Nghiên cứu đặc điểm hình ảnh, vai trò của FDG PET CT trong đánh giá giai đoạn, phát hiện tái phát ở bệnh nhân ung thư vú trước và sau điều trị tt tiếng anh

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF NATIONAL DEFENCE VIETNAM MILITARY MEDICAL UNIVERSITY NGUYEN TRONG SON STUDY ON 18FDG UPTAKE CHARACTERISTICS, THE ROLE OF PET/CT IN DIAGNOSIS OF STAGE, RECURRENCE, METASTASES IN BREAST CANCER PATIENTS BEFORE AND POST TREATMENT Specialty : Radiology and Nuclear Medicine Code : 9720111 PH.D THESIS SUMMARY HANOI - 2019 THE RESEARCH WAS FINISHED AT VIETNAM MILITARY MEDICAL UNIVERSITY Supervisors: Prof Ph.D Mai Trong Khoa Assoc.Prof Ph.D Nguyen Danh Thanh Judge 1: Prof Ph.D Nguyên Ba Đuc Judge 2: Assoc.Prof Ph.D Le Ngoc Ha Judge 3: Assoc.Prof Ph.D Bui Van Lenh The thesis will be defended before the Thesis Assessment Council at Institute level At: Vietnam Military Medical University Date month year The thesis can be found at: - National Library - Vietnam Military Medical University Library LIST OF WORKS RELATED TO THE THESIS HAS BEEN PUBLISHED Nguyen Trong Son, Nguyen Danh Thanh (2019) The role of 18 FDG PET/CT in the diagnosis of recurrence and distance metastases in 98 post treatment breast cancer patients, J.of Practical Medicine, (1102): 27-30 Nguyen Trong Sơn, Nguyen Danh Thanh (2019) Results of 18 FDG PET/CT stage diagnosis in 55 breast cancer patients J of Community Medicine, (51): 48-52 INTRODUCTION Breast cancer (BC) is the most common female cancer, with higher rate of morbidity in Europe and American, lower in Asia and Africa In Viet Nam, BC is the most common female cancer with morbidity rate is increasing each year The diagnosis of BC is based on clinical history, histology and diagnosis imaging such as mammography, ultrasound, CT scan, MRI SPECT (Single Photon Emission Computed Tomography) and PET (Positron Emission Tomography) are nuclear imaging method, which have high value in clinical practice and BC PET/CT with 18FDG can detect early changes of metabolic shift of disease, even before physiological and anatomical changes In patients with BC, 18FDG PET/CT allows us to find axillary node, extraaxillary locoregional node (supraclavicular or internal mammary nodes), thoracic and abdominal metastases, bone metastases, evaluate cancer stage before treatment After 18FDG PET/CT, changed the stage diagnosis in 1/3 of patients and treatment tactics was changed in 1/6 of patients with BC 18 FDG PET/CT also has high accuracy rate, sensitivity (Se) and specificity (Sp) in follow up scan to find recurrence, metastases after treatment Especially when patient with clinical symptoms of recurrence or high serum concentration of tumor markers but has no abnormal sign in other conventional imaging method, or even when patients has no clinical symptoms In Vietnam nowadays, it had a few studies about value of 18FDG PET/CT in patients with BC But there didn't have a systematic study about characteristics of 18FDG uptake in tumors, recurrence and distance metastases lesions; axilary nodes, extraaxilary nodes; stage diagnosis value of 18FDG PET/CT, at which clinical stage 18FDG PET/CT should be intiated? And which the role of PET/CT for follow up? So we did our study about "Study on 18FDG uptake characteristics, the role of PET/CT in diagnosis of stage, recurrence, metastases in breast cancer patients before and post treatment" with following research objectives: 1/ Study on 18FDG uptake characteristics, the role of PET/CT in diagnosis of stage in breast cancer patients pre-treatment 2/ Evaluate the role of 18FDG PET/CT in finding recurrence lesions and metastases in breast cancer patients post-treatment - New contributions The results of thesis confirmed the value of the 18FDG PET/CT method in the staging diagnosis of breast cancer patients: tumor detection at the rate of 100% of the patients, detected nodal metastases on 36/55 patients (65.6%) and metastases on 9/55 patients (16.4%) 18FDG PET/CT method changed the diagnosis, were upstaging TNM of 21/55 patients (38.2%), which is the basis for physicians to select the appropriate treatment method Treatment tactics was changed in 9/55 patients (16.4%) The thesis demonstrated the role of 18FDG PET/CT in lymph node detection, distance metastases, local recurrence of tumor in post treatment breast cancer patients The thesis has identified the 18FDG uptake characteristics of tumors, nodes, and distance metastases of breast cancer patients, the relations between SUVmax of primary tumor with lymph node status, distance metastases, tumor size and histological grade, histopathological type It also found the relations between SUV max of metastatic nodules with location and lymph node size - The dissertation structure: The dissertation consists of 118 pages, including: Introduction (2 pages), Overview (40 pages), Subjects and method (10 pages), Results (29 pages), Discussions (34 pages), Conclusions (2 pages) and Proposals: page It also have 35 tables, charts, pictures, 138 references (21 Vietnamese and 117 English), and Index CHAPTER 1: OVERVIEW Using 18 FDG PET/CT to find tumor, lymph nodes and distance metastases has important role in stage diagnosis of cancer and follow up post-treatments 18 FDG PET/CT help us early and accurately evaluate treatments responses, and easily distinguish between tumor and scar, fibrosis and early detect recurrence lesions, better than conventional imaging methods (CT scan, MRI ), give us more accurate in biopsy, reduce false negative rate Conventional imaging methods such as CT, MRI often has difficulty and easily give false negative when metastases and lymph nodes are size smaller than 1cm 18FDG PET/CT have higher value of Se and Sp in cancer staging pre and post-treatments compare to conventional CT scan 18FDG PET/CT also has about 10-15% more accurate compare to PET scan alone in cancer staging diagnosis Se and Sp value of 18FDG PET/CT in BC diagnosis is 80-96% and 83-100% respectively 18 FDG PET/CT Sp value in distinguishing between benign and malign lesions is about 90% Using 18FDG PET/CT can detect lymph nodes, which sizes are not big enough to be found in conventional CT scan 18 FDG uptake in PET/CT allows us to detect axillary nodes and lymph nodes group III as supraclavicular node, inner mammary node 18 FDG PET/CT is prefer to evaluated local and distance metastases in advanced stage of BC It was helpful for detecting occult non-symptoms metastases lesions, which can be missed in conventional imaging methods 18 FDG PET/CT has important role in determining the stage of disease for patients in stage IIB (T2N1, T3N0) and IIIA (T3N1) Beside the role of staging diagnosis, the 18 FDG uptake by a primary tumor also has high value in prognosis Patient who has higher SUVmax in primary tumor has poorer outcome Patient who has ER (+)/ Her2 (-) and high SUVmax has shorter over survival time Post-treatments, local recurrence often found in 5-9% patient in N0 stage, increase to 20-28% in patient with axillary nodes Mammography is currently preferred methods for detecting local recurrence and post-treatment follow up MRI is also used to distinguish between scars and recurrence lesions, or to diagnose complications 18FDG PET/CT has high value in detecting abnormal after radiotherapy treatment or mammoplasty complications Locations with high rate of recurrent post-treatments are thoracic wall and upper clavical nodes 18FDG PET/CT is useful for detecting local recurrence and distance metastases post-treatments CHAPTER 2: SUBJECTS AND METHODS 2.1 SUBJECTS Patients with a cancer diagnosis were confirmed by histopathology as breast carcinoma, with full records - Group 1: 55 patients with BC, underwent 18FDG PET/CT before treatment to diagnosis cancer stage, study on uptake characteristic 18 FDG of turmors, lymph nodes, metastases - Group 2: 98 post- treatments (surgery +/- radiotherapy +/- chemotherapy) breast cancer patient, underwent 18FDG PET/CT to: + Subgroup 1: post-treatments follow up: time from last treatment to PET/CT time was at least months + Subgroup 2: patients had clinical symptoms, with recurrence lesions and metastases detected on other conventional imaging methods as mammography, CT MRI, ultrasound, bone scintigraphy + Subgroup 3: patients with high tumor markers concentrations (CEA, CA15.3) - Exclude patients who are pregnant or breastfeeding; Patients at risk of near death due to other serious illnesses PET/CT was taken at Viet Duc Hospital, Bachmai Hospital and K hospital from 2013 to march 2019 2.2 METHODS 2.2.1 Study design Non-control prospective clinical study, cross-sectional description with convenience sampling 2.2.2 Steps to proceed 2.2.2.1 Clinical and subclinical In group 1: Pre-treatment breast cancer patients - Clinical: age; reason why they came to hospital; form of breast cancer detection; some subclinical characteristics - Some pathological characteristics of tumor: + Tumor locations; lymph node status, metastases + Histopathology + Histological stage: I, II, III + Pathological type: invasive ductal carcinoma, invasive lobular carcinoma + Clinical subtype: Luminal A, Luminal B, Her2-positive, triple negative + Tumor markers test: CEA (normal: