FDG-PET/CT在原位导管癌（DCIS）组织学升级鉴别中的作用

IF 0.2 4区医学 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Iranian Journal of Radiology Pub Date : 2021-09-11 DOI:10.5812/iranjradiol.113862

N. Jung, B. Kang, Sung Hun Kim, I. Yoo, Y. Lim, W. Yoo

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The clinicopathological characteristics and FDG-PET/CT findings of the patients were compared with respect to cancer invasion. The predictors of DCIS upgrade to invasive cancer were also examined. Moreover, the diagnostic performance of visual and semi-quantitative analyses of FDG-PET/CT in predicting invasion was compared, based on the maximum standardized uptake value (SUVmax), divided by the cutoff point in a receiver operating characteristic (ROC) curve analysis. Results: The final pathological findings indicated 119 cases of pure DCIS and 46 cases of DCIS with invasion. The optimal SUVmax threshold was 1.9 in the ROC curve analysis. Young age, high SUVmax, positivity in the visual analysis of FDG-PET/CT, and large pathological tumor size were significantly more frequent in the DCIS + invasion group. 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引用次数: 0

摘要

背景：准确的术前检测导管原位癌（DCIS）的侵袭性成分对于适当的治疗至关重要。18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）可显示癌症的代谢活性和侵袭性，可作为DCIS侵入性成分的预测指标之一。目的：确定FDG-PET/CT检查结果是否与活检中DCIS的组织学升级有关。方法：在这个回顾性队列中，我们回顾了162名患者中的165例DCIS，这些患者在2008年4月至2015年9月期间接受了术前FDG-PET/CT检查。将患者的临床病理特征和FDG-PET/CT表现与癌症侵袭进行比较。DCIS升级为侵袭性癌症的预测因素也进行了检查。此外，基于最大标准化摄取值（SUVmax）除以受试者工作特性（ROC）曲线分析中的截止点，比较了FDG-PET/CT的视觉和半定量分析在预测侵袭方面的诊断性能。结果：最终病理结果显示119例为单纯DCIS，46例为浸润性DCIS。在ROC曲线分析中，最佳SUVmax阈值为1.9。DCIS+侵袭组中，年轻、高SUVmax、FDG-PET/CT视觉分析阳性和大的病理性肿瘤明显更常见。在单变量分析中，DCIS组织学升级的重要预测因素是年龄（P=0.011）、SUVmax（P<0.001）、FDG-PET/CT的视觉分析（P=0.004）和病理性肿瘤大小（P=0.003）。在多变量分析中，当模型包括SUVmax、年龄和大小时，SUVmax（比值比[OR]=3.31，P=0.003）和肿瘤大小（OR=1.20，P=0.022）是显著的（模型1）。另一方面，当模型包括视觉分析、年龄和大小（模型2）时，年龄（OR=0.96，P=0.032）、视觉分析（OR=4.67，P=0.006）和肿瘤大小（OR=1.25，P=0.005）是显著的预测因素。视觉分析的敏感性显著较高，而半定量分析的特异性、阳性预测值（PPV）和准确性显著较高。结论：FDG-PET/CT是预测DCIS升级为侵袭性癌症的一种潜在的成像工具。

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Role of FDG-PET/CT in Identification of Histological Upgrade of Ductal Carcinoma in Situ (DCIS) in Needle Biopsy

Background: Accurate preoperative detection of the invasive components of ductal carcinoma in situ (DCIS) is essential for an appropriate treatment. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan, which can indicate the metabolic activity and aggressiveness of breast cancer, may be used as one of the predictors of the invasive components of DCIS in needle biopsy. Objectives: To determine whether the FDG-PET/CT findings are associated with the histological upgrade of DCIS in biopsy. Methods: In this retrospective cohort, we reviewed 165 cases of DCIS in 162 patients, who underwent preoperative FDG-PET/CT examinations between April 2008 and September 2015. The clinicopathological characteristics and FDG-PET/CT findings of the patients were compared with respect to cancer invasion. The predictors of DCIS upgrade to invasive cancer were also examined. Moreover, the diagnostic performance of visual and semi-quantitative analyses of FDG-PET/CT in predicting invasion was compared, based on the maximum standardized uptake value (SUVmax), divided by the cutoff point in a receiver operating characteristic (ROC) curve analysis. Results: The final pathological findings indicated 119 cases of pure DCIS and 46 cases of DCIS with invasion. The optimal SUVmax threshold was 1.9 in the ROC curve analysis. Young age, high SUVmax, positivity in the visual analysis of FDG-PET/CT, and large pathological tumor size were significantly more frequent in the DCIS + invasion group. The significant predictors of DCIS histological upgrade were age (P = 0.011), SUVmax (P < 0.001), visual analysis of FDG-PET/CT (P = 0.004), and pathological tumor size (P = 0.003) in the univariate analysis. In the multivariate analysis, the SUVmax (odds ratio [OR] = 3.31, P = 0.003) and tumor size (OR = 1.20, P = 0.022) were significant when the model included the SUVmax, age, and size (model 1). On the other hand, age (OR = 0.96, P = 0.032), visual analysis (OR = 4.67, P = 0.006), and tumor size (OR = 1.25, P = 0.005) were significant predictors when the model included visual analysis, age, and size (model 2). The sensitivity was significantly higher in the visual analysis, whereas the specificity, positive predictive value (PPV), and accuracy were significantly higher in the semi-quantitative analysis. Conclusion: FDG-PET/CT is a potentially useful imaging tool to predict the upgrade of DCIS to invasive cancer.

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来源期刊

Iranian Journal of Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

0.50

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： The Iranian Journal of Radiology is the official journal of Tehran University of Medical Sciences and the Iranian Society of Radiology. It is a scientific forum dedicated primarily to the topics relevant to radiology and allied sciences of the developing countries, which have been neglected or have received little attention in the Western medical literature. This journal particularly welcomes manuscripts which deal with radiology and imaging from geographic regions wherein problems regarding economic, social, ethnic and cultural parameters affecting prevalence and course of the illness are taken into consideration. The Iranian Journal of Radiology has been launched in order to interchange information in the field of radiology and other related scientific spheres. In accordance with the objective of developing the scientific ability of the radiological population and other related scientific fields, this journal publishes research articles, evidence-based review articles, and case reports focused on regional tropics. Iranian Journal of Radiology operates in agreement with the below principles in compliance with continuous quality improvement: 1-Increasing the satisfaction of the readers, authors, staff, and co-workers. 2-Improving the scientific content and appearance of the journal. 3-Advancing the scientific validity of the journal both nationally and internationally. Such basics are accomplished only by aggregative effort and reciprocity of the radiological population and related sciences, authorities, and staff of the journal.