| PET/CT imaging has been widely used in the diagnosis,staging,treatment and efficacy evaluation of breast cancer,but it is usually limited to conventional single imaging.lmaging agent 18F-FDG is not a tumor specific imaging agent.Some inflammatory lesions can also ingest 18F-FDG in varying degrees.Some studies have shown that the uptake of 18F-FDG by tumor cells is also related to many factors such as histological differentiation,pathological type,microvessel density and so on.Therefore,conventional siugle imaging may underestimate the uptake of 18F-FDG by the lesion.Dual-phase imaging can solve this problem to a certain extent.However,there are few studies on the diagnostic value of dual phase imaging for breast cancer and regional lymph node metastasis.Invasive ductal carcinoma is the most common pathological type of breast cancer.The purpose of this study is to investigate the diagnostic value of 18F-FDGPET/CT dual phase imaging in invasive ductal carcinoma of the breast and regional lymph node metastasis.Part Ⅰ Diagnostic value of 18F-FDG PET/CTdual phase imaging in different molecular subtypes of breast invasive ductal carcinomaObjective:To investigate the diagnostic value of 18F-FDG PET/CT dual-phase imaging in different molecular subtypes of breast invasive ductal carcinoma.Methods:The clinical imaging data of 169 female patients with breast invasive ductal carcinoma confirmed by pathology and underwent 18F-FDG PET/CT dual-phase imaging were analyzed retrospectively.The maximum standardized uptake value(SUVmax)at the lesion sites in early phase and delayed phase were calculated respectively,and the retention index(RI)was calculated,RI=[(delayed SUVmax-early SUVmax)/early SUVmax]×100%.The changes of early phase SUVmax,delayed phase SUVmax and RI among different molecular subtype groups were analyzed.The receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic limit of the expression status of different molecular markers.Results:(1)In 169 cases of breast cancer,the number of ER positive and negative cases was 113 and 56 respectively.The number of PR positive and negative cases was 96 and 73 respectively.The number of HER-2 positive and negative cases was 51 and 118 respectively.The number of high expression and low expression of Ki-67 was 133 and 36 respectively.In different molecular marker groups,SUVmax in delayed phase was higher than that in early phase in the same group(P<0.001).(2)The SUVmax of early phase and delayed phase in ER and PR negative group were higher than those in positive group;The SUVmax of early phase and delayed phase in HER-2 positive group were higher than those in negative group;The early SUVmax and delayed SUVmax of Ki-67 high expression group were higher than those of low expression group,and the differences werer statistically significant(P<0.001).In RI,ER and PR negative groups were higher than positive groups(P<0.001),but there was no statistical significance between HER-2 positive and negative groups,or between ki-67 high expression and low expression groups(P=0.641 and 0.930,respectively).(3)ROC curve analysis of molecular marker expression showed that in terms of Er negative and positive expression,the area under the curve(AUC)of SUVmax in delayed phase was 0.853,the diagnostic limit was 10.89,the sensitivity was 80.4%,and the specificity was 75.2%.In terms of negative and positive expression of PR,the maximum AUC of SUVmax in delayed phase was 0.861,the diagnostic limit was 10.46,the sensitivity was 83.6%,and the specificity was 76.0%.In terms of negative and positive expression of HER-2,the maximum AUC of SUVmax in early phase was 0.712,the diagnostic limit was 9.31,the sensitivity was 60.2%,and the specificity was 80.4%.In terms of high and low expression of Ki-67,the maximum AUC of SUVmax in delayed phase was 0.924,the diagnostic limit was 8.77,the sensitivity was 91.7%,and the specificity was 85.0%.(4)Among 169 patients with breast invasive ductal carcinoma,there were 32 cases of Luminal A,81 cases of Luminal B,26 cases of HER-2 overexpression and 30 cases of triple negative type.Compared with the early phase of the four molecular subtypes,the SUVmax of the delayed phase was higher than that of the early phase(P<0.001).(5)There were significant differences in early phase SUVmax,delayed phase SUVmax and RI among the four groups(P<0.001).Among them,SUVmax in early phase was the highest in triple negative group and the lowest in luminal type A group(all P<0.001),but there was no statistical difference between luminal type B and HER-2 overexpression group(P=0.065);SUVmax in delayed phase was the highest in triple negative type and the lowest in luminal A type(P<0.001).In RI,the triple negative type and the HER-2 overexpression type were higher than the Luminal B type and Luminal A type(P≤0.001),but there were no statistically significant differences between the triple negative type and the HER-2 overexpression type,or between the Luminal A type and Luminal B type(P=0.614 and 0.327,respectively).Conclusion:(1)18F-FDG PET/CT dual-phase imaging can distinguish the molecular typing of breast invasive ductal carcinoma to a certain extent.(2)SUVmax in early phase and delayed phase were higher in ER and PR negative group than in positive group,higher in HER-2 positive group than in negative group,and higher in Ki-67 high expression group than in low expression group.RI in ER and PR negative group was higher than that in positive group,but there was no significant difference between HER-2 positive and negative groups and between Ki-67 high expression and low expression groups.(3)In different molecular subtypes of breast cancer,the delayed phase SUVmax increased to varying degrees.SUVmax in early phase and delayed phase were higher in triple negative type and lowest in luminal A type.RI was highest in triple negative and her-2 overexpressed types,and lowest in Luminal A and Luminal B groups,but of limited value in distinguishing triple negative from HER-2 overexpressed types and Luminal A from Luminal B types.PartⅡ Diagnostic value of 18F-FDG PET/CT dual phase imaging in different histological grades of breast invasive ductal carcinomaObjective:To investigate the diagnostic value of 18F-FDG PET/CTdual phase imaging in breast invasive ductal carcinoma with different histological grades.Methods:The clinical imaging data of 169 female patients with breast invasive ductal carcinoma confirmed by pathology and underwent 18F-FDG PET/CT dual-phase imaging were analyzed retrospectively.The maximum standardized uptake value(SUVmax)at the lesion sites in early phase and delayed phase were calculated respectively,and the retention index(RI)was calculated,RI=[(delayed SUVmax-early SUVmax)/early SUVmax]×100%.The changes of early phase SUVmax,delayed phase SUVmax and RI in different histological grades of breast cancer were analyzed.Receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic limit of different histological differentiation levels.Results:(1)Among 169 patients with breast cancer,the number of grade Ⅰ,Ⅱ andⅢ were 27,91 and 51,respectively.The tumor diameter of 169 patients was positively correlated with histological grade,early phase SUVmax and delayed phase SUVmax(r=0.50,0.78 and 0,80,respectively,P<0.001).Histological grade was positively correlated with early phase SUVmax and delayed phase SUVmax(r=0.53 and 0.55,respectively P<0.001).(2)The tumor diameter in grade Ⅰ group was not correlated with early phase SUVmax and delayed phase SUVmax(P=0.145 and 0.112,respectively).The tumor diameter in grade Ⅱ group and grade Ⅲ group were positively correlated with early phase SUVmax and delayed phase SUVmax,respectively(r=0.89,0.80 and 0.84,0.90,respectively,P<0.001).(3)The SUVmax of delayed phase in grade Ⅰ group,grade Ⅱ group and grade Ⅲgroup were higher than that of early phase(P<0.001).(4)Comparison of SUVmax,RI and tumor diameter at different histological levels:①SUVmax in early phase and delayed phase were the highest in grade Ⅲ group(P<0.01),and the lowest in grade Ⅰ group(P<0.001).②RI was the highest in grade Ⅲ group(P<0.05),but there was no significant difference between grade Ⅰ group and grade Ⅱ Group(P=0.905).③The tumor diameter was the largest in grade Ⅲ group and the smallest in gradeⅠ group(P<0.001).(5)The ROC curve analysis of different histological levels showed that the maximum SUVmax AUC in the early phase between grade Ⅰ and grade Ⅱ of histological differentiation was 0.912,the diagnostic limit was 8.33,the sensitivity was 72.5%,and the specificity was 100%.In the delayed phase between grade Ⅱ and Ⅲ of histological differentiation,the maximum SUVmax AUC was 0.670,the diagnostic limit was 12.34,the sensitivity was 54.9%,and the specificity was 74.7%.Conclusion:(1)18F-FDGPET/CT dual-phase imaging SUVmax can provide a certain basis for the histological grading of breast invasive ductal carcinoma.(2)Delayed phase SUVmax increased in different histological grades of breast cancer.RI was the highest in grade Ⅲ differentiation group,but there was no statistical difference between grade Ⅰ and grade Ⅱ groups..(3)Breast cancer with lower histological differentiation(grade Ⅲ)not only had larger tumor diameter,but also had higher SUVmax of early phase and delayed phase,as well as a larger increase in RI.Part Ⅲ Diagnostic value of 18F-FDG PET/CT dual phase imaging in axillary lymph node metastasis of breast invasive ductal carcinomaObjective:To investigate the diagnostic value of 18F-FDG PET/CT dual phase imaging in axillary lymph node metastasis of breast invasive ductal carcinomaMethods:The imaging and clinical data of 38 patients with breast invasive ductal carcinoma by 18F-FDG PET/CT dual phase imaging were analyzed.According to pathological diagnosis,axillary lymph nodes(4<short diameter≤10mm)were divided into metastatic group and non-metastatic group.The short diameter,early phase and delayed phase maximum standardized uptake value(SUVmax)of the two groups of lymph nodes were measured,and the retention index(RI)was calculated,RI=[(delayed SUVmax-early SUVmax)/early SUVmax]× 100%.The diagnostic efficacy was analyzed by receiver operating characteristic curve(ROC).Results:(1)A total of 378 axillary lymph nodes were resected in 38 breast patients,of which 199 lymph nodes were accurately matched with the lymph nodes shown in PET/CT images,including 91 metastatic and 108 non-metastatic.There was no significant difference in diameter between lymph node metastasis and non metastasis groups(P=0.459).(2)SUVmax in delayed phase was higher than that in early phase in lymph node metastasis group(P<0.001).However,there was no significant difference in SUVmax between early phase and delayed phase in non metastasis group(P=0.170).(3)The early phase SUVmax and delayed phase SUVmax of the metastasis group were higher than those of the non metastasis group(P<0.001),and the RI of the metastasis group was higher than that of the non metastasis group(P<0.001).(4)The area under the curve(AUC)of early phase SUVmax,delayed phase SUVmax and RI were 0.976,0.943 and 0.691,respectively,and the optimal bounds were 4.12,4.06 and 10.8%,respectively.The sensitivity was 87.9%,84.6%and 51.6%respectively,and the specificity was 98.1%,93.5%and 82.4%respectively.The AUC of the three diagnostic indexes was the highest in early phase SUVmax and the lowest in RI(P<0.001).(5)Dual-phase SUVmax and RI analysis between subgroups of metastatic lymph nodes:①Within the group of 4<short diameter≤6mm(n=33),there was no significant difference between early phase SUVmax and delayed phase SUVmax(P=0.13).The delayed SUVmax in the group with 6<short diameter≤8mm(n=31)was higher than that in the early phase(P<0.001),and the delayed SUVmax in the group with 8<short diameter≤10mm(n=27)was also higher than that in the early phase(P<0.001).②Biphasic SUVmax and RI were the lowest in 4<short diameter≤6mm group and the highest in 8<short diameter≤10mm group(P<0.001).Conclusion:(1)18F-FDG PET/CT dual-phase imaging has a certain value in judging axillary lymph node metastasis of breast invasive ductal carcinoma.(2)Early phase SUVmax has the highest diagnostic value.SUVmax in delayed phase increased and tended to metastasize,but the diagnostic efficacy decreased.(3)Compared with early SUVmax,the smaller the metastatic lymph nodes,the less obvious the rise of SUVmax in delayed phase.Biphasic SUVmax and RI also increased with the increase of metastatic lymph node diameter. |
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