99Tcm-MIBI显像在乳腺癌新辅助化疗中的应用价值

Clinical value of 99Tcm-MIBI imaging in neoadjuvant chemotherapy of breast cancer

  • 摘要: 目前, 新辅助化疗(NAC)已成为局部晚期乳腺癌的标准治疗方法, 而肿瘤的多药耐药性(MDR)是乳腺癌NAC失败的主要原因之一。MDR的产生与mdrl编码的P-糖蛋白(P-gp)介导的耐药机制有关。99Tcm-MIBI是一种肿瘤阳性显像剂, 也是P-gp的作用底物, 可作为非侵入性的体内显像方法用于评估不同肿瘤中P-gp介导的耐药机制。研究显示, 99Tcm-MIBI早期显像反映MIBI进入肿瘤细胞的多少及速率, 并与其恶性程度密切相关, 可用于NAC疗效的评估;而延迟显像反映MIBI被排出肿瘤细胞外的量及速度, 并与细胞膜P-gp的表达及MDR密切相关, 可无创性地检测由P-gp引起的多药耐药, 预测NAC的敏感性。

     

    Abstract: Neoadjuvant chemotherapy(NCT) has become a standard therapeutic method for focal advanced breast carcinoma. The multidrug resistance(MDR) of tumors is one of the main causes of chemotherapy failure in breast cancer. MDR development involves the transmembrane P-glycoprotein(P-gp) encoded by the MDR gene MDR1. 99Tcm-methoxyisobutylisonitrile(MIBI) is a radiotracer for scintigraphy of tumors. MIBI is also a transport substrate for P-gp and has been used in assessing P-gp-mediated MDR in a variety of tumors. The nuclear medicine community in the USA has suggested the use of 99Tcm-MIBI scintigraphy as a noninvasive method in in vivo imaging of MDR. Studies have shown that early imaging of 99Tcm-MIBI reveals the accumulative quantity of MIBI in breast tumors, and correlated with malignant extent of tumor. Thus, early imaging through 99Tcm-MIBI can be conducted to evaluate the curative effect of NCT in breast cancer. Delayed imaging reveals the washout rates of MIBI from breast tumors, which is correlated with P-gp expression and MDR. Thus, delayed 99Tcm-MIBI may provide important information on P-gp-mediated MDR and may predict chemotherapy sensitivity.

     

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