The Value Of ^99mTc-3PRGD₂ SPECT/CT Of Identify Benign And Malignant Breast Lesions And The Relationship With Molecular Subtype

Objective:To evaluated the value of ^99mTc-3PRGD₂ SPECT/CT imaging in the diagnosis of breast cancer and the relationship with molecular classification.Methods:45 patients?53.0�9.5 years old?with suspected breast malignant nodules or masses undergone ^99mTc-3PRGD₂ five minutes early imaging and SPECT/CT in prone position one hour later from October 2016 to June 2017.All patients were not punctured or treated before the examination.The pathology was the gold standard.Then the method of semi-quantitative was used to evaluate the values of ^99mTc-3PRGD₂ SPECT/CT breast scan in patients with nodules compare with ultrasound in the differential diagnosis of benign and malignant diseases.Besides the relationship between molecular classification and semi-quantitative index of ^99mTc-3PRGD₂ SPECT/CT was analyzed.Results:1.There were 56 lesions in total.The pathological results indicated that there were 35malignant lesions and benign lesions.The T/NT values of malignant lesions were significantly higher than benign lesions?3.92�1.67 vs 2.04�0.46,t=-3.77,P<0.01?in the SPECT/CT images.The sensitivity,specificity,and accuracy of ^99mTc-3PRGD₂SPECT/CT was 82.9%?29/35??85.7%?18/21??83.9%?47/56?.The area under the ROC was 0.81.2.The area under the ROC of ultrasound was 0.78.The sensitivity,specificity and accuracy was 85.7%?30/35??66.7%?14/21??78.6%?44/56?.The diagnostic efficacy of^99mTc-3PRGD₂ was similar to ultrasonography?c²=3.18,P>0.05?.The sensitivity and accuracy of the ability of identifying the benign and malignant lesions could improve combining with ^99mTc-3PRGD₂ and ultrasound.3.The 2h SPECT/CT T/NT values of lesions of 5min SPECT static images of positive group were significantly higher than of the negative group of early static scan?4.59�1.49vs 3.28�1.27,t=-3.90,P<0.05?.There were 26 malignant lesions in the positive group of early static scan.14 fibroadenomas were found in the negative group of early static scan.4.The invasive ductal carcinoma was pathologically confirmed in 35 of 45 patients.The Luminal A subtype,Luminal B subtype,ERBB2+subtype,Basal-like subtype were found in 6,9,9 and 11 patients,respectively.Patients with ERBB2+subtype had higher T/NT ratio compared patients with basal-like subtype?5.25?3.35,6.65?vs3.1?2.2,3.8?,P<0.05?.Besides,the T/NT ratios in the HER-2 positive group were significantly higher than those in the HER-2 negative group?t values:-3.99,P<0.05?.Conclusions:1.The critical value of ^99mTc-3PRGD₂ SPECT/CT in the differential diagnosis of benign and malignant lesions was 2.9.The diagnostic efficacy of ^99mTc-3PRGD₂ was similar to ultrasonography.The sensitivity and accuracy of the ability of identifying the benign and malignant lesions could improve combining with ^99mTc-3PRGD₂ and ultrasound.2.^99mTc-3PRGD₂ SPECT of early static scan of 5minutes and SPECT/CT of 2 hours could provide a certain gain value with atypical ultrasonography.3.The semi quantitative index of ^99mTc-3PRGD₂ SPECT/CT is higher in the group of HER2 positive than of the HER-2 negative group,which is expected to be a imaging method for early prediction of molecular classification of breast cancer and evaluation of ERBB2+subtype of patients with targeted therapy.