| Purpose:1.To research the correlation with the changes in maximum standardized uptake value(SUVmax) of PET-CT imaging using 18F-fluorodeoxyglucose (18F-FDG) in different period during neoadjuvant chemotherapy of breast cancer and the prediction of histopathologic response, and to discusses the valuable and feasibility of early applicating 18F-FDG PET-CT imaging for evaluation effect of breast cancer to neoadjuvant chemotherapy.2.To compare the efficiency on prediction the outcome of neoadjuvant chemotherapy between the changes of SUVmax and T/N (the organization of target/non-target tissue) during different pierod, so as to select suitable index and the specific values to evaluate the therapeutic effect.3.To determine whether a relationship exists between SUVmax and the markers Ki-67,COX-2 status before neoadjuvant chemotherapy in breast cancer,and to study the influencing factors of SUVmax before the therapy.4.To study the changs of Ki-67,COX-2 expression pre and post neoadjuvant chemotherapy in breast cancer patients,and its correlation with the changes of SUVmax. Patients and Methods:1.In a prospevtive trial, 18F-FDG PET-CT scans were performed in 22 women with primary breast cancer before neoadjuvant chemotherapy(all patients underwent 18F-FDG PET-CT less than 1 week before chemotherapy),the SUVmax values were recorded over all breast tumors,then,divided the patients into different groups base on tumor size,axillary lymph node status,Ki-67 expression,COX-2 expression ,and the SUVmax of different groups were compared.2.18F-FDG PET-CT scans were performed after the first and second cycle of neoadjuvant chemotherapy,cacluated the decrease in SUVmax (%)and T/N(%)of the tumors respectively.Respongder and nonresponder were defined by the changes of the tumor size or by histopathology,then the SUVmax and T/N decreased in responder compared with that in nonresponder.3.Tested the accuracy of early prediction the outcome of neoadjuvant chemotherapy by using the ROC curves for⊿SUVmax1,⊿SUVmax2,⊿T/N1,⊿T/N2,⊿SUVmax1%,⊿SUVmax2%,⊿T/N1%,⊿T/N2%,and found the best point to evaluate therapeutic effect under the ROC cruves.4.Divided the patients into different groups according to the markers Ki-67, COX-2 expression before chemotherapy , the⊿SUVmax1 and⊿SUVmax2 of different groups were compared.5. Divided the patients into different groups according to the changs of Ki-67,COX-2 expression pre and post neoadjuvant chemotherapy ,then the⊿SUVmax1 and⊿SUVmax2 of different groups were compared. Results: 1.A positive relationship was found between the SUVmax and tumour size(r=0.433, p=0.022), axillary lymph node status(t=3.750,p=0.001) before neoadjuvant chemotherapy in breast cancer.There was no correlation between the SUVmax and Ki-67, COX-2 expression(p>0.05)before chemotherapy.2.There was not association between the changes of⊿SUVmax1,⊿SUVmax2 and Ki-67,COX-2 expression before chemotherapy(p>0.05).3.According to the evaluation criteria in solid tumors: the responder group had a greater decline in⊿SUVmax1,⊿SUVmax1%,⊿T/N1,⊿T/N1%,⊿SUVmax2, ⊿SUVmax2%,⊿T/N2,⊿T/N2% than the non-responder group(p<0.05).Under the ROC curves,the best prediction effect of⊿SUVmax1 was 2.05(sensitivity 80.0%,specificity 84.6%),the best prediction effect of⊿SUVmax2 was 3.50(sensitivity 84.6% , specificity 92.3%),the best prediction effect of⊿SUVmax1% was 35.1%(sensitivity 90.0%,specificity 92.3%),the best prediction effect of⊿SUVmax2% was 48.0%(sensitivity 84.6%,specificity 84.6%),the best prediction effect of⊿T/N1 was 2.12(sensitivity 80.0%,specificity 76.9%),the best prediction effect of⊿T/N2 was 4.28(sensitivity 76.9%,specificity 92.3%),the best prediction effect of⊿T/N1% was 32.2%(sensitivity 90.0% , specificity 76.9% ), the best prediction effect of⊿T/N2% was 53.4%(sensitivity 76.9%,specificity 84.6%).4.According to the pathological reaction grading:a significant difference between the responder and non- responder groups in⊿SUVmax1%,⊿T/N1,⊿T/N1%,⊿SUVmax2,⊿SUVmax2%,⊿T/N2,⊿T/N2%(p<0.05),we could not find difference between responders and non- responders in⊿SUVmax1(t=1.820,p =0.109)。Under the ROC curves, the best prediction effect of⊿SUVmax2 was 3.50(sensitivity 88.9%,specificity 76.5%),the best prediction effect of⊿SUVmax1% was 36.3%(sensitivity 85.7% , specificity 81.2%),the best prediction effect of⊿SUVmax2% was 57.7%(sensitivity 88.9%,specificity 94.1%),the best prediction effect of⊿T/N1 was 2.48(sensitivity 85.7%,specificity 81.2%),the best prediction effect of⊿T/N2 was 4.28(sensitivity 88.9%,specificity 82.4%),the best prediction effect of⊿T/N1% was 42.8%(sensitivity 85.7%,specificity 87.5%),the best prediction effect of⊿ T/N2% was 53.4%(sensitivity 88.9%,specificity 76.5%).5. There was no correlation between the⊿ SUVmax1,⊿ SUVmax2 and the changs of Ki-67,COX-2 expression pre and post neoadjuvant chemotherapy(p>0.05).Conclusions: 1.This study suggests a possible predictive value of 18F-FDG PET-CT for the assessment of pathological response of primary breast cancer after neoadjuvant chemotherapy , when–36.3% of⊿ SUVmax1% is used as threshold value for pathological response(sensitivity is 85.7%,specificity is 81.2%),when–57.7% of⊿S UVmax2% is used as threshold value for pathological response(sensitivity is 88.9%,specificity is 94.1%),so⊿S UVmax2% has a more accurately pathological reaction predicition.But according to the solid tumors therapeutic efficacy standard , when–35.1% of⊿ SUVmax1% is used as threshold value for response(sensitivity is 90.0%,specificity is 92.3%),when–48.0% of⊿S UVmax2% is used as threshold value for response(sensitivity is 84.6%, specificity is 84.6%),the⊿S UVmax1% is more accurately than⊿S UVmax2%.2.There was a positive relationship between the tumour size,axillary lymph node status and SUVmax before chemotherapy,but no correlation between the SUVmax and Ki-67,COX-2 expression.3.There was no correlation between the changs of⊿ SUVmax and the Ki-67,COX-2 expression pre and post neoadjuvant chemotherapy.4. Whether the pathological reaction standard or the solid tumors therapeutic efficacy standard,he dates of⊿T/N are no better than⊿S UVmax on the newadjuvant chemotherapy efficacy evaluation in our research. |
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