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目的:评价新辅助化疗(NAC)前~(18)F-FDG PET/CT检查提高乳腺癌术后危险分组并对术后放疗的指导价值。方法:2009年7月至2013年5月一共收集乳腺癌患者309例,纳入研究224例。所有患者在NAC前行体部~(18)F-FDG PET/CT检查,后行NAC后,结合淋巴结传统诊断方法B超、B超介导下穿刺活检,根据NCCN2013指南,将患者进行肿瘤复发的风险性分组:低风险组(T1N0、T2N0)、中风险组(T0N1、T1N1、T2N1、T3N0)和高风险组(T3N1、T4、Tx N2、Tx N3)。根据治疗前PET/CT检查,计算同侧腋窝4个及4个以上淋巴结即pet N2(4+)或者乳内淋巴结或者锁骨区淋巴结即隐匿淋巴结(pet N3),采用配对卡方检验,评价化疗前PET/CT检查提高危险分组的价值。结果:~(18)F-FDG PET/CT在35例低风险组患者中发现pet N3患者4例(占11.4%);在123例中风险组患者中,~(18)F-FDG PET/CT发现pet N2(4+)患者20例,pet N3患者16例,一共提高分级31例(占25.2%);在66例高风险组的患者中,新发现pet N3患者9例(占13.6%);在低风险组和中风险组一共提高35例(占22.2%)复发风险分级。根据配对卡方检验和一致性检验,~(18)F-FDG PET/CT检查与传统检查危险性评估存在一致性,其中Kappa=0.748,小于0.75,认为一致性中等;配对卡方P=0.000,根据数据显示,PET/CT检查较传统方法将肿瘤复发风险性分组提高。结论:NAC前~(18)F-FDG PET/CT检查对患者的复发风险进行较好的评价,减少因NAC低估乳腺癌复发风险性而耽误的术后放疗;同时对于高风险组患者,可以发现隐匿部位淋巴结,为放疗野范围的确定提供有力保障。
OBJECTIVE: To evaluate the value of pre-neoadjuvant chemotherapy (NAC) ~ (18) F-FDG PET / CT in improving postoperative risk subgroups and postoperative radiotherapy. Methods: A total of 309 cases of breast cancer were collected from July 2009 to May 2013, and 224 cases were included in the study. All patients were followed up with NAC in the front of the body by FNA (18 F-FDG PET / CT) and NAC followed by traditional lymph node biopsy and B-mediated biopsy. According to NCCN2013 guidelines, patients were followed up for tumor recurrence Risk group: low risk group (T1N0, T2N0), medium risk group (T0N1, T1N1, T2N1, T3N0) and high risk group (T3N1, T4, Tx N2, Tx N3). According to PET / CT examination before treatment, 4 or more lymph nodes in the ipsilateral armpits, pet N2 (4+) or lymph nodes in the breast or petular lymph nodes (pet N3) were calculated. Paired chi-square test was used to evaluate the efficacy of chemotherapy Pre-PET / CT improves the value of risk subgroups. Results: Four patients (11.4%) with pet N3 were found in ~ (18) F-FDG PET / CT in 35 low risk patients. Among the 123 middle risk patients, 18 F-FDG PET / Twenty-one pet N2 (4+) patients and 16 pet-N3 patients (31.2%) were detected by CT. Of the 66 high-risk patients, 9 were found to be pet N3 (13.6% ); In the low-risk group and the medium-risk group a total of 35 cases (22.2%) increased the risk of recurrence. According to the paired chi-square test and the consistency test, there was consistency between ~ (18) F-FDG PET / CT and traditional examination of risk assessment, with Kappa = 0.748, less than 0.75, According to the data, PET / CT examination improved the risk of tumor recurrence compared with traditional methods. Conclusions: The NAC preoperative ~ (18) F-FDG PET / CT examination can evaluate the patients’ risk of relapse and reduce the postoperative radiotherapy delayed by NAC underestimating the recurrence risk of breast cancer. At the same time, for high-risk patients, Found hidden parts of the lymph nodes, to determine the scope of the radiotherapy field to provide a strong guarantee.