误的术后放疗；同时对于高风险组患者，可以发现隐匿部位淋巴结，为放疗野范围的确定提供有力保障。

Pre-neoadjuvant chemotherapy 18F-FDG PET/CT examination to evaluate the postoperative radiotherapeutic value in stage II-III breast cancer #br#

Objective: To evaluate postoperative radiotherapy with 18F-FDg PET/CT before neoadjuvant chemotherapy in breast cancer patient staging II and III. Methods: We retrieved the 18F-FDg PET/CT record of 309 breast cancer patients in our hospital from July 2009 to May 2013. Distant metastases were detected in 85 patients, and 224 patients were included in this study. Conventional regional staging consisted of fine needle aspiration and/or sentinel lymph node biopsy. According to the guideline of NCCN 2013, patients were classified as low-risk group (T2N0), intermediate-risk group (T0N1, T1N1, T2N1, T3N0), or high-risk group (T3N1, T4,TxN2, TxN3). The presence and number of FDg-avid nodes were evaluated and the proportion of patients that would be upstaged by 18F-FDg PET/CT, based on detection of ≥4 FDg-avid axillary nodes defined as petN2(4+) or occult petN3-disease. Results: 18F-FDg PET/CT detected occult N3-disease in 11.4% (4/35) of 35 lowrisk patients. In 123 intermediate-risk patients, 18F-FDg PET/CT detected≥4 FDg avid nodes in 20 patients and occult N3-disease in 16 patients, thereby finally upstaging 25.2% (31/123) of the patients. Conclusion: 18F-FDg PET/CT imaging before neoadjuvant chemotherapy can accurately assess the patient’s risk of recurrence. For the high-risk group of patients, 18F-FDg PET/CT can detect occult lymph nodes and provide powerful guarantee for ascertainment of the range of radiation field.