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乳腺癌原发灶1 8F - FDG PET-CT代谢参 数与患者临床病理 特征的关系研究

作者:牛增志

所属单位:河南省安阳市人民医院普外科 (河南 安阳 455000)

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摘要

目的 探讨乳腺癌原发灶18F脱氧葡萄糖(1 8F-FDG)正电子发射计算 机断层扫描(PET-CT)代谢参数与患者临 床病理特征的关系。方法 收集2013年3 月-2018年3月在我院行18F-FDG PET-CT检 查并经手术病理证实的45例乳腺癌患者 临床资料,测定乳腺癌原发灶最大标准 摄取值(SUVmax)、代谢体积(MTV)、糖酵 解总量(total lesion glycolysis,TLG) 等代谢参数及转移淋巴结的SUVmax。结 果 45例乳腺癌均有较高18F-FDG摄取, 原发灶SUVmax为(4.88±1.52),SUVmean 为(2.59±0.81),MTV为(8.19±2.51) cm3 ,TLG为(21.96±6.42)g;其中28例 有淋巴结转移,转移淋巴结SUVmax为 (3.79±1.14)。乳腺癌原发灶SUVmax、 MTV、TLG与均肿瘤最大径、组织学分 级、T分期、淋巴结转移有明显相关性 (P<0.05)。ER阴性者较ER阴性者TLG明显 增高(P<0.05),PR阴性者较阳性者MTV、 TLG明显增高(P<0.05)。而HER-2阳性与阴 性者、p53阳性与阴性者的SUVmax、MTV、 TLG比较差异均无统计学意义(P>0.05)。 Spearman相关性分析显示,乳腺癌转 移淋巴结的SUVmax与原发灶SUVmax、 MTV、TLG均呈正相关(r=0.476、0.469、 0.437,P<0.05),且与T分期亦呈正相关 (r=0.613,P<0.05)。结论 乳腺癌原发灶 18F-FDG PET-CT代谢参数与临床病理特征 具有相关性,其中以TLG最为显著。

Objective To investigate the relationship between 18F-fluorodeoxy glucose (FDG) positron emission computed tomography (PET-CT) metabolism parameters and clinicopathological features of primary lesions of breast cancer. Methods The clinical data of 45 patients with breast cancer examined by 18F-FDG PET-CT and confirmed by surgery and pathology in the hospital from March 2013 to March 2018werecollected. Metabolism parameters such as the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG)of primary lesions of breast cancer and SUVmax of metastatic lymph nodes were determined. Results The 18F-FDGuptake of the 45 cases was relatively higher. The SUVmax, SUVmean, MTV and TLG of primary lesions were (4.88±1.52),(2.59±0.81),(8.19±2.51)cm3 and(21.96±6.42)g respectively. There were 28 cases with lymph node metastases, and the SUVmax of metastatic lymph nodes was (3.79±1.14). The SUVmax, MTV and TLG of primary lesions of breast cancer were significantly correlated with the maximum diameter, histological grade, T stage and lymph node metastasis (P<0.05). The TLG of ER-negative patients was significantly higher than that of ER-negative patients (P<0.05). The MTV and TLG of PR-negative patients were significantly higher than those of positive patients (P<0.05). There was no significant difference in SUVmax, MTV or TLG between HER-2 positive and negative patients or between p53 positive and negative patients (P>0.05). Spearman correlation analysis showed that the SUVmax of metastatic lymph nodes in breast cancer was positively correlated with the SUVmax, MTV and TLG of primary lesions (r=0.476, 0.469, 0.437, P<0.05), and positively correlated with Tstage (r=0.613, P<0.05). Conclusion There is a correlation between 18F-FDG PET-CT metabolism parameters and clinicopathological features of primary lesions of breast cancer, and the correlation of TLG is the most significant.

【关键词】乳腺癌;正电子发射计算机断 层扫描;体层摄影术;脱氧葡 萄糖;临床病理特征

【中图分类号】R737.9;R445.5

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.04.025

前言

乳腺癌是常见女性恶性肿瘤之一,发病率约为41.64/10万,居 女性恶性肿瘤之首,严重危害妇女生命健康[1]。肿瘤原发灶和区域 淋巴结的良好控制是提高生存率、改善患者生活质量之关键,而准 确临床诊断与分期有助于治疗方案制定。近年来,18F脱氧葡萄糖 (fluorodeoxyglucose,FDG)正电子发射计算机断层扫描(positron emission tomograpgy/computed tomography, PET-CT)在临床应用逐 渐广泛,其不仅可提供解剖结构信息,还能够获取肿瘤能量代谢信 息,已成为肿瘤诊断的重要手段[2]。有研究显示,18F-FDG PET-CT代谢 参数与能够反映肿瘤恶性程度。但目前国内关于乳腺癌原发灶18F-FDG PET-CT代谢参数与疾病分期、淋巴结转移情况、肿瘤分化程度等关系 的报道尚少[3]。为此,本研究回归性分析45例乳腺癌初诊患者临床资 料,旨在探讨18F-FDG PET-CT代谢参数与患者临床病理特征的相关性, 现报告如下。