Title
The feasibility of dedicated breast PET for the assessment of
residual tumor after neoadjuvant chemotherapy( 内容と審査の要
旨(Summary) )
Author(s)
子安, 裕美
Report No.(Doctoral
Degree)
博士(医学) 甲第1096号
Issue Date
2019-03-25
Type
博士論文
Version
none
URL
http://hdl.handle.net/20.500.12099/77923
※この資料の著作権は、各資料の著者・学協会・出版社等に帰属します。Ặ ྡ 㸦 ᮏ ⡠ 㸧 Ꮚ Ᏻ ⿱ ⨾ 㸦ᒱ㜧┴㸧 Ꮫ ࡢ ✀ 㢮 ༤ ኈ㸦་Ꮫ㸧
Ꮫ ᤵ ␒ ྕ ⏥➨1096 ྕ
Ꮫ ᤵ ᪥ ᖹᡂ31 ᖺ 3 ᭶ 25 ᪥ Ꮫ ᤵ せ ௳ Ꮫつ๎➨㸲᮲➨㸯㡯ヱᙜ
Ꮫ ㄽ ᩥ 㢟 ┠ 7KH IHDVLELOLW\ RI GHGLFDWHG EUHDVW 3(7 IRU WKH DVVHVVPHQW RI UHVLGXDOWXPRUDIWHUQHRDGMXYDQWFKHPRWKHUDS\ ᑂ ᰝ ጤ ဨ 㸦ᰝ㸧ᩍᤵ ྜྷ⏣ ᘯ 㸦ᰝ㸧ᩍᤵ ᅵ ₩ ᩍᤵ ᳃㔜 ୍㑻 ㄽ ᩥ ෆ ᐜ ࡢ せ ᪨ )'*3(7 ᳨ᰝࡣ㸪ங⒴デ⒪࠾࠸࡚Ḟࡏ࡞࠸デ᩿ࢶ࣮ࣝࡋ࡚ᐃ╔ࡋ࡚࠸ࡿࡀ㸪ࡑࡢ┠ⓗࡣ ࣜࣥࣃ⠇㌿⛣㸪㐲㝸㌿⛣᳨⣴࠾ࡼࡧᒁᡤⓎデ᩿┠ⓗ㝈ࡽࢀ࡚࠾ࡾ㸪ཎⓎᕢࡢホ౯ࡣ✵㛫ศ ゎ⬟ࡢ㝈⏺ࡽ⏝ࡀ㞴ࡋ࠸ࡉࢀ࡚࠸ࡿࠋ ㏆ᖺ㸪ᒁᡤ㐍⾜ங⒴ࡢ⒪࠾࠸࡚⾡๓Ꮫ⒪ἲࡣᶆ‽⒪࡞ࡗ࡚࠸ࡿࠋ⾡๓Ꮫ⒪ἲᚋ S&5 ࡀᚓࡽࢀࡓ࡛ࡣ㸪᭷ពணᚋࢆᨵၿࡍࡿ࠸࠺ሗ࿌ࡀ࠶ࡾ㸪⾡๓Ꮫ⒪ἲᚋࡢཎⓎᕢࡢホ౯ࡣᝈ ⪅ࡢணᚋண ࠾࠸࡚㠀ᖖ㔜せ࡛࠶ࡿࠋ ⾡๓Ꮫ⒪ἲᚋࡢ⒪ຠᯝุᐃࡣᵝࠎ࡞⏬ീデ᩿ࢶ࣮ࣝࡀ⏝ࡉࢀ࡚࠸ࡿࡀ㸪ᚑ᮶ࡢ࣐ࣥࣔࢢࣛ ࣇ࣮ࡸ㉸㡢Ἴ᳨ᰝ࡛ࡣ㸪⒪ᚋࡢ⒕ᙧᡂࡼࡾṧᏑ⭘⒆ࡢ᭷↓ࢆ㐣ホ౯ࡋ࡚ࡋࡲ࠺ഴྥ࠶ࡿࠋ ᭱㏆࡛ࡣ㐀ᙳ 05, ࡢ⏝ࡀ᥎ዡࡉࢀ࡚࠸ࡿࡀ㸪05, ࡛ࡶ⃰ᰁ㒊࠾࠸࡚ṧᏑኚ⒕㒊ࡢ⥺⥔ࡢ ุูࡀᅔ㞴࡞ሙྜࡀ࠶ࡾ㸪ᩓᅾᛶࡢᚤᑠኚࡘ࠸࡚ࡶ᳨ฟࡀ㞴ࡋ࠸➼㸪ࡸࡣࡾホ౯㝈⏺ࡀ࠶ࡿࠋ ࡑࡇ࡛㸪)'*3(7 ࡢ✵㛫ศゎ⬟ࢆᨵၿࡋࡓஙᡣᑓ⏝ 3(7 ࡛ࡣ㸪⭘⒆ࡢ⢾௦ㅰ╔┠ࡍࡿࡇ࡛㸪ࡇ ࢀࡲ࡛ホ౯ᅔ㞴࡛࠶ࡗࡓᑠࡉ࡞ṧᏑኚࡢ᳨ฟᮇᚅ࡛ࡁࡿ⪃࠼㸪ࡑࡢ᳨ฟ⬟ࡘ࠸࡚ᚑ᮶ࡢ )'* 3(7 ᳨ᰝࡢẚ㍑᳨ウࢆ⾜ࡗࡓࠋ ࠙ᑐ㇟᪉ἲࠚ ᖺ ᭶ࡽ ᖺ ᭶ࡲ࡛ᮌἑグᛕ㝔࡛ங⒴ࡢデ᩿ࡢࡶ⾡๓Ꮫ⒪ἲࢆ⾜ࡉࢀ㸪ங ᡣษ㝖⾡┤๓ᕢホ౯┠ⓗࡋ࡚㌟ 3(7 ࠾ࡼࡧஙᡣᑓ⏝ 3(7 ࡀ⾜ࡉࢀࡓ ࢆᑐ㇟ࡋࡓࠋ ㌟ 3(7 ࠾ࡼࡧஙᡣᑓ⏝ 3(7 ࡢࡑࢀࡒࢀ࠾࠸࡚㸪ኚ㒊ࡢ 689PD[ ್ࢆ ᐃ㸪ࡲࡓṧᏑ⭘⒆ࡢ᭷↓ ࡘ࠸࡚Ꮡᅾ☜ಙᗘࢆ ྡࡢᨺᑕ⥺⛉་ࡀ ẁ㝵࡛ホ౯ࡋ㸪S&5 ⩌ QRQS&5 ⩌࡛㸪ឤᗘ㸪≉␗ᗘ㸪 $8& ࢆࡑࢀࡒࢀẚ㍑᳨ウࡋࡓࠋ ࠙⤖ᯝࠚ ஙᡣᑓ⏝ 3(7 ࡛ࡣ㸪689PD[ ್ࡀ QRQS&5 ⩌࠾࠸࡚ S&5 ⩌ẚ㍑ࡋ࡚᭷ព㧗್ࢆ♧ࡋࡓ QRQ S&5㸸 sYVS&5㸸s㸪3 ࠋᐃ㔞ホ౯࠾࠸࡚㸪ṧᏑ⭘⒆᳨ฟࡢ ឤᗘࡣ㸪㌟ 3(7 ẚ㍑ࡋ࡚ஙᡣᑓ⏝ 3(7 ࠾࠸࡚᭷ព㧗್ࢆ♧ࡋࡓ ஙᡣᑓ⏝ 3(7㸸YV ㌟ 3(7㸸3 ࠋࡲࡓ㸪ᐃᛶホ౯࠾࠸࡚ࡶ㸪ྠᵝࡢ⤖ᯝࡀᚓࡽࢀࡓࠋ ஙᡣᑓ⏝ 3(7㸸 YV㌟ 3(7㸸3 ࠋ
࠙⪃ᐹࠚ ᚑ᮶ࡢ )'*3(7 ࢆ⏝࠸ࡓ㐣ཤࡢሗ࿌࡛ࡣ㸪⾡๓Ꮫ⒪ἲᚋࡢṧᏑ⭘⒆ࡢ᳨ฟ⋡ࡣ ప ࡃ㸪ᅇࡢᡃࠎࡢ᳨ウ࡛ࡶ㌟ 3(7 ࡛ࡢឤᗘࡣ ప್ࢆ♧ࡋࡓࠋஙᡣᑓ⏝ 3(7 ࢆ⏝࠸ࡓࡇࢀࡲ ࡛ࡢሗ࿌࡛ࡣ㸪FP ௨ୗࡢኚ࠾࠸࡚≉ኚࡢ᳨ฟ⋡ࡀྥୖࡍࡿࡉࢀ࡚࠸ࡿࠋᅇࡢ᳨ウ࡛ࡣ㸪 ୰ 㸦㸧࡛ṧᏑኚࡢࢧࢬࡀ FP ௨ୗ࡛࠶ࡾ㸪⭘⒆ࡢ⦰ᑠࡼࡗ࡚ᚑ᮶ 3(7 ࡛ࡣከࡃ ࡢ࡛ኚࡢ᳨ฟࡀྍ⬟࡛࠶ࡗࡓࠋ୍᪉㸪ஙᡣᑓ⏝ 3(7 ࠾࠸࡚ࡣ㸪✵㛫ศゎ⬟ࡢᨵၿࡼࡾࡼ ࡾከࡃࡢ᳨࡛ฟࡀྍ⬟࡞ࡾ㸪ᐇ㝿ᚑ᮶ࡢ )'*3(7 ࡛ࡣ ୰ ࡢࡳࡀ᳨ฟ࡛ࡁࡓࡢᑐࡋ㸪 ஙᡣᑓ⏝ 3(7 ࡛ࡣ ᳨࡛ฟྍ⬟࡛࠶ࡗࡓࠋ ࡋࡋ࡞ࡀࡽ㸪ஙᡣᑓ⏝ 3(7 ࢆ⏝࠸࡚ࡶ࡞࠾ ࡢ᳨࡛ฟྍ⬟࠸࠺⤖ᯝ࡛࠶ࡗࡓࠋᅇࡢ ᳨ウ࡛ࡣ ੈࢆ㉸࠼ࡿኚࡘ࠸࡚ࡣࡀஙᡣᑓ⏝ 3(7 ᳨࡛ฟྍ⬟࡛࠶ࡗࡓࡀ㸪 ੈᮍ‶ࡢ࡛ ࡣஙᡣ 3(7 ࡛ࡶ᳨ฟ࡛ࡁ࡞࠸ኚࡀྵࡲࢀ࡚࠸ࡓࠋᑠኚ㸪≉ᩓᅾᛶࡢኚࡘ࠸࡚ࡣஙᡣ 3(7 ࡛ ࡢ᳨ฟࡶ㝈⏺ࡀ࠶ࡿ࠸࠼ࡿࠋ ࡲࡓ㸪ᅇࡢ᳨ウ࡛ࡣ㸪⟶ෆᡂศࡢࡳṧᏑࡋ࡚࠸ࡓኚࡘ࠸࡚ࡶஙᡣ 3(7 ࡛ ୰ ኚࡀ ᳨ฟࡉࢀࡓࠋ⟶ෆᡂศࡢࡳࡢṧᏑ࡛࠶ࡗ࡚ࡶ㸪PDVV ࢆᙧᡂࡍࡿࡼ࠺࡞ሙྜࡣஙᡣ 3(7 ᳨࡛ฟࡉࢀ ࡿࡇࡀ࠶ࡾ㸪ࡇࢀࡀஙᡣ 3(7 ࠾࠸࡚≉␗ᗘࡀపୗࡋࡓཎᅉ⪃࠼ࡽࢀࡿࠋ ࠙⤖ㄽࠚ ⾡๓Ꮫ⒪ἲᚋࡢṧᏑ⭘⒆ࡢホ౯࠾࠸࡚㸪ஙᡣᑓ⏝ 3(7 ㌟ 3(7 ࢆẚ㍑ࡋࡓࡇࢁ㸪ࡑࡢ᳨ฟ ឤᗘࡣ㸪ᐃ㔞ホ౯࠾ࡼࡧᐃᛶホ౯࠸ࡎࢀࡶ᭷ពᕪࢆࡶࡗ࡚ஙᡣ 3(7 ࡀ㧗್ࢆ♧ࡋ㸪ṧᏑ⭘⒆᳨ฟ ࠾ࡅࡿஙᡣ 3(7 ࡢ᭷⏝ᛶࡀ᫂ࡽ࡞ࡗࡓࠋ ㄽ ᩥ ᑂ ᰝ ࡢ ⤖ ᯝ ࡢ せ ᪨ ⏦ㄳ⪅ ᏊᏳ⿱⨾ࡣ㸪ஙᡣᑓ⏝ 3(7 ࠾ࡅࡿ⾡๓Ꮫ⒪ἲᚋࡢṧᏑ⭘⒆ࡢ᳨ฟ⬟ࢆᚑ᮶ᆺࡢ㌟ 3(7 ẚ㍑᳨ウࡋࡓࠋࡑࡢ⤖ᯝ㸪ஙᡣᑓ⏝ 3(7 ࡣ㸪⾡๓Ꮫ⒪ἲᚋࡢṧᏑ⭘⒆ࡢホ౯࠾࠸࡚㸪ᚑ᮶ࡢ ㌟ 3(7 ࡼࡾࡶඃࢀࡓ᳨ฟ⋡ࢆ᭷ࡍࡿࡇࢆ᫂ࡽࡋࡓࠋ ᮏ◊✲ࡢᡂᯝࡣᚋࡢங⒴ࡢ⏬ീデ᩿ࡢⓎᒎᑡ࡞ࡽࡎᐤࡍࡿࡶࡢㄆࡵࡿࠋ 㹙ㄽᩥබ⾲ㄅ㹛 .R\DVX+*RVKLPD61RGD<1LVKLERUL+7DNHXFKL00DWVXQDJD.<DPDGD70DWVXR0 7KH IHDVLELOLW\ RI GHGLFDWHG EUHDVW 3(7 IRU WKH DVVHVVPHQW RI UHVLGXDO WXPRU DIWHU QHRDGMXYDQWFKHPRWKHUDS\
