18F-FDG PET/CT在乳腺癌术后随访中的价值

目的研究18F-FDG PET/CT在乳腺癌术后复发转移中的诊断价值以及在治疗决策改变和预后中的价值。 方法回顾性分析2007年7月至2016年9月行18F-FDG PET/CT检查的59例女性乳腺癌术后患者，分析PET/CT对真阳性患者临床治疗策略的影响，并对真阳性组和真阴性组患者进行Kaplan-Meier生存分析。在PET/CT显像真阳性组中，按照患者年龄、雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体2（HER2）及乳腺癌亚型进行分组，组间SUV_max的比较采用t检验。 结果在59例乳腺癌术后患者中，18F-FDG PET/CT诊断乳腺癌术后复发转移的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为100%、87.5%、94.9%、92.1%、100%。PET/CT真阳性组与真阴性组患者平均随访时间分别为（58.33±37.69）个月和（47.40±25.99）个月，中位数生存时间分别为3.58年和4.16年，PET/CT真阴性患者的总生存时间（OS）和无进展生存时间（PFS）长于真阳性患者，且差异有统计学意义（χ2=10.274和17.187，均P < 0.01）。35例PET/CT真阳性患者中，25例分期上调，30例检查后治疗策略改变。乳腺癌复发转移灶的SUV_max在年龄、ER、PR、HER2及亚型分组间的差异无统计学意义（t=0.808、0.225、0.355、-0.426和-1.076，均P>0.05）。 结论 18F-FDG PET/CT显像在诊断乳腺癌术后复发转移中有较高的灵敏度和准确率，能及时修正乳腺癌术后复发转移患者的临床再分期，以及指导临床治疗策略的改变，在乳腺癌的术后随访中具有较高的临床应用价值。

Clinical value of 18F-FDG PET/CT in follow-up of postoperative breast cancer

Objective To evaluate the clinical value of 18F-FDG PET/CT imaging in detecting the recurrence and metastasis,therapeutic strategy,and prognosis of postoperative breast cancer patients.Methods From July 2007 to September 2016,59 patients with postoperative breast cancer were retrospectively studied.The influence of PET/CT imaging results on the choice of therapeutic strategy was analyzed.Kaplan-Meier survival analysis was conducted based on the true-positive and true-negative groups of patients.Comparison of SUVmax according to the age,estrogen receptor(ER),progesterone receptor (PR),human epidermal growth factor receptor-2 (HER2),and subtypes of the patients in the PET/CT imaging true-positive group was performed using t-test.Results The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of 18F-FDG PET/CT were 100％,87.5％,94.9％,92.1％,and 100％,respectively.No statistically significant difference in the SUVmax for breast cancer recurrence and metastasis was observed between the two groups of patients according to age,ER,PR,HER2,and subtypes of breast cancer(t=0.808,0.225,0.355,-0.426 and-1.076,all P＞0.05).The true-positive and true-negative groups were followed for a median period of 58.33 ±37.69 and 47.40±25.99 months,and their median survival times were 3.58 and 4.16 years,respectively.The two groups significantly differed in the overall survival and progression-free survival times (Kaplan-Meier survival analysis,x2=10.274,P＜0.01;x2=17.187,P＜0.01).Clinical restaging was raised in 25 true-positive patients after PET/CT imaging,and the therapeutic strategy was changed in 30 true-positive patients.Conclusions PET/CT imaging is highly sensitive and accurate in diagnosing the recurrence and metastasis of postoperative breast cancer and allows clinical restaging in a timely manner.It helps in choosing the appropriate clinical therapeutic strategy,thereby improving the prognosis of patients.Compared with the true-positive patients,the truenegative patients who underwent PET/CT imaging had a better prognosis.Therefore,PET/CT imaging has a high clinical value in the follow-up of postoperative breast cancer patients.