首页>
美国卫生研究院文献>Indian Journal of Surgical Oncology
>Special Relevance of FDG-PET as an Upfront Diagnostic Modality at Initial Diagnosis and in Suspected Recurrence in Patients of Breast Carcinoma Hailing From Lower Socioeconomic Status Owing to Relative Late Presentation: A Pilot Study in a Medical College Hospital Setting in India
【2h】
Special Relevance of FDG-PET as an Upfront Diagnostic Modality at Initial Diagnosis and in Suspected Recurrence in Patients of Breast Carcinoma Hailing From Lower Socioeconomic Status Owing to Relative Late Presentation: A Pilot Study in a Medical College Hospital Setting in India
FDG-PET has found relatively limited use in routine management of breast carcinoma due to its limited utility in assessing the primary and axillary lymph node status. The aim of the study was to assess its role in a medical school and municipal hospital setting of Mumbai, where majority belongs to the lower socioeconomic status and presents relatively late and hence whole body FDG-PET could find important place for assessing whole body disease status that would justify being used upfront in this group of patients. Thus, the premise of this study was that FDG-PET will have special relevance in this particular setting for evaluation of patients of breast carcinoma with respect to initial staging, detection of locoregional recurrence and metastasis and assessing response to systemic treatment. A total of 52 patients proven to have breast carcinoma, who had undergone 18F FDG–PET for disease staging at initial diagnosis and in in recurrent disease staging with a few cases as a baseline study for early treatment monitoring purposes over a study period of 3 years, were included in this analysis. 33.3 % of patients with pretreatment baseline FDG-PET were upstaged with diagnosis of additional lesions in the adrenal gland, liver, internal mammary, cervical lymph nodes and the mediastinum. On a lesion specific analysis, the percentage of increased lesion detection (including both lymph node with distant metastasis) by FDG-PET was 42.7 %. FDG-PET was found to be 100 % sensitive and specific for confirming recurrent breast cancer. Four out of 18 patients on chemotherapy underwent second FDG-PET after first cycle of chemotherapy, showed responsiveness to chemotherapy by decreased maximum standardized uptake value (SUVmax). FDG-PET showed 9 liver lesions in 6 patients, only 3 of them was reported in USG. In one patient USG abdomen was inconclusive between hemangioma and metastasis, FDG-PET ruled out liver metastasis in this patient. In the examined patient population belonging to lower socioeconomic status, where usual presentation is relatively late, upfront whole body survey with FDG-PET or PET/CT is of considerable value in view of higher probability of existence of metastatic disease, thus can be an important one-stop shop tool in assessing whole body disease status in a single examination. It also proved efficacious in diagnosing loco regional and distant recurrence, metabolic characterization of lump and early response to treatment in the examined few cases following one cycle of chemotherapy in locally advanced breast cancer.
展开▼
机译：由于FDG-PET在评估原发和腋窝淋巴结状态方面的实用性有限，因此在乳腺癌的常规治疗中发现了相对有限的用途。这项研究的目的是评估其在孟买医学院和市立医院中的作用，那里的大多数属于较低的社会经济地位，并且呈现相对较晚的时间，因此，全身FDG-PET可以在评估全身疾病状况中找到重要的位置这将证明在此组患者中预先使用是合理的。因此，本研究的前提是FDG-PET在此特定环境下将特别相关，以评估乳腺癌患者的初始分期，局部复发和转移的检测以及评估对全身治疗的反应。共有52名被证明患有乳腺癌的患者，他们在初次诊断时和在复发性疾病分期中接受过 18 F FDG-PET的疾病分期，其中有少数病例作为早期治疗监测的基线研究这项研究包括3年研究期内的目标。接受基线FDG-PET预处理的患者中有33.3％的患者被诊断为肾上腺，肝脏，内部乳腺，宫颈淋巴结和纵隔的其他病灶升级。在病灶特异性分析中，FDG-PET增加的病灶检测率（包括两个具有远处转移的淋巴结）的百分比为42.7％。发现FDG-PET对确认复发性乳腺癌具有100％的敏感性和特异性。在接受化疗的18位患者中，有4位在第一个化疗周期后接受了第二次FDG-PET治疗，通过降低最大标准摄取值（SUVmax）表现出对化疗的反应。 FDG-PET在6例患者中显示9个肝脏病变，在USG中只有3例报道。在一名患者USG腹部血管瘤和转移之间无定论，FDG-PET排除了该患者的肝转移。在接受检查的属于较低社会经济地位的患者人群中，通常呈现时间相对较晚，鉴于存在转移性疾病的可能性较高，因此用FDG-PET或PET / CT进行的前期全身检查具有重要价值，因此可能是重要的在一次检查中评估全身疾病状况的一站式工具。在局部晚期乳腺癌的一个化疗周期后的少数病例中，它被证明可有效诊断局部和远处复发，肿块的代谢特征以及对治疗的早期反应。
展开▼
