The Clinical Value Of ¹⁸F-FDG PET/CT In Preoperative Evaluation Of Breast Cancer

ObjectiveTo evaluate the value of ¹⁸F-FDG PET/CT in the preoperative diagnosis of breast cancer and its influence on treatment.To evaluate the relationships between the primary tumor maximum standardized uptake value?SUVmax?and histopathological and molecular subtypes.Methods182 patients with breast tumor who visited our hospital and underwent PET/CT imaging from May 2017 to August 2018.The primary tumor and metastatic lesions were diagnosed by two experienced nuclear medicine physicians with visual analysis and semi-quantitative analysis respectively.The feasibility of PET/CT diagnosis of axillary metastasis and the number of metastases were evaluated.All the results were compared with the pathological results.ResultsBy the patient based,the sensitivity,specificity and accuracy of PET/CT diagnosed by visual analysis method were 96.1%,63.0% and 86.3%,respectively.When the semi-quantitative analysis method was used,the optimal threshold SUVmax was 3.35,and the sensitivity,specificity and accuracy were 92.1%,61.1% and 83.0%,respectively.By the breast lesion based,the sensitivity,specificity and accuracy of PET/CT diagnosed by visual analysis method were 92.8%,73.1% and 85.6%,respectively.When the semi-quantitative analysis method was used,the optimal threshold SUVmax was 3.29,and the sensitivity,specificity and accuracy of diagnosis were 89.9%,71.8% and 83.3%,respectively.There was no significant difference between visual analysis and semi-quantitative analysis in the diagnosis of breast cancer.SUVmax in patients with breast tumor was significantly correlated with the maximum diameter and pathological grade of breast lesions,but not with age and menstrual status.Spearman test showed that the correlation coefficients r of ER,PR,HER2 and Ki-67 were-0.254,-0.197,0.278 and 0.501,respectively.The expression of P53?P=0.704?was not correlated with the uptake of ¹⁸F-FDG.The uptake of ¹⁸F-FDG in the four groups?Luminal A,Luminal B,Basal-like,and HER2 positive?was statistically significant?P=0.000?.Luminal A and the other three groups showed significant statistical difference?P=0.000?,and SUVmax was lower than the other three groups.Basal-like subtype,Luminal B subtype and HER2 positive subtype showed no statistical difference.For regional lymph nodes,By the patient based,the sensitivity,specificity and accuracy of PET/CT in the diagnosis of axillary lymph node metastasis were 83.0%,81.4% and 82.1%,respectively.By lymph node based,the diagnostic sensitivity,specificity and accuracy were 83.9%,95.6% and 93.4%,respectively.In the case of distant metastasis,PET/CT has defined the diagnosis of distant metastasis and played a decisive role in the selection of treatment options.A total of 18 metastases were found in 12 patients with distant metastasis,all of which were confirmed by biopsy and follow-up.Conclusion¹⁸F-FDG PET/CT can be used by visual analysis or semi-quantitative analysis to provide reference for preoperative evaluation of tumors,which has important clinical value in the diagnosis,differential diagnosis and lymph node staging of breast cancer.The SUVmax of primary breast cancer is significantly correlated with ER,PR,HER2 and ki-67,but not with the expression of P53 receptor.SUVmax can be used as a relevant indicator for molecular subtyping prediction.