Prognostic Value of Primary Tumor Uptake on F-18 FDG PET/CT in Patients with Invasive Ductal Breast Cancer. Nucl Med Mol Imaging. 2011;45:117-124. [PMID: 24899990 DOI: 10.1007/s13139-011-0081-0]

The influence of receptor expression and clinical subtypes on baseline [18F]FDG uptake in breast cancer: systematic review and meta-analysis

BACKGROUND

To quantify the relationship between [18F]FDG uptake of the primary tumour measured by PET-imaging with immunohistochemical (IHC) expression of ER, PR, HER2, Ki-67, and clinical subtypes based on these markers in breast cancer patients.

METHODS

PubMed and Embase were searched for studies that compared SUVmax between breast cancer patients negative and positive for IHC expression of ER, PR, HER2, Ki-67, and clinical subtypes based on these markers. Two reviewers independently screened the studies and extracted the data. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were estimated by using DerSimonian-Laird random-effects models. P values less than or equal to 5% indicated statistically significant results.

RESULTS

Fifty studies were included in the final analysis. SUVmax is significantly higher in ER-negative (31 studies, SMD 0.66, 0.56-0.77, P < 0.0001), PR-negative (30 studies, SMD 0.56; 0.40-0.71, P < 0.0001), HER2-positive (32 studies, SMD - 0.29, - 0.49 to - 0.10, P = 0.0043) or Ki-67-positive (19 studies, SMD - 0.77; - 0.93 to - 0.61, P < 0.0001) primary tumours compared to their counterparts. The majority of clinical subtypes were either luminal A (LA), luminal B (LB), HER2-positive or triple negative breast cancer (TNBC). LA is associated with significantly lower SUVmax compared to LB (11 studies, SMD - 0.49, - 0.68 to - 0.31, P = 0.0001), HER2-positive (15 studies, SMD - 0.91, - 1.21 to - 0.61, P < 0.0001) and TNBC (17 studies, SMD - 1.21, - 1.57 to - 0.85, P < 0.0001); and LB showed significantly lower uptake compared to TNBC (10 studies, SMD - 0.77, - 1.05 to - 0.49, P = 0.0002). Differences in SUVmax between LB and HER2-positive (9 studies, SMD - 0.32, - 0.88 to 0.24, P = 0.2244), and HER2-positive and TNBC (17 studies, SMD - 0.29, - 0.61 to 0.02, P = 0.0667) are not significant.

CONCLUSION

Primary tumour SUVmax is significantly higher in ER-negative, PR-negative, HER2-positive and Ki-67-positive breast cancer patients. Luminal tumours have the lowest and TNBC tumours the highest SUVmax. HER2 overexpression has an intermediate effect.

Correlation of 18-fluorodeoxyglucose uptake values on PET-CT scan with histological prognostic markers in breast cancer

BACKGROUND

Positron emission tomography-computed tomography (PET-CT) scan utilizes 18-fluorodeoxyglucose (18-FDG), based on the principle of higher glycolytic activity and reduced glucose-6-phosphatase levels in cancer cells. This imaging modality is usually advised in the metastatic evaluation of stage III breast cancer patients. The correlation of maximum standard uptake values of primary lesion with different pathological and molecular markers has not been studied extensively.

METHODS

Retrospective analysis of the data was performed from our prospectively maintained breast cancer database. All the patients who had undergone 18-FDG PET-CT scan at initial evaluation for staging between June 2017 and April 2020 were included in the study. One-way ANOVA test or Student's t-test as appropriate was performed to assess the difference of means in maximum standard uptake values (SUVmax) of the primary lesion and axillary nodes with clinical stage, histological grade, molecular subtype. Bonferroni post hoc test was also applied.

RESULTS

Out of 388 patients in the breast cancer database, 45 patients met inclusion criteria. There was a significant correlation of molecular subtype (p = 0.029) with SUVmax of the primary lesion. Higher primary SUVmax was associated with higher T stage (p = 0.01) and higher histological grade (p = 0.06). In each molecular subtype, there was an increase in mean SUVmax of the primary lesion with increasing histological grade and vice versa.

CONCLUSIONS

SUVmax of the primary lesion in breast cancer patients reflects tumor biology. Higher SUVmax can predict patients with triple-negative breast cancers and higher grades in primary tumors. However, further large-scale validatory studies are essential.

Diagnostic performance of dedicated breast positron emission tomography

Background

Dedicated breast positron emission tomography (dbPET) has been developed for detecting smaller breast cancer. We investigated the diagnostic performance of dbPET in patients with known breast cancer.

Methods

Eighty-two preoperative patients with breast cancer were included in the study (84 tumours: 11 ductal carcinomas in situ [DCIS], 73 invasive cancers). They underwent mammography (MMG), ultrasonography (US), and contrast-enhanced breast magnetic resonance imaging (MRI) before whole-body PET/MRI (WBPET/MRI) and dbPET. We evaluated the sensitivity of all modalities, and the association between the maximum standard uptake value (SUVmax) level and histopathological features.

Results

The sensitivities of MMG, US, MRI, WBPET/MRI and dbPET for all tumours were 81.2% (65/80), 98.8% (83/84), 98.6% (73/74), 86.9% (73/84), and 89.2% (75/84), respectively. For 11 DCIS and 22 small invasive cancers (≤ 2 cm), the sensitivity of dbPET (84.9%) tended to be higher than that of WBPET/MRI (69.7%) (p = 0.095). Seven tumours were detected by dbPET only, but not by WBPET/MRI. Five tumours were detected by only WBPET/MRI because of the blind area of dbPET detector, requiring a wider field of view. After making the mat of dbPET detector thinner, all 22 scanned tumours were depicted. The higher SUVmax of dbPET was significantly related to the negative oestrogen receptor status, higher nuclear grade, and higher Ki67 (p < 0.001).

Conclusions

The sensitivity of dbPET for early breast cancer was higher than that of WBPET/MRI. High SUVmax was related to aggressive features of tumours. Moreover, dbPET can be used for the diagnosis and oncological evaluation of breast cancer.

Relationships of 18F-FDG uptake by primary tumors with prognostic factors and molecular subtype in ductal breast cancer

OBJECTIVES

In this study, we aimed to investigate the correlation between SUVmax of primary tumor and prognostic factors/molecular subtype in ductal breast cancer patients.

MATERIALS AND METHODS

We retrospectively reviewed 150 female patients with pathologically proven invasive ductal breast cancer from January 2015 to October 2019 who underwent ¹⁸F-FDG PET/CT for initial staging. Histopathological prognostic features of the primary tumor (histological grade, hormone receptor status, Ki-67 index, vb.) were obtained from the tru-cut biopsy report. In ¹⁸F-FDG PET/CT studies, the maximum standardized uptake value (SUVmax) of the primary breast tumor was calculated and compared with the presence of axillary lymphadenopathy and/or distant metastases, histopathological prognostic factors and molecular subtype.

RESULTS

The high SUVmax of primary breast tumors is significantly correlated with the clinicopathological factors: high tumor size, high histologic grade, high Ki-67 index, axillary lymph node positivity and distant metastasis. SUVmax value was significantly higher in patients with basal subtype than patients with Luminal A subtype (8,14 ± 3,71 and 4,64 ± 2,45, p = 0,002). Correlation analysis revealed a low correlation between Ki-67 index and SUVmax (r = 0,276, p = 0,001) and moderate correlation between tumor size and SUVmax (r = 0,470, p = 0,001). In multivariate linear regression analysis, Ki-67 index and tumor size had a statistically significant effect on SUVmax values. As these parameters increase, it is seen that it increases SUVmax values (p = 0,004, Std Beta: 0,228, 95% CI:0,010-0,055 and p = 0,001, Std Beta:0,374, 95% CI:0,55-0,136, respectively).

CONCLUSION

High SUVmax value is associated with factors suggesting poor prognosis. Pretreatment ¹⁸F-FDG PET/CT can be used as a tool to predict prognosis in breast cancer.

Evaluation of the Histopathological Features of Early-stage Invasive Ductal Breast Carcinoma by 18Fluoride-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Objectives:

This study investigates the relationship between ¹⁸fluoride-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) parameters and histopathological features in patients with early-stage invasive ductal breast carcinoma (IDBC).

Methods:

Patients with early-stage IDBC who underwent ¹⁸F-FDG PET/CT scan for staging were included in this retrospective study. The status of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2, Ki-67 proliferative index, and grades of tumors were recorded. The conventional metabolic parameters [maximum standard uptake value (SUV_max) and average standard uptake value] and volume-based parameters [metabolic tumor volume (MTV) and total lesion glycolysis] of the primary tumor were obtained from the ¹⁸F-FDG PET/CT images. The associations and correlations between the ¹⁸F-FDG PET/CT parameters and histopathological features were assessed.

Results:

One hundred forty-three patients were included. ¹⁸F-FDG PET/CT parameters, other than MTV, were significantly associated with the ER and PR status and Ki-67 index, while T-staging was significantly associated with all ¹⁸F-FDG PET/CT parameters. In the axillary lymph node (ALN) involvement, no significant difference was found in the ¹⁸F-FDG PET/CT parameters. In terms of the pathological stage, a significant difference was found in all ¹⁸F-FDG PET/CT parameters. ¹⁸F-FDG PET/CT parameters, other than MTV, were significantly higher in non-luminal breast tumors than luminal tumors and in high-grade tumors than low-grade ones. Triple-negative tumors had the highest ¹⁸F-FDG PET/CT parameter, but the difference was insignificant for MTV. The SUV_max had the strongest correlation with Ki-67 proliferative index.

Conclusion:

Tumors with aggressive histopathological features had higher ¹⁸F-FDG PET/CT parameter values. This study suggests that ¹⁸F-FDG PET/CT may provide prognostic information in patients with early-stage IDBC.

Relationships of 18F-FDG uptake by primary tumors with prognostic factors and molecular subtype in ductal breast cancer

OBJECTIVES

In this study, we aimed to investigate the correlation between SUVmax of primary tumor and prognostic factors/molecular subtype in ductal breast cancer patients.

MATERIALS AND METHODS

We retrospectively reviewed 150 female patients with pathologically proven invasive ductal breast cancer from January 2015 to October 2019 who underwent 18F-FDG PET/CT for initial staging. Histopathological prognostic features of the primary tumor (histological grade, hormone receptor status, Ki-67 index, vb.) were obtained from the tru-cut biopsy report. In 18F-FDG PET/CT studies, the maximum standardized uptake value (SUVmax) of the primary breast tumor was calculated and compared with the presence of axillary lymphadenopathy and/or distant metastases, histopathological prognostic factors and molecular subtype.

RESULTS

The high SUVmax of primary breast tumors is significantly correlated with the clinicopathological factors: high tumor size, high histologic grade, high Ki-67 index, axillary lymph node positivity and distant metastasis. SUVmax value was significantly higher in patients with basal subtype than patients with Luminal A subtype (8.14±3.71 and 4.64±2.45, p=0.002). Correlation analysis revealed a low correlation between Ki-67 index and SUVmax (r=0.276, p=0.001) and moderate correlation between tumor size and SUVmax (r=0.470, p=0.001). In multivariate linear regression analysis, Ki-67 index and tumor size had a statistically significant effect on SUVmax values. As these parameters increase, it is seen that it increases SUVmax values (p=0.004, Std Beta: 0.228, 95% CI: 0.010-0.055 and p=0.001, Std Beta: 0.374, 95% CI: 0.55-0.136, respectively).

CONCLUSION

High SUVmax value is associated with prognotic factors suggesting poor prognosis. Pretreatment 18F-FDG PET/CT can be used as a tool to predict prognosis in breast cancer.

Efficacy of sentinel lymph node biopsy with radioisotope alone and the prediction of sentinel node status using PET-CT in breast cancer

Purpose

Sentinel lymph node biopsy (SLNB) using both a radioactive isotope (RI) and blue dye is considered highly effective; however, there were limitations with the use of both agents in some hospitals, and blue dye has been shown to have some adverse effects. Additionally, preoperative prediction of sentinel lymph node (SLN) status using the maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET-CT) can help avoid unnecessary axillary dissection or SLNB. Thus, we evaluated the efficacy and oncologic safety of SLNB using an RI alone in terms of long-term outcomes and determined the association between SLN metastasis and SUVmax of the primary tumor.

Methods

This retrospective study was conducted at Konyang University Hospital between March 2011 and May 2018. Overall, 142 patients with breast cancer who underwent SLNB using an RI alone were enrolled. Data on identification and false-negative rates were collected. The SUVmax of primary tumors on PET-CT were analyzed for their association with SLN metastasis.

Results

The identification and false-negative rates were 98.6% and 0%, respectively. There was no axillary local recurrence in patients with negative SLN findings. The correlation between the SUVmax of the primary tumor and SLN status was significant (r=0.249, P=0.005); the cutoff value for negative SLN metastasis was <2.15.

Conclusion

The single agent method using an RI is not inferior to other methods and serves as a feasible option for SLNB. And the number of excised SLNs could be minimized when the SUVmax of primary tumor is extremely low.

Utility of 18F-FDG PET/CT for predicting pathologic complete response in hormone receptor-positive, HER2-negative breast cancer patients receiving neoadjuvant chemotherapy

Background

Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) is a predictor of improved outcomes in breast cancer. In patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2) -negative breast cancer, the response to NAC is variable and mostly limited. This study was an investigation of the predictive relevance of parameters of ¹⁸F-FDG PET/CT for the pCR to NAC in patients with HR-positive, HER2–negative breast cancer. Methods: AH total of 109 consecutive HR-positive and HER2-negative breast cancer patients who were treated with NAC were enrolled in this prospective cohort study. The relationships between pretreatment ¹⁸F-FDG PET/CT and clinical outcomes including pathologic response to NAC were evaluated. Results: All patients finished their planned NAC cycles and eight patients (7.3%) achieved pCR. In the receiver operating characteristic (ROC) curve analysis, pSUVmax exhibited high sensitivity and specificity for predicting pCR. Furthermore, multivariate logistic regression analysis revealed pSUVmax as a predictive factor for pCR (hazard ratio = 17.452; 95% CI = 1.847–164.892; p = 0.013).

Conclusion

The results of this study suggest that ¹⁸F-FDG PET/CT pSUVmax is a predictive factor for pCR of HR-positive, HER2-negative breast cancer to NAC.

Nomogram using F-18 fluorodeoxyglucose positron emission tomography/computed tomography for preoperative prediction of lymph node metastasis in gastric cancer

BACKGROUND

Lymph node (LN) metastasis is an important prognostic factor in patients with gastric cancer (GC). However, the evaluation of LN metastasis status in the preoperative setting is not accurate. Therefore, precise preoperative prediction of LN metastasis status is crucial for optimal treatment in patients with GC.

AIM

To develop a preoperative nomogram for LN metastasis using F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) and preoperative laboratory test findings in GC.

METHODS

In this study, the data of 566 GC patients who underwent preoperative F-18 FDG PET/CT and subsequent surgical resection were analyzed. The LN metastasis prediction model was developed in the training cohort and validated in the internal validation cohort. Routine preoperative laboratory tests, including albumin and carbohydrate antigen (CA) 19-9 were performed in all patients. Univariate and multivariable logistic regression was performed to validate the preoperative predictive indicators for LN metastasis.

RESULTS

Of the 566 patients, 232 (41%) had confirmed histopathologic LN metastasis. Univariate logistic regression revealed that the tumor location, blood hemoglobin, serum albumin levels, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, CA 19-9, maximum standardized uptake value (SUVmax) of the primary tumor (T_SUVmax), and SUVmax of LN (N_SUVmax) were significantly associated with LN metastasis. In multivariate analysis, T_SUVmax (OR = 1.08; 95%CI: 1.02–1.15; P = 0.011) and N_SUVmax (OR = 1.49; 95%CI: 1.19–1.97; P = 0.002) were found to be significant predictive factors for LN metastasis. The LN metastasis prediction model using T_SUVmax, N_SUVmax, serum albumin, and CA 19-9 yielded an area under the curve (AUC) of 0.733 (95%CI: 0.683–0.784, P = 0.025) in the training cohort and AUC of 0.756 (95%CI: 0.678–0.833, P < 0.001) in the test cohort.

CONCLUSION

T_SUVmax and N_SUVmax measured by preoperative F-18 FDG PET/CT are independent predictive factors for LN metastasis in GC.

Imaging and monitoring HER2 expression in breast cancer during trastuzumab therapy with a peptide probe 99mTc-HYNIC-H10F

PURPOSE

The novel molecular imaging probe ^99mTc-HYNIC-H10F was developed for patient screening and efficacy monitoring of trastuzumab therapy by SPECT imaging of HER2 expression in breast cancer.

METHODS

^99mTc-HYNIC-H10F was developed by labeling H10F peptide with ^99mTc following an optimized protocol. Biodistribution and SPECT/CT were performed in mouse models bearing HER2-positive SK-BR3 and HER2-negative MDA-MB-231 human breast cancer xenografts, respectively. The treatment response to trastuzumab was monitored and quantified by SPECT/CT in two HER2-positive breast cancer models (SK-BR3 and MDA-MB-361). The preliminary clinical study was performed in two patients with breast cancer.

RESULTS

SPECT/CT with ^99mTc-HYNIC-H10F showed that the SK-BR3 tumors were clearly visualized, while the signals from MDA-MB-231 tumors were much lower. The tumor uptake of ^99mTc-HYNIC-H10F could be blocked by excess unlabeled H10F peptide but not by excess trastuzumab. The growth of two HER2-positive tumors was prominently suppressed at day 11 post-treatment. However, SPECT/CT reflected much earlier therapy response at day 4 post-treatment. The HER2 expression in tumors of breast cancer patients could be detected by ^99mTc-HYNIC-H10F SPECT/CT imaging.

CONCLUSIONS

^99mTc-HYNIC-H10F specifically accumulates in HER2-positive tumors. Compared with trastuzumab, ^99mTc-HYNIC-H10F binds to a different domain of HER2 antigen, providing new opportunities to monitor HER2 expression levels before/during/after trastuzumab treatment for more effective personalized treatment.

Prognostic value of metabolic tumour volume and total lesion glycolysis in 18F-FDG PET/CT scans in locally advanced breast cancer staging

OBJECTIVE

To determine whether metabolic tumour volume (MTV) and total lesion glycolysis (TLG) are able to predict recurrence risk in locally advanced breast cancer (LABC) patients.

MATERIAL AND METHODS

Retrospective study of LABC patients who undertook neoadjuvant, local and adjuvant treatment and follow up. A ¹⁸F-FDG PET/CT study for initial staging was performed analysing in this study different metabolic parameters (MTV, TLG, SUVmax and SUVmed) both in the primary tumour (T) as well as in axillary nodes (N) and whole-body (WB).

RESULTS

Forty females were included between January 2010-2011; follow up until January 2015 was completed. The average follow-up was 46 months. Twenty percent presented recurrence: local disease (n=2) and distant metastasis (n=6); 3 patients died (38% of the patients which recurred and 7.5% from the total). SUVmax, MTV and TLG, in T, N and WB, were higher in those patients with recurrence. The MTV and TLG parameters in the tumour (T) were related to the recurrence rate (P=.020 and P=.028, respectively); whereas SUVmax in the lymph nodes (N) was significantly related (P=.008) to the recurrence rate. The best cut-off points to predict recurrence where: MTV T ≥19.3cm³, TLG T≥74.4g and SUVmax N≥13.8, being 10-12 times more likely to recidivate when these thresholds where exceeded. Tumour grade was the only clinical-pathological variable which was related to recurrence probability (p=.035).

CONCLUSIONS

In this study of LABC patients the metabolic parameters which have a better relationship with recurrence rate are: MTV and TLG in the primary tumour, SUVmax in the regional lymph node disease and whole-body PET data.

Predictive Value of 18F-FDG PET/CT for Axillary Lymph Node Metastasis in Invasive Ductal Breast Cancer

BACKGROUND

This study assessed whether primary tumor maximum standardized uptake value (pSUV_max) measured by ¹⁸F-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) could improve the prediction of axillary lymph node (ALN) metastasis in invasive ductal breast cancer (IDC).

METHODS

In this study, 128 IDC patients who underwent pretreatment ¹⁸F-FDG PET/CT and surgical resection of primary tumor with sentinel lymph node biopsy, ALN dissection, or both were analyzed. All the patients were classified as five molecular subtypes. The optimal cutoff values of pSUVmax for all the patients and each molecular subtype for the prediction of ALN metastasis were determined using receiver operating characteristic (ROC) analysis. Furthermore, the prognostic accuracy of ALN metastasis was assessed using c-statistics.

RESULTS

The findings showed ALN metastasis in 52 patients (40.6%). The ¹⁸F-FDG PET/CT procedure had a sensitivity of 48.1% and a specificity of 94.7% for ALN metastasis. In the ROC analysis of pSUVmax for ALN metastasis, the optimal cutoff value was 3.9 for all the patients, 2.8 for the luminal A subtype, 3.3 for the luminal B (human epidermal growth factor receptor 2 [HER2]-negative) subtype, 5.3 for the luminal B (HER2-positive) subtype, 12.7 for the HER2-positive subtype, and 11.5 for the triple-negative subtype. A predictive ALN metastasis model using nodal ¹⁸F-FDG uptake finding gave a c-statistic of 0.714, and a model combination of nodal ¹⁸F-FDG uptake finding with pSUV_max of all the patients gave a c-statistic of 0.736 (P = 0.3926). However, the combination of nodal the ¹⁸F-FDG uptake finding with the pSUV_max of each molecular subtype gave a c-statistic of 0.791 (P = 0.0047).

CONCLUSIONS

Combining the pSUV_max of each molecular subtype with the nodal ¹⁸F-FDG uptake finding can improve the prediction of ALN metastasis in IDC.

Initial Fludeoxyglucose (18F) Positron Emission Tomography-Computed Tomography (FDG-PET/CT) Imaging of Breast Cancer - Correlations with the Primary Tumour and Locoregional Metastases

BACKROUND

We aimed to evaluate initial PET/CT features of primary tumour and locoregional metastatic lymph nodes (LNs) in breast cancer and to look for potential relationships between several parameters from PET/CT.

MATERIAL/METHODS

Twenty-three women (mean age; 48.66±12.23 years) with a diagnosis of primary invasive ductal carcinoma were included. They underwent PET/CT imaging for the initial tumour staging and had no evidence of distant metastates. Patients were divided into two groups. The LABC (locally advanced breast cancer) group included 17 patients with ipsilateral axillary lymph node (LN) metastases. The Non-LABC group consisted of six patients without LN metastases. PET/CT parameters including tumour size, axillary LN size, SUV_max of ipsilateral axillary LNs (SUV_max-LN), SUV_max of primary tumour (SUV_max-T) and NT ratios (SUV_max-LN/SUV_max-T) were compared between the groups. Correlations between the above-mentioned PET/CT parameters in the LABC group as well as the correlation between tumour size and SUV_max-T within each group were evaluated statistically.

RESULTS

The mean values of the initial PET/CT parameters in the LABC group were significantly higher than those of the non-LABC group (p<0.05). The correlation between tumour size and SUV_max-T value within both LABC and non-LABC groups was statistically significant (p<0.05). In the LABC group, the correlations between the size and SUV_max-LN values of metastatic axillary LNs, between tumour size and metastatic axillary LN size, between SUV_max-T values and metastatic axillary LN size, between SUV_max-T and SUV_max-LN values, and between tumour size and SUV_max-LN values were all significant (p<0.05).

CONCLUSIONS

We found significant correlations between PET/CT parameters of the primary tumour and those of metastatic axillary LNs. Patients with LN metastases had relatively larger primary tumours and higher SUV_max values.

Prognostic value of primary tumor SUVmax on F-18 FDG PET/CT compared with semi-quantitative tumor uptake on Tc-99m sestamibi breast-specific gamma imaging in invasive ductal breast cancer

OBJECTIVE

This study aimed to evaluate the prognostic value of F-18 FDG PET/CT in comparison with Tc-99m sestamibi breast-specific gamma imaging (BSGI) and previously established clinical prognostic parameters of invasive ductal breast carcinoma (IDC).

METHODS

We retrospectively included 157 female IDC patients (mean age 49.2 years, range 29.9-78.9) who underwent PET/CT and BSGI. The maximum standardized uptake value (SUV_max) and tumor to normal background ratios (TNRs) of their primary tumors were measured on PET/CT and BSGI, respectively. Univariate and multivariate survival analyses were performed to evaluate the prognostic value of the measured parameters and other clinical prognostic factors: age, menopausal status, breast density, pathologic tumor size (pTS), axillary nodal status (ANS), nuclear grade, histologic grade, hormone receptor status of estrogen (ER) and progesterone receptors (PR) and HER-2 expression.

RESULTS

Among 157 patients, recurrences occurred in 22 patients (14.0 %). In univariate analyses, pTS (p < 0.0001), ANS (p < 0.0001), nuclear grade (p = 0.0046), histologic grade (p = 0.0001), ER status (p < 0.0001), PR status (p = 0.0037), HER-2 status (p = 0.0007), primary tumor SUV_max (p < 0.0001) and TNR (p = 0.0001) were significant predictors of recurrence. Among them, pTS (p = 0.0172), ANS (p = 0.0416), ER status (p = 0.0375) and primary tumor SUV_max (p = 0.0239) were independent prognostic factors in multivariate regression analysis.

CONCLUSIONS

High primary tumor SUV_max of PET/CT and high TNR of BSGI were poor prognostic factors in IDC patients; in addition, primary tumor SUV_max was an independent prognostic factor along with pTS, ANS and ER status.

Metabolomics of Breast Cancer Using High-Resolution Magic Angle Spinning Magnetic Resonance Spectroscopy: Correlations with 18F-FDG Positron Emission Tomography-Computed Tomography, Dynamic Contrast-Enhanced and Diffusion-Weighted Imaging MRI

Purpose

Our goal in this study was to find correlations between breast cancer metabolites and conventional quantitative imaging parameters using high-resolution magic angle spinning (HR-MAS) magnetic resonance spectroscopy (MRS) and to find breast cancer subgroups that show high correlations between metabolites and imaging parameters.

Materials and methods

Between August 2010 and December 2013, we included 53 female patients (mean age 49.6 years; age range 32–75 years) with a total of 53 breast lesions assessed by the Breast Imaging Reporting and Data System. They were enrolled under the following criteria: breast lesions larger than 1 cm in diameter which 1) were suspicious for malignancy on mammography or ultrasound (US), 2) were pathologically confirmed to be breast cancer with US-guided core-needle biopsy (CNB) 3) underwent 3 Tesla MRI with dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) and positron emission tomography-computed tomography (PET-CT), and 4) had an attainable immunohistochemistry profile from CNB. We acquired spectral data by HR-MAS MRS with CNB specimens and expressed the data as relative metabolite concentrations. We compared the metabolites with the signal enhancement ratio (SER), maximum standardized FDG uptake value (SUV max), apparent diffusion coefficient (ADC), and histopathologic prognostic factors for correlation. We calculated Spearman correlations and performed a partial least squares-discriminant analysis (PLS-DA) to further classify patient groups into subgroups to find correlation differences between HR-MAS spectroscopic values and conventional imaging parameters.

Results

In a multivariate analysis, the PLS-DA models built with HR-MAS MRS metabolic profiles showed visible discrimination between high and low SER, SUV, and ADC. In luminal subtype breast cancer, compared to all cases, high SER, ADV, and SUV were more closely clustered by visual assessment. Multiple metabolites were correlated with SER and SUV in all cases. Multiple metabolites showed correlations with SER and SUV in the ER positive, HER2 negative, and Ki-67 negative groups.

Conclusion

High levels of PC, choline, and glycine acquired from HR-MAS MRS using CNB specimens were noted in the high SER group via DCE MRI and the high SUV group via PET-CT, with significant correlations between choline and SER and between PC and SUV. Further studies should investigate whether HR-MAS MRS using CNB specimens can provide similar or more prognostic information than conventional quantitative imaging parameters.

PET Imaging of Breast Cancer: Role in Patient Management

Breast cancer is the most common malignancy in females. Imaging plays a critical role in diagnosis, staging and surveillance, and management of disease. Fluorodeoxyglucose (FDG) PET the imaging is indicated in specific clinical setting. Sensitivity of detection depends on tumor histology and size. Whole body FDG PET can change staging and management. In recurrent disease, distant metastasis can be detected. FDG PET imaging has prognostic and predictive value. PET/MR is evolving rapidly and may play a role management, assessment of metastatic lesions, and treatment monitoring. This review discusses current PET modalities, focusing on of FDG PET imaging and novel tracers.

Diagnostic and prognostic value of (18)F-FDG PET/CT for axillary lymph node staging in patients with breast cancer

PURPOSE

To investigate the diagnostic and prognostic value of (18)F-FDG-PET/CT for axillary lymph node (LN) staging in breast cancer patients, employing histologic evaluation as the reference.

METHODS

Among 196 patients with biopsy-proven breast cancer who had undergone (18)F-FDG-PET/CT before mastectomy or breast-conserving surgery with sentinel LN biopsy and/or axillary LN dissection, 200 axillae were retrospectively analyzed by visual assessment and quantitatively using SUVmax. LN SUVmax as well as other clinicopathological features were assessed for their prognostic value using the log-rank test and Cox method.

RESULTS

Metastasis was diagnosed histopathologically in 56 (28 %) axillae. The sensitivity, specificity, and accuracy of visual PET/CT for diagnosing node metastasis were 55.4, 95.8, and 84.5 %, respectively. When the optimal discriminative SUVmax cutoff was 1.5, these figures were 51.8, 97.2, and 84.5 %, respectively. Fourteen of 55 patients (25.5 %) with LN metastases suffered a recurrence during follow-up (median 39 months). Patients with a high nodal SUVmax (≥1.7) had a significantly lower progression-free survival rate than those with a low SUVmax (p = 0.0499). Axillary nodal and primary tumor SUVmax as well as estrogen receptor status were significantly associated with recurrence.

CONCLUSION

Axillary nodal SUVmax may be a prognostic indicator of disease recurrence in patients with axillary LN metastases.

Tumor Heterogeneity Assessed by 18F-FDG PET/CT Is Not Significantly Associated with Nodal Metastasis in Breast Cancer Patients

INTRODUCTION

The purpose of this study was to evaluate the association of tumor heterogeneity as assessed by positron emission tomography/computed tomography (PET/CT) with pathological factors of breast cancer, and the prediction of nodal metastasis through tumor heterogeneity.

METHODS

From January 2013 to December 2013, 102 patients with invasive ductal carcinoma of the breast were enrolled into this study. [18F]Fluorodeoxyglucose PET/CT was performed before surgery. The metabolic tumor volume (MTV) of each lesion was calculated and a series of standardized uptake value (SUV) thresholds (e.g. 40%, 50%, 60%, 70%, and 80% of SUVmax) was obtained. A threshold-volume (dV/dT) curve was acquired by plotting thresholds to MTV values automatically calculated with these thresholds. Tumor heterogeneity was calculated from the slope of the threshold-volume curve and defined as heterogeneity factor (HF).

RESULTS

HF differed significantly according to T stage (p < 0.0001), N stage (p = 0.0131) and American Joint Committee on Cancer (AJCC) stage (p = 0.0006). Among the pathological parameters, dermal lymphatic involvement (p = 0.0039) showed the significant correlations with HF. Lymphovascular invasion (p = 0.0005) was the only independent factor for predicting nodal metastasis.

CONCLUSIONS

Tumor heterogeneity measured by 18F-FDG PET/CT is significantly associated with dermal lymphatic involvement. However, PET might not be able to predict nodal metastasis in breast cancer.

Preoperative 18F-FDG PET/CT predicts disease-free survival in patients with primary invasive ductal breast cancer

BACKGROUND

Previous studies have correlated the maximum standardized uptake value (SUVmax) of breast cancer lesions with histological and biological characteristics such as tumor size, histologic grade, or hormonal receptor expression status. However, controversy remains concerning the prognostic value of SUVmax in breast cancer.

PURPOSE

To determine if the SUVmax of a tumor on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is associated with disease-free survival in patients with primary invasive ductal breast cancer.

MATERIAL AND METHODS

The institutional review board of our hospital approved this retrospective study. From 2009 to 2011, 508 women (mean age, 53.6 years; age range, 26-85 years) with newly diagnosed invasive ductal breast cancer who had undergone preoperative 18F-FDG PET/CT followed by surgery were identified. Clinicopathological variables and FDG uptake quantified by SUVmax were analyzed. The Cox proportional hazards model was used to evaluate the association between SUVmax and disease-free survival after controlling for clinicopathological parameters.

RESULTS

There were 21 recurrences at a median follow-up of 46 months. The mean SUVmax of the primary tumor was significantly higher in patients with a recurrence than those who remained disease-free (9.5 ± 3.5 vs. 6.6 ± 4.2, P < 0.001). A receiver operating characteristic curve indicated that a SUVmax of 5.95 was the optimal cut-off value to predict disease-free survival. Multivariate analysis identified a high SUVmax (≥5.95) and high T stage as independent significant variables associated with worse disease-free survival.

CONCLUSION

A high primary tumor SUVmax on 18F-FDG PET/CT was an independent factor associated with worse disease-free survival in patients with primary invasive ductal breast cancer.

Invasive cribriform carcinoma of the breast: mammographic, sonographic, MRI, and 18 F-FDG PET-CT features

BACKGROUND

Invasive cribriform carcinoma (ICC) of the breast is a rare type of invasive carcinoma which shows a favorable prognosis and a lower frequency of axillary nodal metastases. Few imaging findings related to ICC have been reported.

PURPOSE

To evaluate imaging findings with multiple imaging techniques in ICC of the breast.

MATERIAL AND METHODS

Twenty-eight cases of histopathologically proven ICC of the breast were gathered for this study. We retrospectively reviewed the mammographic, sonographic, and magnetic resonance imaging (MRI) findings of ICC according to the American College of Radiology (ACR) breast imaging reporting and data system (BI-RADS) lexicon. 18 F-fluorodeoxyglucose positron emission tomography-computed tomography (18 F-FDG PET-CT) findings were also evaluated. Microscopic slides of surgical specimens were reviewed by a breast pathologist.

RESULTS

The mean age of the patients was 51 years. The most common mammographic findings were irregular shape (72.8%), spiculated margin (63.7%), and a high density (81.8%) mass. Microcalcifications were noted in 9/28 cases. The most common shape was pleomorphic (66.7%). The most common sonographic findings were irregular shape (77.8%), spiculated margin (29.6%), hypoechogenicity (81.5%), and no posterior acoustic features (85.2%). On MRI, most ICCs presented as irregular shaped mass (62.0%) and irregular (42.9%) margin. All four patients (16.0%) who presented with non-mass-like enhancement pattern showed a segmental distribution. The 18 F-FDG PET-CT showed a mean maximum standardized uptake value (SUVmax) of 5.90. Axillary nodal metastases were found in 17.9% (5/28) of the surgical specimens. Immunohistochemical studies showed a high positivity for estrogen and progesterone receptor (100% and 87.5%, respectively).

CONCLUSION

The imaging features of invasive cribriform carcinoma are highly suggestive of malignancy and are not distinguishable from those of other breast cancers like infiltrating ductal carcinoma.

Prediction of survival and cancer recurrence using metabolic volumetric parameters measured by 18F-FDG PET/CT in patients with surgically resected rectal cancer

OBJECTIVE

The goal of the present study was to determine whether the volumetric parameters such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by F-FDG PET/CT could be used as prognostic factors for the recurrence-free survival (RFS) and overall survival (OS) in patients with surgically resected rectal cancer.

PATIENTS AND METHODS

A retrospective review identified 73 patients with surgically resected rectal cancer who received F-FDG PET/CT. Survival analysis was conducted using Kaplan-Meier analysis, and survival curves stratified by age, sex, lymph node status, surgical resection margin, American Joint Committee on Cancer (AJCC) stage, and volumetric parameters of F-FDG PET/CT were generated for the estimation of OS and RFS. Independent predictive factors for survival were determined using Cox proportional hazards model.

RESULTS

High MTV, high TLG, advanced AJCC stage, lymph node (+), and surgical margin (+) group showed shorter OS in rectal cancer patients. Cox proportional hazards regression analysis showed that only surgical margin (+) was associated with poor OS. The early AJCC stage, lower MTV, and lower TLG were associated with better RFS in the current study. Cox proportional hazards regression analysis reveals that the surgical margin (+) was the potent predictor of OS. However, none of the factors was associated with RFS.

CONCLUSIONS

In conclusion, the results of this study suggest that volumetric parameters of F-FDG PET/CT could be significant prognostic factors in surgically resected rectal cancer.

Tumour 18 F-FDG Uptake on preoperative PET/CT may predict axillary lymph node metastasis in ER-positive/HER2-negative and HER2-positive breast cancer subtypes

OBJECTIVES

To evaluate the association between tumour FDG uptake on preoperative PET/CT and axillary lymph node metastasis (ALNM) according to breast cancer subtype.

METHODS

The records of 671 patients with invasive breast cancer who underwent (18) F-FDG PET/CT and surgery were reviewed. Using immunohistochemistry, tumours were divided into three subtypes: oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive, and triple-negative. Tumour FDG uptake, expressed as maximum standardized uptake value (SUVmax), and clinicopathological variables were analysed.

RESULTS

ALNM was present in 187 of 461 ER-positive/HER2-negative, 54 of 97 HER2-positive, and 38 of 113 triple-negative tumours. On multivariate analysis, high tumour SUVmax (≥4.25) (P < 0.001), large tumour size (>2 cm) (P = 0.003) and presence of lymphovascular invasion (P < 0.001) were independent variables associated with ALNM. On subset analyses, tumour SUVmax maintained independent significance for predicting ALNM in ER-positive/HER2-negative (adjusted odds ratio: 3.277, P < 0.001) and HER2-positive tumours (adjusted odds ratio: 14.637, P = 0.004). No association was found for triple-negative tumours (P = 0.161).

CONCLUSIONS

Tumour SUVmax may be an independent prognostic factor for ALNM in patients with invasive breast cancer, especially in ER-positive/HER2-negative and HER2-positive subtypes, but not in those with triple-negative subtype.

KEY POINTS

• Tumour SUVmax could be an imaging biomarker for predicting ALNM • Tumour SUVmax predicting ALNM is effective in ER-positive/HER2-negative and HER2-positive subtypes • Tumour SUVmax predicting ALNM is inaccurate in triple-negative subtypes • Accurate prognostic prediction based on molecular subtype may facilitate individualized management.

Correlation of Primary Tumor FDG Uptake with Clinicopathologic Prognostic Factors in Invasive Ductal Carcinoma of the Breast

PURPOSE

The purpose of this study was to investigate the correlation of primary tumor FDG uptake to clinicopathological prognostic factors in invasive ductal carcinoma of the breast.

METHODS

We retrospectively reviewed 136 of 215 female patients with pathologically proven invasive ductal breast cancer from January 2008 to December 2011 who underwent F-18 FDG PET/CT for initial staging and follow-up after curative treatment with analysis of estrogen receptor (ER), progesterone receptor (PR) and human epithelial growth factor receptor 2 (HER2). The maximum standardized uptake value (SUVmax) of the primary breast tumor was measured and compared with hormonal receptor and HER2 overexpression status.

RESULTS

The high SUVmax of primary breast tumors is significantly correlated with the clinicopathological factors: tumor size, histologic grade, TNM stage, negativity of ER, negativity of PR, HER2 overexpression and triple negativity. The recurrent group with non-triple negative cancer had a higher SUVmax compared with the non-recurrent group, though no significant difference in FDG uptake was noted between the recurrence and non-recurrent groups in subjects with triple-negative cancer. Lymph node involvement was the independent risk factor for cancer recurrence in the multivariate analysis.

CONCLUSIONS

In conclusion, high FDG uptake in primary breast tumors is significantly correlated with clinicopathological factors, such as tumor size, histologic grade, TNM stage, negativity of the hormonal receptor, HER2 overexpression and triple negativity. Therefore, FDG PET/CT is a helpful prognostic tool to direct the further management of patients with breast cancer.

Localization and prediction of malignant potential in recurrent pheochromocytoma/paraganglioma (PCC/PGL) using 18F-FDG PET/CT

BACKGROUND

To our knowledge, data are lacking on the role of 18F-FDG PET/CT in the localization and prediction of neuroendocrine tumors, in particular the pheochromocytoma/paraganglioma (PCC/PGL) group.

PURPOSE

To evaluate the role of 18F-FDG PET/CT in localizing and predicting the malignant potential of PCC/PGL.

MATERIAL AND METHODS

Twenty-three consecutive patients with a history of PCC/PGL, presenting with symptoms related to catecholamine excess, underwent 18F-FDG PET/CT. Final confirmation of the diagnosis was made using the composite references. PET/CT findings were analyzed on a per-lesion basis and a per-patient basis. Tumor SUVmax was analyzed to predict the dichotomization of patient endpoints for the local disease and metastatic groups.

RESULTS

We investigated 23 patients (10 men, 13 women) with a mean age of 46.43 ± 3.70 years. Serum catecholamine levels were elevated in 82.60% of these patients. There were 136 sites (mean SUVmax: 16.39 ± 3.47) of validated disease recurrence. The overall sensitivities for diagnostic CT, FDG PET, and FDG PET/CT were 86.02%, 87.50%, and 98.59%, respectively. Based on the composite references, 39.10% of patients had local disease. There were significant differences in the SUVmax distribution between the local disease and metastatic groups; a significant correlation was noted when a SUVmax cut-off was set at 9.2 (P<0.05).

CONCLUSION

In recurrent PCC/PGL, diagnostic 18F-FDG PET/CT is a superior tool in the localization of recurrent tumors. Tumor SUVmax is a potentially useful predictor of malignant tumor potential.

Predictive value of volumetric parameters measured by F-18 FDG PET/CT for lymph node status in patients with surgically resected rectal cancer

OBJECTIVE

The objective of this study was to investigate the predictive role of volumetric parameters such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by F-18 FDG PET/CT for regional lymph node (rLN) metastasis in rectal cancer patients.

METHODS

Retrospectively, 74 rectal cancer patients were enrolled. All patients received surgical treatment and F-18 FDG PET/CT at diagnosis. The F-18 FDG PET/CT findings of primary cancer and rLN involvement were compared with the pathologic diagnosis within 5 weeks after operation. Univariate and multivariate analyses were used to analyze the associations among the pathologic LN status and age, sex, T stage, AJCC stage, SUVmax, lymphatic invasion, venous invasion, neural invasion, and volumetric parameters.

RESULTS

The LN (+) group showed statistically significant higher values of MTV2.5 (p < 0.0001), MTV3 (p < 0.0001), MTV3.5 (p = 0.0001), TLG2.5 (p = 0.0007), TLG3 (p = 0.0011), and TLG3.5 (p = 0.0024). In univariate analysis, T stage, AJCC stage, neural invasion, and volumetric parameters were factors significantly associated with pathologic LN involvement. However, in multivariate analysis, advanced T stage, high AJCC stage, MTV2.5, and TLG2.5 were associated with pathologic LN involvement in rectal cancer.

CONCLUSION

This study showed that, not only T stage and AJCC stage, but also volumetric parameters such as MTV2.5 and TLG2.5 are useful factors for the prediction of pathologic LN status in rectal cancer patients.

18[F]FDG-PET/CT is a useful molecular marker in evaluating tumour aggressiveness: a revised understanding of an in-vivo FDG-PET imaging that alludes the alteration of cancer biology

Molecular imaging employing (18)[F]FDG-PET/CT enables in-vivo visualization, characterisation and measurement of biological process in tumour at the molecular and cellular level. In oncology, this approach can be directly applied as translational biomarkers of disease progression. In this article, the improved roles of FDG as an in-vivo glycolytic marker which reflect biological changes across in-vitro cellular environment are discussed. New understanding in how altered metabolism via glycolytic downstream drivers of malignant transformation as reviewed below offers unique promise as to monitor tumour aggressiveness and hence optimize the therapeutic management.

A case of xanthoma disseminatum: evaluation and monitoring by 18F-fluorodeoxyglucose positron emission tomography/computed tomography

Xanthoma disseminatum (XD) is a rare benign histiocytic disorder with extensive mucocutaneous xanthomas that often involves other sites such as the central nervous system (CNS), respiratory tract and abdominal organs. Evaluation of the extent of disease is important because lesions in critical locations may increase morbidity and mortality. However, there are no well-established tools for the evaluation and monitoring of XD. Here, we report a case of XD in a 21-year-old male patient showing skin, mucous membrane, CNS and internal organ involvement. In this case, (18) F-fluorodeoxyglucose positron emission tomography/computed tomography was useful in detecting the extent of the disease and in estimating the therapeutic response.

Volume-based parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography improve disease recurrence prediction in postmastectomy breast cancer patients with 1 to 3 positive axillary lymph nodes

PURPOSE

To determine whether volume-based parameters on pretreatment (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in breast cancer patients treated with mastectomy without adjuvant radiation therapy are predictive of recurrence.

METHODS AND MATERIALS

We retrospectively analyzed 93 patients with 1 to 3 positive axillary nodes after surgery, who were studied with (18)F-fluorodeoxyglucose positron emission tomography/computed tomography for initial staging. We evaluated the relationship between positron emission tomography parameters, including the maximum standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis (TLG), and clinical outcomes.

RESULTS

The median follow-up duration was 45 months. Recurrence was observed in 11 patients. Metabolic tumor volume and TLG were significantly related to tumor size, number of involved nodes, nodal ratio, nuclear grade, estrogen receptor (ER) status, and triple negativity (TN) (all P values were <.05). In receiver operating characteristic curve analysis, MTV and TLG showed better predictive performance than tumor size, ER status, or TN (area under the curve: 0.85, 0.86, 0.79, 0.74, and 0.74, respectively). On multivariate analysis, MTV was an independent prognostic factor of locoregional recurrence-free survival (hazard ratio 34.42, 95% confidence interval 3.94-882.71, P=.0008) and disease-free survival (DFS) (hazard ratio 13.92, 95% confidence interval 2.65-103.78, P=.0018). The 3-year DFS rate was 93.8% for the lower MTV group (<53.1; n=85) and 25.0% for the higher MTV group (≥53.1; n=8; P<.0001, log-rank test). The 3-year DFS rate for patients with both ER-positive status and MTV<53.1 was 98.2%; and for those with ER-negative status and MTV≥53.1 it was 25.0% (P<.0001).

CONCLUSIONS

Volume-based parameters improve recurrence prediction in postmastectomy breast cancer patients with 1 to 3 positive nodes. The addition of MTV to ER status or TN has potential benefits to identify a subgroup at higher risk for recurrence.

Effects of DNA ploidy and S-phase fraction on fluorine-18 FDG uptake of primary breast cancer lesions

BACKGROUND

Flow cytometry (FCM) evaluating DNA content is emerging as the tool to monitor cell proliferation and malignant potential in several cancers such as stomach, lung, and salivary gland tumor. The purpose of this study was to correlate (18)F-FDG uptake of dual-time-point (DTP) positron emission tomography (PET) imaging with DNA ploidy and S-phase fraction (SPF) in primary breast cancer lesions.

PATIENTS AND METHODS

Seventy-two consecutive female patients (mean age ± SD, 52.7 ± 11.1 years; range, 28-81 years) had undergone (18)F-FDG DTP PET/computed tomography (CT) imaging for staging of breast malignancy in our institution during a 5-month period. FCM was performed on fresh-frozen samples of specimens obtained from surgery. (18)F-FDG uptake was then compared with DNA content.

RESULTS

Forty-four malignant lesions were included in this study. On FCM, DNA aneuploidy was detected in 14 lesions (31.8%). The maximum standardized uptake values (SUV(max1) and SUV(max2)) (SUV(max1), 6.8 ± 4.6 vs. 3.4 ± 2.4; P = .017), (SUV(max2), 7.9 ± 5.7 vs. 3.6 ± 2.7; P = .015) and retention index (RI) (12.8 ± 11.6 vs. 2.4 ± 10.8; P = .010) were significantly higher in DNA aneuploidy cancer than in DNA diploidy cancer. The value of RI (11.3 ± 11.5 vs. 2.6 ± 11.2; P = .022) was significantly higher in high SPF (> 15%) breast cancer than in low SPF (≤ 15%) breast cancer.

CONCLUSIONS

High (18)F-FDG uptake in breast cancer might be an indicator of DNA aneuploidy and high SPF. We propose that (18)F-FDG PET/CT imaging may be a noninvasive and useful tool for predicting the DNA content in breast cancer.

Prognostic Significance of Metabolic Tumor Volume Measured by (18)F-FDG PET/CT in Operable Primary Breast Cancer

PURPOSE

We investigated whether PET indices measured by (18) F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can predict prognosis in patients with operable primary breast cancer.

METHODS

We reviewed 53 patients with operable primary breast cancer who underwent pretreatment FDG PET/CT. PET indices, maximum standardized uptake value (SUV) and metabolic tumor volume (MTV), were measured in the primary breast tumor (P), metastatic lymph nodes (N) and total tumor (T). The Cox proportional hazards model was used with age, tumor size, clinical lymph node status, method of surgery, presence or absence of neoadjuvant chemotherapy, histological type, histological grade, hormone receptors and HER2 status to predict disease-free survival (DFS) and overall survival (OS).

RESULTS

Median follow-up period was 50 months (range, 17-73 months), during which 17 patients had recurrent disease and nine of whom died. The univariate analysis showed that high SUV of N (NSUV, P = 0.011), MTV of N (NMTV, P = 0.011) and MTV of T (TMTV, P = 0.045) as well as high histological grade (P = 0.008), negative estrogen (P = 0.045) and negative progesterone (P = 0.029) receptor status were associated with shorter DFS. High NSUV (P = 0.035), NMTV (P = 0.035) and TMTV (P = 0.035) as well as high histological grade (P = 0.012) and negative estrogen receptor status (P = 0.009) were associated with shorter OS. NSUV, NMTV and TMTV were found to be significantly associated with high histological grade (P = 0.005). However, those failed to be statistically significant prognostic factors on multivariate analysis.

CONCLUSIONS

PET indices seem to be useful in the preoperative evaluation of prognosis in patients with operable primary breast cancer. NSUV, NMTV and TMTV might be considerable factors associated with patient outcome in operable breast cancer.

18F-FDG uptake by metastatic axillary lymph nodes on pretreatment PET/CT as a prognostic factor for recurrence in patients with invasive ductal breast cancer

This study assessed the maximum standardized uptake value of metastatic axillary lymph nodes in patients with invasive ductal breast cancer (IDC) to determine the pretreatment prognostic value of (18)F-FDG PET/CT for disease-free survival (DFS).

METHODS

Sixty-five female IDC patients who had undergone pretreatment (18)F-FDG PET/CT and had pathologically confirmed axillary lymph node involvement without distant metastasis were enrolled. All patients showed complete remission after first-line treatment. To obtain nodal SUVmax, a transaxial image representing the highest (18)F-FDG uptake was carefully selected and a region of interest was manually drawn on the (18)F-FDG-accumulating lesion. Clinicopathologic parameters such as age, TNM stage, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, and primary-tumor and nodal SUVmax on PET were analyzed for their usefulness in predicting recurrence. Combinatorial effects and interactions between variables that were significant by univariate analysis were examined using multivariate Cox proportional-hazards models.

RESULTS

Twelve of 65 patients (18.5%) experienced recurrence during follow-up (median follow-up, 36 mo; range, 21-57 mo). Nodal SUVmax was significantly higher in patients with recurrence than in those who were disease-free (recurrence group: 5.2 ± 2.3, vs. disease-free group: 1.9 ± 1.9, P < 0.0001). A receiver-operating-characteristic curve demonstrated a nodal SUVmax of 2.8 (sensitivity, 91.7%; specificity, 86.8%; area under the curve, 0.890) to be the optimal cutoff for predicting DFS. Univariate analysis revealed that T stage, N stage, estrogen receptor status, and primary-tumor and nodal SUVmax correlated significantly with DFS. Among these 5 variables, only nodal SUVmax was found to be a single determinant of DFS by multivariate analysis (hazard ratio, 31.54; 95% confidence interval, 2.66-373.39; P = 0.0065).

CONCLUSION

Nodal SUVmax on pretreatment (18)F-FDG PET/CT may be an independent prognostic factor for disease recurrence in patients with IDC.