The Value of 18F-FDG PET/CT Combined with Tumor Markers in Diagnosis and Differential Diagnosis of Breast Cancer Complicated with Second Primary Lung Cancer
Objective To investigate the value of 18F-FDG PET/CT combined withtumor markers in diagnosis and dif-ferential diagnosis of breast cancer complicated with second primary lung cancer(SPLC).Methods From November 2015 to March 2022,664 patients with breast cancer who underwent 18F-FDG PET/CT examination in the Affiliated Qingdao Central Hospital of Qingdao University were retrospectively analyzed.61 cases of SPLC[55 cases of adenocarcinoma(ADC),4 cases of squamous cell cancer(SCC),2 cases of small cell lung cancer(SCLC)],30 cases of metastatic pulmo-nary breast cancer(MBC)and 23 cases of inflammatory lesions were selected.All patients were tested for relevant tumor markers within two weeks before and after the examination.No treatment was given during the examination.The number of SCC and SCLC cases was small,and statistical analysis was not performed.Chi-square test,Fisher exact probability test and Kruskal-Wallis rank sum test were used to compare general data,18F-FDG PET/CT findings and tumor marker levels in ADC group,MBC group and inflammatory group.The independent risk factors of ADC were screened by Logistic regression analy-sis,and the diagnostic efficiency of different independent risk factors was analyzed by ROC curve.Results Of the 55 ADC patients,12 cases were minimally invasive adenocarcinoma(MIA),31 cases were invasive non-mucous adenocarcinoma low-risk group,8 cases were invasive non-mucous adenocarcinoma high-risk group,and 4 cases were invasive mucous adeno-carcinoma.The age of patient at diagnosis of lung lesions in ADC group was larger than MBC group.The interval time of lung lesions change in ADC group was longer than MBC group andinflammatory group.The ground-glass opacity,vacuolar sign,burr sign,vessel convergence sign and pleural traction sign of lung lesions in ADC group were more than MBC group;the circular morphology in ADC group was less than MBC group.The ground-glass opacity in ADC group was more than in-flammatory group;the sharp angle sign and knife cut sign in ADC group were less than inflammatory group.SUVmax,SUVmean,SULmax and SULmean of lung lesions in ADC group were all lower than MBC group and inflammatory group.The 4 cases of SCC mostly showed large soft tissue mass and bronchial cut-off sign(3/4);the median levels of SUVmax,SUVmean,SULmax and SULmean were 9.4,5.6,6.9 and 4.2,respectively.2 cases of SCLC were mostly circular nodules with smooth edge(2/2);the median levels of SUVmax,SUVmean,SULmax and SULmean were 8.0,5.1,5.5 and 3.5,respectively.CA15-3 and CA1 2-5 levels in ADC group and inflammatory group were lower than MBC group.CEA level in ADC group and MBC group was higher than inflammatory group.The median levels of SCCA and CYFRA21-1 in SCC patients were 6.1 ng/ml and 7.3 ng/ml,respectively.The median levels of NSE and ProGRP in SCLC patients were 17.7 ng/ml and 50.1 pg/ml,re-spectively.When MBC group was taken as control group,the ground-glass opacity,burr sign,SUVmax(≤2.5),CA15-3(19.8 U/ml)were independent risk factors for predicting ADC.The AUC value of combined the four to diagnose ADC was 0.888,and the sensitivity and specificity were 85.45％and 80.00％,respectively.When inflammatory group was taken as the control group,the ground-glass opacity,knife cut sign,SULmax(≤2.1),CEA(＞2.8 ng/ml)were independent risk factors for predicting ADC.The AUC value of combined the four to diagnose ADC was 0.909,and the sensitivity and speci-ficity were 85.45％and 91.30％,respectively.Conclusion ADC accounted for the majority of SPLC,mainly MIA and of invasive non-mucinous adenocarcinoma low-risk group.ADC on 18F-FDG PET/CT was mostly manifested as lesions contai-ning ground glass components,with vacuolar sign,burr sign,vessel convergence sign and pleural traction sign.SCC mostly presented as large soft tissue mass and bronchial cut-off sign.SCLC mostly presented as circular nodules with smooth edge.The 18F-FDG metabolism of ADC was lower than that of MBC and inflammatory lesions.The median levels of l8F-FDG up-take of three types of lung cancer and MBC were SCC,SCLC,MBC and ADC from high to low.18F-FDG PET/CT combined with tumor markers would be helpful for the diagnosis and differential diagnosis of SPLC.
Breast cancerSecond primary lung cancerPositron emission tomographyTumor markersDifferential diagnosis
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