Radionuclide Response Assessment of Breast Cancer

2-(fluorine-18)-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography after breast conserving surgery: Correlation with molecular markers of breast cancer

Aim:

To investigate the role of 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) early after breast-conserving surgery (BCS) in patients with breast cancer (BC) and whether we can determine which molecular biomarkers of breast carcinoma put the patients at risk.

Materials and Methods:

This retrospective study involved 88 patients with histologically proven T1 or T2 BC, who were treated with BCS and underwent ¹⁸F-FDG PET/CT study. The correlation between biological markers (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 [HER2], and Ki-67) of the primary tumor and ¹⁸F-FDG PET/CT findings was analyzed.

Results:

¹⁸F-FDG PET/CT demonstrated the presence of BC disease (locoregional disease [LRD], distant metastases, or contralateral BC) in 26 of 88 patients (29.5%). Regarding immunohistochemical profiles, BC expressing high levels of Ki-67 were associated with an increased percentage of LRD, which was the major recurrence pattern on ¹⁸F-FDG PET/CT. Although the BC disease was observed more commonly in patients with HER2 positivity compared to those of HER2 negative, the difference did not reach statistical significance. The patients with T2 tumor or a higher histopathological grade had a higher percentage of BC disease.

Conclusions:

This study demonstrated that patients with early stage BC treated with BCS have a remarkable risk of the presence of BC even early after surgery, and there was a clinically important relationship between ¹⁸F-FDG PET/CT findings and biological markers of BC. These findings suggest that high-risk molecular biomarkers (Ki-67, HER2) can be taken into account in the decision-making the process for both preoperative imaging and planning of the surgical approach.

Technetium-99m methoxyisobutylisonitrile scintimammography for monitoring and early prediction of breast cancer response to neoadjuvant chemotherapy

PURPOSE

The aim of the study was to evaluate the clinical value of scintimammography (SMG) with technetium-99m methoxyisobutylisonitrile (Tc-MIBI) for evaluating the efficacy of neoadjuvant chemotherapy (NAC).

MATERIALS AND METHODS

A total of 65 patients with advanced breast cancer (BC) were included in the study. Planar SMG with 740 MBq of Tc-MIBI was performed before the start and after two to three and four to six cycles of NAC. NAC efficacy was estimated as progression (grade I), stabilization (grade II), partial effect (grade III), prominent efficacy (grade IV), and complete response (grade V). In 59 women, histopathologic verification of BC response to NAC was performed according to the Miller-Payne classification with the same scores as were used in the evaluation of scintigraphic response.

RESULTS

After two to three cycles of NAC, disease progression was detected in five of 65 (7.7%) patients. In 27 (41.5%) patients SMG detected early stabilization of BC. Only one of these patients achieved prominent (grade IV) response after the end of NAC. Partial (grade III) response after two to three cycles of NAC was seen in 24 (36.9%) patients. One-third of them had grades IV-V response at the end of treatment. The most promising was the group of nine (13.8%) patients with early-grades IV-V response, all of which transformed to complete response at the end of NAC. As per histopathologic verification, early SMG had 85.7% sensitivity, 94.2% specificity, and 93.2% accuracy in predicting complete pathologic response to four to six cycles of NAC.

CONCLUSION

After two to three cycles of NAC, SMG with Tc-MIBI can determine patients with low, intermediate, and high probability of complete response to five to six cycles of NAC Video Abstract: http://links.lww.com/NMC/A43.