PET-CT与乳腺癌分子病理分型、治疗反应及预后的相关性研究进展

近年来，PET-CT在乳腺癌诊疗中的作用受到越来越多的关注。PET-CT可以作为一种无创诊断乳腺癌分子病理分型的检查手段，并且可以用于预测患者的治疗效果和预后。在乳腺癌的分子病理分型方面，luminal A型乳腺癌氟脱氧葡萄糖（FDG） PET-CT检查最大标准摄取值（SUVmax）最低，其次是luminal B型，最高的是三阴性或人类表皮生长因子受体2（HER2）过表达型乳腺癌，但SUVmax诊断乳腺癌分子病理分型的敏感度和特异度均不高，临床应用价值有限。在预测治疗效果和患者的预后方面，FDG PET-CT检查中FDG摄取值下降越多，治疗效果越好，且标准摄取值越低的患者预后越好。新型示踪剂18F-氟雌二醇（18F-FES）和[89Zr]曲妥珠单抗的应用可为乳腺癌患者的诊疗提供更多的信息。18F-FES PET-CT可以有效评估乳腺癌病灶的雌激素受体（ER）状态及患者对内分泌治疗的反应；[89Zr]曲妥珠单抗PET-CT可以显示HER2阳性的病灶，但是其特异度和敏感度较低。本文对近年来PET-CT在乳腺癌分子病理分型的判断、患者对治疗的应答及预后的预测相关研究进展进行综述。
Abstract: In recent years, PET-CT has an increasing importance in the diagnosis and treatment of breast cancer. PET-CT scan can be used as a noninvasive method for molecular subtyping of breast cancer, and prediction of therapeutic effect and prognosis of patients. Studies have revealed that luminal A subtype has a significantly lower maximum standard intake value (SUVmax) than the other subtypes; triple-negative and human epidermal growth factor receptor 2 (HER2) positive tumors have relatively high SUVmax than luminal B subtype, but the specificity and sensitivity of SUVmax in diagnosis of molecular subtypes are very low, so its clinical application is limited. In predicting the effectiveness of the treatment and the prognosis of the patients, the decreased uptake of fluorodeoxyglucose (FDG) is correlated with better therapeutic effect. In addition, patients with high FDG uptake have worse survival outcomes. New tracers, such as 18F-fluoroestradiol (18F-FES) and[89Zr]trastuzumab play an important role in molecular subtyping of breast cancer. 18F-FES PET-CT can effectively evaluate the estrogen receptor (ER) status of breast cancer and the response to endocrine therapy.[89Zr]trastuzumab PET-CT can evaluate the expression of HER2 and localization of HER2-overexpressing tumors, but their specificities and sensitivities are also low. In this article, we review the recent advances on the correlation of PET-CT findings with molecular subtypes, treatment response and prognosis of breast cancer. Key words: Breast neoplasms/pathology Prognosis Treatment outcome Review Breast neoplasms/radionuclide imaging Positron-emission tomography