目的 探讨^99Tc^m-甲氧基异丁基异腈（MIBI）显像评价乳腺癌新辅助化疗（NCT）疗效的价值。方法 35例局部进展期乳腺癌（LABC）患者术前化疗前后分别触诊估测肿瘤最大垂直长径及行^99Tc^m-MIBI显像，术后对乳腺癌标本行病理检查及P-糖蛋白（P-gP）、增殖细胞核抗原（PCNA）免疫组织化学染色。观察注射^99Tc^m-MIBI后60min显像图。采用目测法和半定量法，以病灶／本底（T／N）放射性比值降低〉35％为有效。临床疗效按WHO标准评价。化疗后肿瘤细胞病理形态学改变以Ⅱ、Ⅲ级定为显效，Ⅰ级定为弱效。结果 病理检查显效与弱效组间，显像目测法分析NCT有效率分别为75％和9％，差异有显著性（P〈0．01），灵敏度、特异性和准确性分别为75％、91％和80％；半定量法评价NCT疗效的灵敏度、特异性和准确性分别为84％、80％和83％；临床测量肿瘤最大垂直长径则分别为50％、64％和54％。^99Tc^m-MIBI显像评价疗效的灵敏度、准确性明显高于临床确诊。24例病理检查示显效的患者中，^99Tc^m-MIBI摄取与PCNA水平相关，与P-gP水平无关。结论 ^99Tc^m-MIBI显像可有效监测LABC患者术前NCT疗效。
Objective To evaluate the value of ^99Tc^m-methoxyisobutylisonitrile （MIBI） imaging in assessing response of breast cancer to neoadjuvant chemotherapy（NCT）. Methods Thirty-five local advanced breast cancer （LABC） patients underwent clinical examination（ measuring the largest tumor diameter） and 99Tcm-MIBI imaging before and after 3 cycles of CEF or CMF or CTF chemotherapy. The pathology was reviewed and immunostaining of P-glycoprotein （P-gp）, proliferating cell nuclear antigen （PCNA） ex- pression were obtained after surgery. Visual analysis was used and tumor/normal tissue （T/N） ratio calculation 〉 35% was considered as effective response. Clinical response was based on WHO creteria. The pathological effect after chemotherapy at Ⅱ or Ⅲ grade was defined as markedly effective, the Ⅰ grade as weakly effective. Results The positive rate of imaging in the patients with markedly pathological effect （75%） was significantly higher than that in the patients with weakly effect （9%）. The sensitivity, specificity and accuracy were 75%, 91% and 80% respectively for ^99Tc^m-MIBI imaging with visual analysis, while 84%, 80% and 83% respectively for semiquantitative analysis, 50%, 64% and 54% respectively for clinical examination.The senstivity and accuracy of the imaging were significantly higher than those of the clinical evaluation（P〈0.05）,In the 24 patients with marked pathological effect.^99Tc^m-MIBI optake and TCNA level were correlated.bot no relationship with P-gp level was found.Conclusion ^99Tc^m-MIBI imaging can effectively monitor the neoadjuvant chemotherapy effect in LABC.
Chinese Journal of Nuclear Medicine