~(18)F-FDG PET/CT在乳腺浸润性导管癌术前诊断及分期中的应用价值
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摘要
目的探讨乳腺浸润性导管癌的~(18)F-FDG PET/CT显像特点。方法回顾性分析13例经穿刺或手术病理证实的乳腺浸润性导管癌的术前~(18)F-FDG PET/CT图像特点,分析其病变SUVmax、密度、皮肤厚度、钙化有/无、同侧腋窝淋巴结、远处转移情况。结果 13例乳腺癌中,全部为浸润性导管癌,其中左侧乳腺癌2例,右侧乳腺癌8例,中央区乳腺癌3例。合并沙粒样钙化3例(23.1%),皮肤增厚7例(53.8%),同侧腋窝淋巴结增大8例(61.5%),手术病理证实为转移瘤,密度增高9例(69.2%),发生肝脏多发转移瘤及胸11椎体转移瘤1例,腰4、5椎体转移瘤1例,右侧颈部及锁骨上淋巴结、全身多发骨骼转移瘤1例,左锁骨上、纵隔淋巴结及全身多发骨骼转移瘤1例。所有病变SUVmax最大值10.7,SUVmax最小值1.8,平均SUVmax3.68±2.4,经统计学分析,健侧乳腺与患侧乳腺SUVmax差异有统计学意义。结论当乳腺密度局限或弥漫性增高伴局部皮肤增厚,同机PET上呈现轻～中度取增高,要考虑到乳腺浸润性导管癌的可能。此外,~(18)F-FDGPET显像在乳腺癌分期中也可以起到很好的参考价值。
Objective To study the imaging characteristics of invasive ductal carcinoma of the breast on ~(18)F-FDG PET/CT, in order to increase the understanding of the disease, and to improve the accuracy of diagnosis. Methods 13 cases of infiltrating ductal carcinoma confirmed by biopsy or surgical pathology and its preoperative ~(18)F-FDG PET/CT image of characteristics, including lesions' s SUVmax, skin thickness, lesions' s density, calcification, ipsilateral axillary lymph node and distant metastasis, were retrospectively analyzed. Results Of the 13 breast cancers, 2 cases located in the left breast, 8 cases in the right breast, and 3 cases in central area. Sand-like calcification was found in 3 cases(23.1%), skin thickening in 7 cases(53.8%), and ipsilateral axillary lymph node enlargement in 8 cases(61.5%), increased density in 9 cases(69.82%), 11 th thoracic vertebral metastase and multiple metastases in liver in 1 case, lumbar 4, 5 vertebral metastatic tumor in 1 case, the right neck, supraclavicular lymph nodes, and multiple bone metastases in 1 case; multiple bone metastases and left supraclavicular and mediastinal lymph nodes in 1 case. The maximun of SUVmax of all lesions was 10.7, the minimum of SUVmax was 1.8, and the average SUVmax was 3.68±2.4, and according to statistically analyzing, significant difference was found between the healthy control breast and breast cancer. Conclusion When breast density localized or diffuse increased with local skin thickening, mild to moderate ~(18)F-FDG uptake on the PET image at the same time, the possibility of breast invasive ductal carcinoma should be taken into consideration, otherwise. ~(18)F-FDG PET imaging had very good reference value in the staging of breast cancer.
Objective To study the imaging characteristics of invasive ductal carcinoma of the breast on ~(18)F-FDG PET/CT, in order to increase the understanding of the disease, and to improve the accuracy of diagnosis. Methods 13 cases of infiltrating ductal carcinoma confirmed by biopsy or surgical pathology and its preoperative ~(18)F-FDG PET/CT image of characteristics, including lesions' s SUVmax, skin thickness, lesions' s density, calcification, ipsilateral axillary lymph node and distant metastasis, were retrospectively analyzed. Results Of the 13 breast cancers, 2 cases located in the left breast, 8 cases in the right breast, and 3 cases in central area. Sand-like calcification was found in 3 cases(23.1%), skin thickening in 7 cases(53.8%), and ipsilateral axillary lymph node enlargement in 8 cases(61.5%), increased density in 9 cases(69.82%), 11 th thoracic vertebral metastase and multiple metastases in liver in 1 case, lumbar 4, 5 vertebral metastatic tumor in 1 case, the right neck, supraclavicular lymph nodes, and multiple bone metastases in 1 case; multiple bone metastases and left supraclavicular and mediastinal lymph nodes in 1 case. The maximun of SUVmax of all lesions was 10.7, the minimum of SUVmax was 1.8, and the average SUVmax was 3.68±2.4, and according to statistically analyzing, significant difference was found between the healthy control breast and breast cancer. Conclusion When breast density localized or diffuse increased with local skin thickening, mild to moderate ~(18)F-FDG uptake on the PET image at the same time, the possibility of breast invasive ductal carcinoma should be taken into consideration, otherwise. ~(18)F-FDG PET imaging had very good reference value in the staging of breast cancer.
引文
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[2] 徐巧玲,尤徐阳,郁春景,等.影响乳腺浸润性导管癌原发病灶摄取18F-FDG的相关因素分析[J].中华核医学与分子影像杂志,2016,36(5):413-419.
[3] 李红,王晓明,辛军,等.乳腺浸润性导管癌18F-FDG摄取的影响因素分析[J].现代肿瘤医学,2012,20(6):1187-1189.
[4] 李雪艳,段钰,于丽娟.18F-FDG PET/CT在乳腺癌腋窝淋巴结转移上的诊断价值[J].中国临床医学影像杂志,2016,27(4):243-247.
[5] 吴东博,于丽娟,陆佩欧,等.18F-FDG PET/CT在乳腺癌术前腋窝淋巴结转移的诊断价值[J].医学影像学杂志,2017,27(4):659-662.
[6] 尹培,柴鹏,冯小伟,等.PET/CT显像SUVmax值与乳腺癌病理分型及组织分级的相关性分析[J].浙江临床医学,2017,19(5):855-856.
[7] 陈宝国.18F-FDG PET/CT诊断浸润性乳腺癌和淋巴结转移的效果[J].现代医用影像学,2016,25(6):1137-1139.
[8] 唐立岷,马超.18F-FDG PET/CT在诊断浸润性乳腺癌和淋巴结转移中的价值[J].上海交通大学学报(医学版),2012,32(6):761-765.
[9] 卓小丽,李诗运,戴儒奇.18F-FDG PET-CT在确定乳腺癌术前诊断与分期中的临床价值[J].标记免疫分析与临床,2016,23(4):442-445.
[10] Koolen BB,Valdés RA,Elkhuizen PH,etal.Locoregional lymph node involvement on 18F-FDG PET/CT in breast cancer patients scheduled for neoadjuvant chemotherapy [J].Breast Cancer Res Treat,2012,135(1):231-240.