| Objective: Analysis the consistency and respective diagnostic efficiency of PEM and PET imaging in diagnosis of breast cancer, to observe the optimal threshold value of SUVmax and TNR in the two methods. To explore the relationship between diagnosticefficiency and lesion size, analysis the relationship between 18F-FDG uptake and tumor lesion size, and the relationship of ER?PR?HER-2 and tumor lesion size,and the relationship of SUVmax?TNR between ER?PR?HER-2 and 18F-FDG uptake,to provide the basis for early diagnosis and guiding treatment of breast cancer.Methods: Patients found breast neoplasm by clinical examination?breast ultrasound or mammary gland molybdenum target X-ray photography participated in the clinical trial to do PEM and PET : (1)Analysis the consistency of PEM and PET imaging in diagnosis of breast cancer; (2) According to pathological results,calculate sensitivity?specificity?positive predictive value?negative predictive value and accuracy of PEM and PET imaging by qualitative analysis and compared each index of the two methods; (3) Using ROC curve to get the optimal threshold value of SUVmax and TNR in PEM and PET imaging as standard to calculate sensitivity?specificity?positive predictive value?negative predictive value and accuracy of PEM and PET imaging, then compared each index of two methods; (4) Calculated the alignment of three methods through qualitative and semi-quantitative analysis (SUVmax?TNR) with the final pathologic diagnosis; (5) The pathological lesions were devided into four groups by ?1cm?>1cm and?2cm?>2cm and?3cm?>3cm, calculated and analysised the diagnostic efficiency of PEM and PET imaging in each group; (6)According to the above methods, analysis the relationship between SUVmax?TNR in PEM and PET imaging and different tumor size respectively; (7) Analysis the differerce of SUVmax?TNR between ER?PR?HER-2 positive and negative groups in PEM and PET imaging.Results: (1) The positive?negative and consistent rate were 97.93%?82.76% and 94.44% in PEM and PET ; (2) In qualitative analysis, the sensitivity of PEM imaging was higher than PET imaging (95.6%, 82.4%, P=0.004), but the specificity?positive predictive value?negative predictive value and the accuracy had no statistical difference (P > 0.05); (3 )By analyzing SUVmax,PEM imaging sensitivity of 91.2%,higher than that of PET imaging sensitivity of 80.2% (P=0.034), but specific degrees below PET imaging, 57.1% and 85.7%, respectively (P=0.008), the positive predictive value and negative predictive value of the difference is not significant (P>0.05), the accuracy of both is same, all are 81.7%, by analyzing TNR, PEM imaging sensitivity of 97.8%, higher than that of PET imaging sensitivity of 84.6%(P=0.002), the negative predictive value was 92.3%, and 68.9% higher than PET imaging (P=0.023),but its specific degrees below PET imaging, 68.6% and 88.6%,respectively(P=0.041), the positive predictive value and accuracy of both no statistically significant difference (P > 0.05) ; (4)The qualitative analysis and semi-quantitative analysis (SUVmax?TNR) with the final pathologic diagnosis of PEM and PET imaging showed good inosculation, TNR based semi-quantitative analysis is better than the other two kinds of diagnostic methods, moreover, the inosculation of PEM and pathologic was higher than PET; (5) The PEM and PET of TNR diagnosis boundary values were 3.5 and 6.6, respectively, in the group of ?2cm,sensitivity and accuracy of the two imaging methods difference was statistically significant (P<0.05), the sensitivity and accuracy of the PEM were higher than that of PET,especially in group?1 cm,particularly the gap between them, in other groups diagnostic performance difference were not statistically significant; (6) Among breast cancer lesions, SUVmax and TNR in PEM and PET has obvious relevance, SUVmax and TNR in PEM images are generally higher than that of PET images, in small lesion group (?1 cm) of PEM and PET TNR difference was statistically significant,the PEM TNR value is higher than that of PET, but SUVmax there was no statistically significant difference in each group ; (7) Among those lesions with perfect immunohistochemical results (ER,PR,HER-2),the focus of the three kinds of receptors between the positive and negative groups in PEM and PET image SUVmax and TNR differences had no statistical significance (P>0.05).Conclusions: (1) The PEM and PET in the diagnosis of breast cancer positive consistent rate and negative rates of consistent and coherent were better, PEM scanner to comply with the regulations of the state food and drug administration(SFDA) to apply for the conditions of the medical device registration certificate; (2)Through the visual analysis, PEM imaging diagnosis, the sensitivity of breast cancer is higher than PET imaging, visual analysis of breast benign lesions is difficult; (3)Through quantitative index analysis, PEM imaging sensitivity is higher than PET imaging diagnosis of breast cancer, but specific degrees lower than PET imaging,semi-quantitative analysis more reliable diagnosis of breast cancer, a visual analysis and diagnosis standard, for TNR PEM negative predictive value higher than that of PET,prompt use of diagnosis of breast cancer is superior to the SUVmax TNR index;(4) The best threshold SUVmax PEM and PET in the diagnosis of breast cancer was 4.4 and 3.7, respectively, TNR best critical value was 3.5 and 6.6, respectively, can be used as two kinds of methods diagnosis reference index of breast benign and malignant lesions ; (5) The qualitative analysis and semi-quantitative analysis(SUVmax, TNR) with the final pathologic diagnosis of PEM and PET imaging showed good inosculation, TNR based semi quantitative analysis is better than the other two methods of diagnosis, diagnosis and pathology of PEM alignment than PET, further confirmed the PEM imaging is better than that of PET and the superiorities of TNR index; (6) Based on the diagnosis of TNR, PEM for 2 cm or less lesions diagnostic sensitivity and specificity were higher, especially lesions<1 cm, the PEM's advantage is more obvious; (7) Breast cancer foci of PEM imaging SUVma, and TNR generally higher than that of PET imaging, TNR of small lesions was obviously higher than that of PET; (8) ER?PR?HER-2 had no obvious relation with SUVmax and TNR in nature, the conclusion should be larger samples confirmed. |
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