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

摘要

目的 分析影响乳腺浸润性导管癌原发灶摄取18 F-FDG的相关因素.方法 将2010年至2015年18F-FDG PET/CT检查发现乳腺病灶的160例女性患者的167个病灶按照病理结果分为良性(118个)、恶性(49个,浸润性导管癌)组,采用Kruskal-WallisH检验和Mann-Whitney u检验比较2组或多组的SUVmax差异并研究乳腺恶性病灶的SUVmax和患者年龄、T分期、淋巴管受侵、组织学分级、转移方式、ER、PR、HER2、细胞增殖核抗原Ki-67表达及乳腺癌亚型等临床病理学参数的关系.采用ROC曲线分析18F-FDG PET/CT对乳腺病灶良恶性的鉴别诊断效能.结果 乳腺浸润性导管癌原发病灶的SUVmax为6.09(3.88,9.26),高于乳腺良性病灶的SUVmax[1.35(0.95,2.35);u=341.0,P＜0.05].浸润性导管癌的SUVmax在不同T分期、有无淋巴管受侵、不同组织学分级、不同转移方式及不同Ki-67表达分组间的差异有统计学意义(u:117.5～209.5,H=7.70,P＜0.01或＜0.05).ROC曲线分析示所有乳腺病灶、最大径≤2.0Cm组和最大径＞2.0 cm组的SUVmax最佳截断值分别为＞2.60、＞1.71和＞3.97;最大径≤2.0 cm乳腺病灶选取SUVmax最佳截断值为＞1.71和＞2.60时,Youden指数分别为0.66、0.61(z=0.566,P＞0.05),当最大径＞2.0 cm乳腺病灶选取SUVmax最佳截断值为＞3.97和＞2.60时,Youden指数分别为0.89和0.81 (z=0.748,P＞0.05).结论 乳腺浸润性导管癌的T分期、淋巴管受侵、组织学分级、转移方式及Ki-67表达影响原发肿瘤组织对18F-FDG的摄取;浸润性导管癌原发病灶SUVmax和病灶大小有关,对于较小的病灶,其SUVmax诊断截断值应该适当下调.%Objective To analyze the relevant factors influencing 18F-FDG uptake in the primary lesion of breast invasive ductal carcinoma (BIDC).Methods A total of 160 female patients underwent 18 F-FDG PET/CT examination from 2010 to 2015 and breast lesions were revealed.Lesions were divided into benign group (n =118) and malignant group (n =49,BIDC) according to pathological results.KruskalWallis H test and Mann-Whitney u test were performed to compare SUVmax of the two groups,and to investigate the relationship between the SUVmax of breast malignant lesion and patients' age as well as clinical pathological parameters including T stage,lymphatic vessel invasion,nuclear grade,route of metastasis,ER,PR,HER2 and Ki-67 expression,and subtype of breast cancer.The diagnostic efficiency of 18F-FDG PET/ CT in differentiating benign and malignant breast lesions was analyzed using ROC curve analysis.Results The SUVmax of BIDC was 6.09(3.88,9.26),higher than that of breast benign lesion (1.35 (0.95,2.35);u=341.0,P＜0.05).The SUVmax of BIDC showed statistically significant difference between groups with different T stage,with or without lymphatic vessel invasion,with different nuclear grade,different routes of metastasis and different Ki-67 expression (u:117.5-209.5,H=7.70,P＜0.01 or 0.05).For all breast lesions,lesions with the maximum diameter ≤ 2.0 cm and lesions with the maximum diameter ＞2.0 cm,the optimum cutoff values of SUVmax were ＞2.60,＞ 1.71 and ＞3.97,respectively.When the optimum cutoff values of SUVmax for breast lesions with the maximum diameter ≤2.0 cm were selected as ＞ 1.71 and ＞2.60,the Youden indexes were 0.66 and 0.61(z=0.566,P＞0.05).When the optimum cutoff values of SUVmax for breast lesions with the maximum diamter ＞2.0 cm were selected as ＞3.97 and ＞2.60,the Youden indexes were 0.89 and 0.81(z=0.748,P＞0.05).Conclusions T stage,lymphatic vessel invasion,nuclear grade,route of metastasis and Ki-67 expression of BIDC influence the uptake of 18F-FDG by tumor tissues.The SUVmax of the primary lesion of BIDC is related to the size of lesion,and thus the diagnostic threshold of SUVmax should be decreased appropriately for small lesions.