PURPOSE The aim of this prospective study is to analyze the global tumor blood flow (BF) and its heterogeneity in newly diagnosed breast cancer (BC) according to tumor biological characteristics and molecular subtypes. These perfusion parameters were compared to those classically derived from metabolic studies to investigate links between perfusion and metabolism. METHODS Two hundred seventeen newly diagnosed BC patients underwent a 18F-FDG PET/CT exam before any treatment. A 2-min dynamic acquisition, centered on the chest, was performed immediately after intravenous injection of 3 MBq/kg of 18F-FDG, followed by a two-step static acquisition 90 min later. Tumor BF was calculated (in ml/min/g) using a single compartment kinetic model. In addition to standard PET parameters, texture features (TF) describing the heterogeneity of tumor perfusion and metabolism were extracted. Patients were divided into three groups: Luminal (HR+/HER2-), HER2 (HER2+), and TN (HR-/HER2-). Global and TF parameters of BF and metabolism were compared in different groups of patients according to tumor biological characteristics. RESULTS Tumors with lymph node involvement showed a higher perfusion, whereas no significant differences in SUV_max or SUV_mean were reported. TN tumors had a higher metabolic activity than HER2 and luminal tumors but no significant differences in global BF values were noted. HER2 tumors exhibited a larger tumor heterogeneity of both perfusion and metabolism compared to luminal and TN tumors. Heterogeneity of perfusion appeared well correlated to that of metabolism. CONCLUSIONS The study of breast cancer perfusion shows a higher BF in large tumors and in tumors with lymph node involvement, not paralleled by similar modifications in tumor global metabolism. In addition, the observed correlation between the perfusion heterogeneity and the metabolism heterogeneity suggests that tumor perfusion and consequently the process of tumor angiogenesis might be involved in the metabolism heterogeneity previously shown in BC.

中文翻译：

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使用动态首过18F-FDG PET / CT在新诊断的乳腺癌中肿瘤灌注及其异质性的生物学相关性。

目的这项前瞻性研究的目的是根据肿瘤的生物学特征和分子亚型，分析新诊断的乳腺癌（BC）中的总体肿瘤血流（BF）及其异质性。将这些灌注参数与经典地从代谢研究得出的参数进行比较，以研究灌注与代谢之间的联系。方法217例新诊断的BC患者在接受任何治疗前均接受了18F-FDG PET / CT检查。静脉注射3 MBq / kg的18F-FDG后立即进行以胸腔为中心的2分钟动态采集，然后在90分钟后进行两步静态采集。使用单室动力学模型计算肿瘤BF（以ml / min / g计）。除了标准的PET参数外，提取描述肿瘤灌注和代谢异质性的纹理特征（TF）。患者分为三组：Luminal（HR + / HER2-），HER2（HER2 +）和TN（HR- / HER2-）。根据肿瘤的生物学特征，比较了不同组患者的BF和代谢的总体和TF参数。结果淋巴结受累的肿瘤显示较高的灌注，而SUV_max或SUV_mean均无显着差异。TN肿瘤的代谢活性高于HER2和管腔肿瘤，但未发现总体BF值有显着差异。与管腔和TN肿瘤相比，HER2肿瘤在灌注和代谢方面均表现出更大的肿瘤异质性。灌注的异质性似乎与代谢的相关性很好。结论乳腺癌灌注研究表明，在大肿瘤和淋巴结受累的肿瘤中，BF较高，而肿瘤整体代谢中没有类似的改变。另外，观察到的灌注异质性与代谢异质性之间的相关性表明，肿瘤灌注以及因此肿瘤血管生成的过程可能参与了先前在BC中显示的代谢异质性。