18F-氟脱氧葡萄糖 (18F-FDG) 的肿瘤内异质性摄取已被证明是预测各种肿瘤治疗效果的替代标志物。然而，转移性人类表皮生长因子受体2 (HER2) 阳性乳腺癌 (MHBC) 中肿瘤内异质性的价值仍未知。本研究的目的是评估18F-FDG摄取异质性来预测Trastuzumab 和 Pertuzumab (TP) 双靶向治疗在MHBC中的治疗效果。回顾性纳入32例进行TP治疗前进行18F-FDG正电子发射计算机断层扫描 (PET/CT) 的MHBC患者。绘制病灶感兴趣区域 (ROI)，记录最大标准摄取值 (SUVmax)、平均标准摄取值 (SUVmean)、总病灶代谢活力 (TLG)、代谢性肿瘤体积 (MTV) 和异质性指数 (HI)。利用Spearman秩和检验分析PET/CT参数与治疗结果的相关性。使用基于时间的生存受试者操作特征曲线 (ROC) 分析确定预测预后的能力。然后使用Kaplan-Meier方法进行生存分析，并通过log-rank检验进行比较。生存分析显示，通过用50%SUVmax作为阈值勾画病灶计算的HI50% 是预测接受TP治疗的MHBC患者的重要预测因子。HI50% (≥ 1.571) 的患者进展无病生存期 (PFS) 明显较差 (6.87 vs. 未达到，p = 0.001)。PFS的曲线下面积 (AUC)、敏感性和特异性分别为0.88、100%和63.6%。18F-FDG摄取异质性可能对预测接受TP治疗的MHBC患者的预后有用。© 2023. 国际肿瘤影像学会 (ICIS)。

Intra-tumoral heterogeneity of 18F-fluorodeoxyglucose (18F-FDG) uptake has been proven to be a surrogate marker for predicting treatment outcome in various tumors. However, the value of intra-tumoral heterogeneity in metastatic Human epidermal growth factor receptor 2(HER2) positive breast cancer (MHBC) remains unknown. The aim of this study was to evaluate 18F-FDG uptake heterogeneity to predict the treatment outcome of the dual target therapy with Trastuzumab and Pertuzumab(TP) in MHBC.Thirty-two patients with MHBC who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) scan before TP were enrolled retrospectively. The region of interesting (ROI) of the lesions were drawn, and maximum standard uptake value (SUVmax), mean standard uptake value (SUVmean), total lesion glycolysis (TLG), metabolic tumor volume (MTV) and heterogeneity index (HI) were recorded. Correlation between PET/CT parameters and the treatment outcome was analyzed by Spearman Rank Test. The ability to predict prognosis were determined by time-dependent survival receiver operating characteristic (ROC) analysis. And the survival analyses were then estimated by Kaplan-Meier method and compared by log-rank test.The survival analysis showed that HI50% calculated by delineating the lesion with 50%SUVmax as threshold was a significant predictor of patients with MHBC treated by the treatment with TP. Patients with HI50% (≥ 1.571) had a significantly worse prognosis of progression free survival (PFS) (6.87 vs. Not Reach, p = 0.001). The area under curve (AUC), the sensitivity and the specificity were 0.88, 100% and 63.6% for PFS, respectively.18F-FDG uptake heterogeneity may be useful for predicting the prognosis of MHBC patients treated by TP.© 2023. International Cancer Imaging Society (ICIS).