J Nucl Med：18FDG–PET–CT 可改善乳腺癌分类**度

一项前瞻性研究显示氟代脱氧葡萄糖正电子发射断层成像术/计算机断层成像术（18FDG-PET-CT）成为检测乳癌患者淋巴转移和远处转移的有效工具。

David Groheux（法国巴黎圣路易斯医院）和他的合着者报道，通过18FDG-PET-CT检查，254名由临床检查、磁共振成像或超声检查诊断为二期或三期乳癌的患者中有30.3%的患者改变了他们的美国癌症分期联合委员会（AJCC）分期结果。

18FDG-PET-CT改变了16.1%的IIB期、31.7%的IIIA 期、51.4% 的IIIB期和47.1%的IIIC期乳癌患者的分期诊断，显示出该设备对这种疾病的最晚期患者的诊断具有最强大的影响力。Groheux等人说：“早期提供这些信息或许能够使那些死亡率最高的乳癌患者有希望获得更好的处置。”

然而，18FDG-PET-CT仅仅改变了4.5%的IIA期患者的分期诊断，对此，这个研究小组认为，这种影像学手段或许仅仅对于IIB及其以上的分期患者更有价值。经18FDG-PET-CT检测出之前未被怀疑的锁骨下淋巴结、锁骨上淋巴结或乳内侧淋巴结转移或远处转移的病灶后立刻改变了分期诊断。

对临床IIB期及其以上患者的长期随访结果显示，18FDG-PET-CT检查有远处转移的患者的三年存活率远低于于没有远处转移迹象的患者，两者分别为57% 和88%。多变量分析显示，18FDG-PET-CT确诊的远处转移灶和三阴性乳癌表型是影响疾病生存的两个最显着的预后因素，其中，M1期患者与M0期患者的相对危险率是26.60，而三阴性表型与其他表型的相对危险率是18.58.

这些研究者说：“18FDG-PET-CT对乳癌临床分期发展的卓越推进以及PET-CT结果与预后的相关性强有力的证明了绝大多数经由18FDG-PET-CT检查划分为M+期的患者被证明确实存在转移。”然而，他们强调由于他们的研究结果是在单个设备上进行的，这一研究还须在其他设备上进行重复。

与乳腺癌相关的拓展阅读：

• J Nucl Med：18FDG–PET–CT 可改善乳腺癌分类精确度
• Clin Cancer Res：研究揭示HER2阴性乳腺癌新的矛盾特征
• BMC Cancer：糖尿病恶化乳腺癌患者预后
• CA Cancer J Clin：Oncotype DX HER2检查结果不能作为乳腺癌治疗方案的决策标准
• Lancet Oncol：拉帕替尼可使早期HER2阳性乳腺癌患者获益
• Ann Surg:肥胖乳腺癌患者术前应使用抗生素
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doi: 10.2967/jnumed.112.106864
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18F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging

David Groheux1,2, Sylvie Giacchetti3, Marc Delord4, Elif Hindié2,5, Laetitia Vercellino1, Caroline Cuvier3, Marie-Elisabeth Toubert1, Pascal Merlet1,6, Christophe Hennequin7 and Marc Espié3

The prognosis of patients with locally advanced breast cancer (LABC) remains poor. We prospectively investigated the impact of 18F-FDG PET/CT at initial staging in this clinical setting and compared PET/CT performance with that of conventional distant work-up. Methods: During 60 mo, consecutive patients with LABC (clinical T4 or N2–N3 disease) underwent 18F-FDG PET/CT. The yield was assessed in the whole group and separately for noninflammatory and inflammatory cancer. The performance of PET/CT was compared with that of a conventional staging approach including bone scanning, chest radiography, or dedicated CT and abdominopelvic sonography or contrast-enhanced CT. Results: 117 patients with inflammatory (n = 35) or noninflammatory (n = 82) LABC were included. 18F-FDG PET/CT confirmed N3 nodal involvement in stage IIIC patients and revealed unsuspected N3 nodes (infraclavicular, supraclavicular, or internal mammary) in 32 additional patients. Distant metastases were visualized on PET/CT in 43 patients (46% of patients with inflammatory carcinoma and 33% of those with noninflammatory LABC). Overall, 18F-FDG PET/CT changed the clinical stage in 61 patients (52%). Unguided conventional imaging detected metastases in only 28 of the 43 patients classified M1 with PET/CT (65%). 18F-FDG PET/CT outperformed conventional imaging for bone metastases, distant lymph nodes, and liver metastases, whereas CT was more sensitive for lung metastases. The accuracy in diagnosing bone lesions was 89.7% for planar bone scanning versus 98.3% for 18F-FDG PET/CT. The accuracy in diagnosing lung metastases was 98.3% for dedicated CT versus 97.4% for 18F-FDG PET/CT. Conclusion: 18F-FDG PET/CT had the advantage of allowing chest, abdomen and bone to be examined in a single session. Almost all distant lesions detected by conventional imaging were depicted with PET/CT, which also showed additional lesions.