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Boers J, Eisses B, Zwager MC, van Geel JJL, Bensch F, de Vries EFJ, Hospers GAP, Glaudemans AWJM, Brouwers AH, den Dekker MAM, Elias SG, Kuip EJM, van Herpen CML, Jager A, van der Veldt AAM, Oprea-Lager DE, de Vries EGE, van der Vegt B, Menke-van der Houven van Oordt WC, Schröder CP. Correlation between Histopathological Prognostic Tumor Characteristics and [ 18F]FDG Uptake in Corresponding Metastases in Newly Diagnosed Metastatic Breast Cancer. Diagnostics (Basel) 2024; 14:416. [PMID: 38396455 PMCID: PMC10887896 DOI: 10.3390/diagnostics14040416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND In metastatic breast cancer (MBC), [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) can be used for staging. We evaluated the correlation between BC histopathological characteristics and [18F]FDG uptake in corresponding metastases. PATIENTS AND METHODS Patients with non-rapidly progressive MBC of all subtypes prospectively underwent a baseline histological metastasis biopsy and [18F]FDG-PET. Biopsies were assessed for estrogen, progesterone, and human epidermal growth factor receptor 2 (ER, PR, HER2); Ki-67; and histological subtype. [18F]FDG uptake was expressed as maximum standardized uptake value (SUVmax) and results were expressed as geometric means. RESULTS Of 200 patients, 188 had evaluable metastasis biopsies, and 182 of these contained tumor. HER2 positivity and Ki-67 ≥ 20% were correlated with higher [18F]FDG uptake (estimated geometric mean SUVmax 10.0 and 8.8, respectively; p = 0.0064 and p = 0.014). [18F]FDG uptake was lowest in ER-positive/HER2-negative BC and highest in HER2-positive BC (geometric mean SUVmax 6.8 and 10.0, respectively; p = 0.0058). Although [18F]FDG uptake was lower in invasive lobular carcinoma (n = 31) than invasive carcinoma NST (n = 146) (estimated geometric mean SUVmax 5.8 versus 7.8; p = 0.014), the metastasis detection rate was similar. CONCLUSIONS [18F]FDG-PET is a powerful tool to detect metastases, including invasive lobular carcinoma. Although BC histopathological characteristics are related to [18F]FDG uptake, [18F]FDG-PET and biopsy remain complementary in MBC staging (NCT01957332).
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Affiliation(s)
- Jorianne Boers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Bertha Eisses
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Mieke C. Zwager
- Department of Pathology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (M.C.Z.); (B.v.d.V.)
| | - Jasper J. L. van Geel
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Frederike Bensch
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Erik F. J. de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (E.F.J.d.V.); (A.W.J.M.G.); (A.H.B.)
| | - Geke A. P. Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Andor W. J. M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (E.F.J.d.V.); (A.W.J.M.G.); (A.H.B.)
| | - Adrienne H. Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (E.F.J.d.V.); (A.W.J.M.G.); (A.H.B.)
| | - Martijn A. M. den Dekker
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands;
| | - Sjoerd G. Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Evelien J. M. Kuip
- Department of Medical Oncology, Radboud Medical Center, 6500 Nijmegen, The Netherlands; (E.J.M.K.); (C.M.L.v.H.)
| | - Carla M. L. van Herpen
- Department of Medical Oncology, Radboud Medical Center, 6500 Nijmegen, The Netherlands; (E.J.M.K.); (C.M.L.v.H.)
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 Rotterdam, The Netherlands; (A.J.); (A.A.M.v.d.V.)
| | - Astrid A. M. van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 Rotterdam, The Netherlands; (A.J.); (A.A.M.v.d.V.)
| | - Daniela E. Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location VU University Medical Center, 1081 Amsterdam, The Netherlands;
| | - Elisabeth G. E. de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
| | - Bert van der Vegt
- Department of Pathology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (M.C.Z.); (B.v.d.V.)
| | | | - Carolina P. Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands; (J.B.); (B.E.); (J.J.L.v.G.); (F.B.); (G.A.P.H.); (E.G.E.d.V.)
- Department of Medical Oncology, Dutch Cancer Institute, 1066 Amsterdam, The Netherlands
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Ndlovu H, Lawal IO, Mokoala KMG, Sathekge MM. Imaging Molecular Targets and Metabolic Pathways in Breast Cancer for Improved Clinical Management: Current Practice and Future Perspectives. Int J Mol Sci 2024; 25:1575. [PMID: 38338854 PMCID: PMC10855575 DOI: 10.3390/ijms25031575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Breast cancer is the most frequently diagnosed cancer and leading cause of cancer-related deaths worldwide. Timely decision-making that enables implementation of the most appropriate therapy or therapies is essential for achieving the best clinical outcomes in breast cancer. While clinicopathologic characteristics and immunohistochemistry have traditionally been used in decision-making, these clinical and laboratory parameters may be difficult to ascertain or be equivocal due to tumor heterogeneity. Tumor heterogeneity is described as a phenomenon characterized by spatial or temporal phenotypic variations in tumor characteristics. Spatial variations occur within tumor lesions or between lesions at a single time point while temporal variations are seen as tumor lesions evolve with time. Due to limitations associated with immunohistochemistry (which requires invasive biopsies), whole-body molecular imaging tools such as standard-of-care [18F]FDG and [18F]FES PET/CT are indispensable in addressing this conundrum. Despite their proven utility, these standard-of-care imaging methods are often unable to image a myriad of other molecular pathways associated with breast cancer. This has stimulated interest in the development of novel radiopharmaceuticals targeting other molecular pathways and processes. In this review, we discuss validated and potential roles of these standard-of-care and novel molecular approaches. These approaches' relationships with patient clinicopathologic and immunohistochemical characteristics as well as their influence on patient management will be discussed in greater detail. This paper will also introduce and discuss the potential utility of novel PARP inhibitor-based radiopharmaceuticals as non-invasive biomarkers of PARP expression/upregulation.
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Affiliation(s)
- Honest Ndlovu
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa; (H.N.); (K.M.G.M.)
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa;
| | - Ismaheel O. Lawal
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa;
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA
| | - Kgomotso M. G. Mokoala
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa; (H.N.); (K.M.G.M.)
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa;
| | - Mike M. Sathekge
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa; (H.N.); (K.M.G.M.)
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa;
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Radiological predictive factors on preoperative multimodality imaging are related to Oncotype DX recurrence score in estrogen-positive/human epidermal growth factor receptor 2-negative invasive breast cancer: a cross-sectional study. Ann Nucl Med 2022; 36:853-864. [PMID: 35819628 DOI: 10.1007/s12149-022-01767-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/13/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The Oncotype DX (ODX) estimates the 10-year risk of metastasis or recurrence of breast cancer and indicates whether chemotherapy is likely to be effective; however, the high cost of this test may limit its use for patients. The aim of this study was to evaluate the potential of preoperative imaging using mammography (MMG), ultrasonography (US), and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and positron emission tomography/computed tomography (PET/CT) metabolic parameters in predicting the ODX recurrence score (ODXRS), which prognosticates estrogen receptor-positive (ER +)/human epidermal growth factor receptor 2-negative (HER2-) breast cancer. METHODS This retrospective study was conducted on 51 patients with ER+/ HER2- early-stage breast cancer with preoperative images available. Surgical specimens were sent for ODX assay and the ODXRS was categorized as low (<18) or intermediate/high (≥18). MMG/US findings were classified according to BI-RADS categories. For MRI analysis, tumor growth orientation was evaluated in addition to morphological assessment in BI-RADS. For PET/CT analysis, standardized uptake value (SUV) of the tumor were measured. Patient, tumor, and image characteristics were compared between the two groups, and predictors of the low ODXRS group were determined by logistic regression analysis. Two-sided P values less than 0.05 were considered statistically significant. RESULTS Thirty-two (63%) and 19 (37%) patients were categorized as low and intermediate/high ODXRS, respectively. On univariate analysis, nuclear grade, tumor margin, and tumor growth orientation on MRI, and SUVmax on PET/CT were significantly associated with a low ODXRS. Multivariate analysis revealed that tumor growth orientation perpendicular to the Cooper's ligament on MRI (P = 0.031) and a low SUVmax on PET/CT (P = 0.016) were independent prognostic factors for a low ODXRS. As a predictor of low ODXRS, the receiver operating characteristic (ROC) analysis of the SUVmax showed that using 3.0 as the optimal cut-off value has a sensitivity and specificity of 94.4% and 73.0%, respectively, with an area under the curve (AUC) of 0.923. CONCLUSIONS The combination of perpendicular tumor growth orientation to Cooper's ligaments on MRI and a low SUVmax on PET/CT may predict a low ODXRS.
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Xu T, Liu J, Xia Y, Wang Z, Li X, Gao Q. Integrated analysis reveals the participation of IL4I1, ITGB7, and FUT7 in reshaping the TNBC immune microenvironment by targeting glycolysis. Ann Med 2021; 53:916-928. [PMID: 34134578 PMCID: PMC8604452 DOI: 10.1080/07853890.2021.1937694] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The overall response rate of immunotherapy in triple-negative breast cancer (TNBC) remains unsatisfactory. Accumulating evidence indicated that glucose metabolic reprogramming could modulate immunotherapy efficacy. However, transcriptomic evidence remains insufficient. METHODS Genes' relationship with glucose metabolism and TNBC-specific immune was demonstrated by weighted gene co-expression network analysis (WGCNA). The glucose metabolic capability was estimated by standardised uptake value (SUV), an indicator of glucose uptake in 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET), and a reflection of cancer metabolic behaviour. PD-(L)1 expression was used to reflect the efficacy of immunotherapy. Additionally, immune infiltration, survival, and gene coexpression profiles were provided. RESULTS Comprehensive analysis revealing that IL4I1, ITGB7, and FUT7 hold the potential to reinforce immunotherapy by reshaping glucose metabolism in TNBC. These results were verified by functional enrichment analysis, which demonstrated their relationships with immune-related signalling pathways and extracellular microenvironment reprogramming. Their expressions have potent positive correlations with Treg and Macrophage cell infiltration and exhausted T cell markers. Meanwhile, their overexpression also lead to poor prognosis. CONCLUSION IL4I1, ITGB7, and FUT7 may be the hub genes that link glucose metabolism, and cancer-specific immunity. They may be potential targets for enhancing ICB treatment by reprogramming the tumour microenvironment and remodelling tumour metabolism.
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Affiliation(s)
- Tao Xu
- Key Laboratory of the Ministry of Education, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahao Liu
- Key Laboratory of the Ministry of Education, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Xia
- Key Laboratory of the Ministry of Education, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi Wang
- Key Laboratory of the Ministry of Education, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingrui Li
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qinglei Gao
- Key Laboratory of the Ministry of Education, Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Erol M, Önner H, Eren Karanis Mİ. Evaluation of the Histopathological Features of Early-stage Invasive Ductal Breast Carcinoma by 18Fluoride-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. Mol Imaging Radionucl Ther 2021; 30:129-136. [PMID: 34658227 PMCID: PMC8522516 DOI: 10.4274/mirt.galenos.2021.25582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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 (SUVmax) 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 SUVmax 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.
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Affiliation(s)
- Mustafa Erol
- University of Health Sciences Turkey, Konya City Hospital, Clinic of Nuclear Medicine, Konya, Turkey
| | - Hasan Önner
- University of Health Sciences Turkey, Konya City Hospital, Clinic of Nuclear Medicine, Konya, Turkey
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Relationship between Prognostic Stage in Breast Cancer and Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. J Clin Med 2021; 10:jcm10143173. [PMID: 34300339 PMCID: PMC8307215 DOI: 10.3390/jcm10143173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 12/14/2022] Open
Abstract
This retrospective study examined the relationship between the standardized uptake value max (SUVmax) of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and the prognostic stage of breast cancer. We examined 358 breast cancers in 334 patients who underwent 18F-FDG PET/CT for initial staging between January 2016 and December 2019. We extracted data including SUVmax of 18F-FDG PET and pathological biomarkers, including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and nuclear grade. Anatomical and prognostic stages were determined per the American Joint Committee on Cancer (eighth edition). We examined whether there were statistical differences in SUVmax between each prognostic stage. The mean SUVmax values for clinical prognostic stages were as follow: stage 0, 2.2 ± 1.4; stage IA, 2.6 ± 2.1; stage IB, 4.2 ± 3.5; stage IIA, 5.2 ± 2.8; stage IIB, 7.7 ± 6.7; and stage III + IV, 7.0 ± 4.5. The SUVmax values for pathological prognostic stages were as follows: stage 0, 2.2 ± 1.4; stage IA, 2.8 ± 2.2; stage IB, 5.4 ± 3.6; stage IIA, 6.3 ± 3.1; stage IIB, 9.2 ± 7.5, and stage III + IV, 6.2 ± 5.2. There were significant differences in mean SUVmax between clinical prognostic stage 0 and ≥II (p < 0.001) and I and ≥II (p < 0.001). There were also significant differences in mean SUVmax between pathological prognostic stage 0 and ≥II (p < 0.001) and I and ≥II (p < 0.001). In conclusion, mean SUVmax increased with all stages up to prognostic stage IIB, and there were significant differences between several stages. The SUVmax of 18F-FDG PET/CT may contribute to prognostic stage stratification, particularly in early cases of breast cancers.
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Relationship of the standard uptake value of 18F-FDG-PET-CT with tumor-infiltrating lymphocytes in breast tumors measuring ≥ 1 cm. Sci Rep 2021; 11:12046. [PMID: 34103577 PMCID: PMC8187353 DOI: 10.1038/s41598-021-91404-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/26/2021] [Indexed: 01/05/2023] Open
Abstract
Evidence suggests that tumor cells and tumor-infiltrating lymphocytes (TILs) compete for glucose in the tumor microenvironment and that tumor metabolic parameters correlate with localized immune markers in several solid tumors. We investigated the relationship of the standardized uptake value (SUV) of 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG-PET-CT) with stromal TIL levels in breast cancer. We included 202 patients who underwent preoperative 18F-FDG-PET-CT and had a tumor measuring ≥ 1 cm. Maximum SUV (SUVmax) was determined using 18F-FDG-PET-CT. Multiple logistic regression was used to identify factors related to high TIL levels (≥ 40%). All tumors were treatment naïve. A significant and weak correlation existed between continuous SUVmax and continuous TIL levels (p = 0.002, R = 0.215). Tumors with high SUVmax (≥ 4) had higher mean TIL levels than those with low SUVmax (< 4). In multivariable analysis, continuous SUVmax was an independent factor associated with high TIL levels; each 1-unit increment in SUVmax corresponded to an odds ratio of 1.14 (95% confidence interval: 1.01–1.29) for high TIL levels. Our study implies that SUV is associated with TILs in breast cancer and provides clinical evidence that elevated glucose uptake by breast tumors can predict the immune system-activated tumor micromilieu.
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Mohamadien NRA, Sayed MHM. Correlation between semiquantitative and volumetric 18F-FDG PET/computed tomography parameters and Ki-67 expression in breast cancer. Nucl Med Commun 2021; 42:656-664. [PMID: 33560720 DOI: 10.1097/mnm.0000000000001376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the relationship between semiquantitative and volumetric parameters on 18F-FDG PET/computed tomography (CT), including maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), tumor to liver ratio (TLR) and tumor to mediastinum ratio (TMR) with the level of Ki-67 expression in breast cancer. PATIENT AND METHODS We retrospectively reviewed 105 female patients with newly diagnosed breast cancer who underwent baseline 18F-FDG PET/CT and had immunohistochemical staining to determine the level of Ki-67 expression. The following PET parameters were measured (SUVmax, SUVmean, MTV, TLG, TLR and TMR) and correlated with level of Ki-67 expression. RESULTS Significant moderate positive correlations were found between the PET parameters (primary SUVmax, SUVmean, TLG, TLR and TMR) and level of Ki-67 expression. The primary SUVmax had the highest correlation coefficient (r = 0.461) followed by TMR (r = 0.455) and P value of <0.001 for both. In ROC analysis, primary SUVmax had the largest area under the curve (0.806, P = 0.0001), with sensitivity of 76.5 % and specificity of 75% for prediction of high Ki-67 level. In univariate analysis, all PET parameters, patient age, tumor grade, molecular subtype, estrogen receptor and progesterone receptor status were significantly associated with Ki-67 level. In multivariate regression analysis, only tumor grade [odds ratio (OR) = 20.460, 95% confidence interval (CI): 11.360-29.559, P = <0.0001], molecular subtype (OR = -21.894, 95% CI: -37.921 to -5.866, P = 0.008), SUVmax (OR = 2.299, 95% CI: 0.703-3.895, P = 0.005) and TLR (OR = -4.908, 95% CI: -9.476 to -0.340, P = 0.035) were found to be the strongest independent predictor factors for the level of Ki-67 expression and hence proliferative activity of malignant cells in breast cancer. CONCLUSION The semiquantitative parameters and volumetric 18F-FDG PET/CT parameter, that is, TLG correlated well with proliferation marker Ki-67 in breast cancer. 18F-FDG PET/CT imaging can be used as a useful noninvasive diagnostic tool in imaging cellular proliferation and hence may substitute for in vitro testing of molecular markers in the diagnoses and staging of breast cancer.
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Affiliation(s)
- Nsreen R A Mohamadien
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine. Assiut University, Assiut, Egypt
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Relationship Between 18F-FDG Uptake with Clinicopathological Prognostic Factors and Biological Subtypes in Breast Cancer. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02706-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Nakajima H, Maeno K, Ito T, Kanai T, Oba T, Ono M, Takayama F, Uehara T, Ito KI. Concomitant use of 18F-FDG PET-CT SUVmax is useful in the assessment of Ki67 labeling index in core-needle biopsy specimens of breast cancer. Gland Surg 2021; 10:1-9. [PMID: 33633957 DOI: 10.21037/gs-20-485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Ki67 is a recognized proliferative and predictive marker in invasive breast cancer. However, results of Ki67 evaluation are affected by the method employed for sample fixation or biopsy, as well as by intratumor heterogeneity. Here, we aimed to compare the Ki67 labeling index (Ki67LI) between core-needle biopsy specimens (CNBSs) and surgically resected specimens (SRSs) of invasive breast cancer, and verify whether the discordance in Ki67LI can be reduced by analyzing the maximum standardized uptake value (SUVmax) obtained from pretreatment whole-body positron emission tomography/computed tomography (PET/CT) in combination with Ki67LI. Methods Tumor tissues were obtained from 118 patients with invasive breast cancer. Ki67LI was evaluated in CNBSs and SRSs by immunohistochemistry. First, we directly compared Ki67LI between CNBS and SRS, "allowing a tolerance margin of 5%." We divided the Ki67LI values into three groups (Low: 0≤ Ki67LI ≤10, Intermediate: 10< Ki67LI <30, and High: 30≤ Ki67LI) and the SUVmax into three groups (SUVmax ≤4, 4< SUVmax <8, and 8≤ SUVmax). We then verified the concordance rate between CNBS and SRS in each group in combination with the SUVmax obtained by PET/CT. Results The median Ki67LI was 17.8% (0.5-75.9%) and 17.0% (1.0-75.7%) in CNBS and SRS, respectively. The overall Ki67LI concordance rate between CNBS and SRS was 37.3% (44/118). The concordance was improved in the Low and High Ki67LI groups by applying SUVmax thresholds of 4 [82.6% (19/23), P=0.033 and 8 (92.3% (12/13), P=0.009], respectively. Conclusions Our results indicated that CNBS Ki67LI alone was not able to reflect SRS Ki67LI with sufficient accuracy. By dividing CNBS Ki67LI into three classes in combination with SUVmax, tumor proliferation could be predicted with higher accuracy in patients with invasive breast carcinoma.
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Affiliation(s)
- Hiroki Nakajima
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Kazuma Maeno
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Tokiko Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Toshiharu Kanai
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Takaaki Oba
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Mayu Ono
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | | | - Tsuyoshi Uehara
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
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11
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Kim SK, Ahn SG, Mun JY, Jeong MS, Bae SJ, Lee JS, Jeong J, Leem SH, Chu IS. Genomic Signature of the Standardized Uptake Value in 18F-Fluorodeoxyglucose Positron Emission Tomography in Breast Cancer. Cancers (Basel) 2020; 12:cancers12020497. [PMID: 32093417 PMCID: PMC7072341 DOI: 10.3390/cancers12020497] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 01/10/2023] Open
Abstract
The standardized uptake value (SUV), an indicator of the degree of glucose uptake in 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), has been used for predicting the clinical behavior of malignant tumors. However, its characteristics have been insufficiently explored at the genomics level. Here, we aim to identify genomic signatures reflecting prognostic SUV characteristics in breast cancer (BRC). Through integrative genomic profiling of 3710 BRC patients, including 254 patients who underwent preoperative FDG-PET, we identified an SUV signature, which showed independent clinical utility for predicting BRC prognosis (hazard ratio [HR] 1.27, 95% confidence interval [CI] = 1.12 to 1.45, p = 2.23 × 10−4). The risk subgroups classified by the signature exhibited mutually exclusive mutation patterns of TP53 and PIK3CA and showed significantly different responsiveness to immunotherapy. Experimental assays revealed that a signaling axis defined by TP53–FOXM1 and its downstream effectors in glycolysis–gluconeogenesis, including LDHA, might be important mediators in the FDG-PET process. Our molecular characterizations support an understanding of glucose metabolism and poor prognosis in BRC with a high SUV, utilizable in clinical practice to assist other diagnostic tools.
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Affiliation(s)
- Seon-Kyu Kim
- Personalized Genomic Medicine Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon 34141, Korea;
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (S.G.A.); (S.J.B.)
| | - Jeong-Yeon Mun
- Department of Biological Science, Dong-A University, Busan 49315, Korea; (J.-Y.M.); (M.-S.J.)
| | - Mi-So Jeong
- Department of Biological Science, Dong-A University, Busan 49315, Korea; (J.-Y.M.); (M.-S.J.)
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (S.G.A.); (S.J.B.)
| | - Ju-Seog Lee
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (S.G.A.); (S.J.B.)
- Correspondence: (J.J.); (S.-H.L.); (I.-S.C.); Tel.: +82-2-2019-3379 (J.J.); +82-51-200-5639 (S.-H.L.); +82-42-879-8520 (I.-S.C.)
| | - Sun-Hee Leem
- Department of Biological Science, Dong-A University, Busan 49315, Korea; (J.-Y.M.); (M.-S.J.)
- Correspondence: (J.J.); (S.-H.L.); (I.-S.C.); Tel.: +82-2-2019-3379 (J.J.); +82-51-200-5639 (S.-H.L.); +82-42-879-8520 (I.-S.C.)
| | - In-Sun Chu
- Genome Editing Research Center, KRIBB, Daejeon 34141, Korea
- Department of Bioinformatics, KRIBB School of Bioscience, Korea University of Science and Technology, Daejeon 34113, Korea
- Correspondence: (J.J.); (S.-H.L.); (I.-S.C.); Tel.: +82-2-2019-3379 (J.J.); +82-51-200-5639 (S.-H.L.); +82-42-879-8520 (I.-S.C.)
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12
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Can C, Komek H. Metabolic and volume-based parameters of (18F)FDG PET/CT for primary mass and axillary lymph node metastasis in patients with invasive ductal carcinoma: a retrospective analysis in relation to molecular subtype, axillary lymph node metastasis and immunohistochemistry and inflammatory markers. Nucl Med Commun 2019; 40:1051-1059. [PMID: 31365497 DOI: 10.1097/mnm.0000000000001074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate metabolic and volume-based parameters of 18-Fluorodeoxyglucose positron emission tomography/computed tomography ((F)FDG PET/CT) for primary mass and axillary lymph node (ALN) metastasis in relation to molecular subtype, and immunohistochemistry and inflammatory markers in patients with invasive ductal carcinoma. METHODS A total of 129 patients (mean±SD age: 49.2±13.0 years) with invasive ductal breast cancer who had (F)FDG PET/CT imaging prior to chemotherapy or surgery were included in this single-center retrospective study. Data on patient age, molecular subtype, ALN metastasis status, inflammatory markers, immunohistochemistry markers and (F)FDG PET/CT imaging parameters for primary mass and ALN were recorded. RESULTS ALN metastasis was evident in 52.7% of patients and associated with significantly higher median diameter (P=0.027), MTV (P<0.001) and TLG (P<0.001). NLR was positively correlated with all primary mass (p ranged from 0.041 to 0.001) and ALN (P ranged from 0.026 to <0.001) PET parameters. PET parameters did not change with respect to molecular subtype or immunohistochemistry markers. Primary mass and ALN metastasis PET parameters showed significant positive correlations for TLG (r=0.274, P=0.001) and SUVmax (r=0.358, P<0.001). CONCLUSION In conclusion, our findings in a retrospective cohort of invasive ductal breast cancer patients revealed primary mass PET parameters to significantly differ with respect to ALN metastasis status and NLR levels, but not according to molecular subtype or immunohistochemistry markers. Accordingly, our findings highlight the value of acquisition of preoperative PET/CT imaging and role of both metabolic and volume-based parameters in predicting aggressiveness of the tumor as correlated with presence of ALN metastasis and high NLR.
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Affiliation(s)
- Canan Can
- Department of Nuclear Medicine, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
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13
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Bakhshayeshkaram M, Salehi Y, Abbasi M, Hashemi Beni R, Seifi S, Hassanzad M, Jamaati HR, Aghahosseini F. A preliminary study to propose a diagnostic algorithm for PET/CT-detected incidental breast lesions: application of BI-RADS lexicon for US in combination with SUVmax. Eur Radiol 2019; 29:5507-5516. [PMID: 30887201 DOI: 10.1007/s00330-019-06106-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/22/2018] [Accepted: 02/12/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To develop a diagnostic algorithm for positron emission tomography (PET)-detected incidental breast lesions using both breast imaging reporting and data system (BI-RADS) and maximum standardized uptake value (SUVmax) criteria. METHODS Fifty-six PET-detected incidental breast lesions from 51 patients, which were subsequently investigated by breast ultrasound within 1 month of the PET study, constituted the study cohort and they were finally verified by tissue diagnosis or a 2-year follow-up. Based on the maximum specificity with sensitivity > 60.0% and maximum sensitivity with specificity > 60.0%, two SUVmax cutoff values were calculated at 2 and 3.7. BI-RADS ≥ 4 was considered as highly suspicious for malignancy. The diagnostic accuracies were estimated for SUVmax levels above or below the cutoff points combined with the BI-RADS suspicion level. RESULTS Overall, 46 benign and 10 malignant lesions were studied. The diagnostic characteristics of SUVmax ≥ 2, SUVmax ≥ 3.7, and BI-RADS ≥ 4 were 80.0%, 60.0%, and 80.0% for sensitivity, 73.9%, 95.7%, and 92.7% for specificity, and 75.0%, 89.3%, and 90.2% for accuracy, respectively. When the SUVmax threshold was set at 2, combined with BI-RADS suspicion level, the sensitivity, specificity, and accuracy were 100.0%, 69.6%, and 75.0%, respectively. The results for SUVmax threshold set at 3.7 combined with BI-RADS were 90.0%, 91.3%, and 91.1% for the sensitivity, specificity, and accuracy, respectively. A diagnostic algorithm was accordingly generated. CONCLUSION The need for biopsy should be justified in low BI-RADS lesions presenting with high SUVmax at 3.7 or higher. The biopsy of patients with high B-IRADS and low SUVmax could be preserved. KEY POINTS • A diagnostic algorithm was developed for PET-detected incidental breast lesions using both BI-RADS and SUVmax criteria. • Diagnostic performance was calculated separately and conjunctively for SUVmax ≥ 2, SUVmax ≥ 3.7, and BI-RADS ≥ 4. • The need for biopsy can be justified in BI-RADS < 4 lesions with SUVmax ≥ 3.7. Lesions with BI-RADS < 4 and indeterminate SUVmax (2 < SUVmax < 3.7) benefit from a short-interval follow-up. BI-RADS < 4 lesions with SUVmax < 2 may confidently be scheduled for routine screening.
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Affiliation(s)
- Mehrdad Bakhshayeshkaram
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Radiology, Shahid Beheshti University of Medical Sciences, Daar-Abad, Niavaran Ave., 19575-154, Tehran, 1956944413, Iran
| | - Yalda Salehi
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrshad Abbasi
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Razieh Hashemi Beni
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Radiology, Shahid Beheshti University of Medical Sciences, Daar-Abad, Niavaran Ave., 19575-154, Tehran, 1956944413, Iran
| | - Sharareh Seifi
- Pediatric Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Hassanzad
- Pediatric Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Paediatrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Jamaati
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Pulmonology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Aghahosseini
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Radiology, Shahid Beheshti University of Medical Sciences, Daar-Abad, Niavaran Ave., 19575-154, Tehran, 1956944413, Iran.
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14
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Surov A, Meyer HJ, Wienke A. Associations Between PET Parameters and Expression of Ki-67 in Breast Cancer. Transl Oncol 2019; 12:375-380. [PMID: 30522044 PMCID: PMC6279710 DOI: 10.1016/j.tranon.2018.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Numerous studies investigated relationships between positron emission tomography and proliferation index Ki-67 in breast cancer (BC) with inconsistent results. The aim of the present analysis was to provide evident data about associations between standardized uptake value (SUV) and expression of Ki-67 in BC. METHODS MEDLINE library, SCOPUS and EMBASE data bases were screened for relationships between SUV and Ki-67 in BC up to April 2018. Overall, 32 studies with 1802 patients were identified. The following data were extracted from the literature: authors, year of publication, number of patients, and correlation coefficients. Associations between SUV and Ki-67 were analyzed by Spearman's correlation coefficient. RESULTS Associations between SUVmax derived from 18F-FDG PET and Ki-67 were reported in 25 studies (1624 patients). The pooled correlation coefficient was 0.40, (95% CI = [0.34; 0.46]). Furthermore, 7 studies analyzed associations between SUVmax derived from 18F-fluorthymidin (FLT) PET and Ki-67 (178 patients). The pooled correlation coefficient was 0.54, (95% CI = [0.37; 0.70]). CONCLUSION SUVmax correlated moderately with expression of Ki-67 and, therefore, cannot be used as a surrogate marker for tumor proliferation. Further studies are needed to evaluate associations between PET parameters and histopathological findings like hormone receptor status in breast cancer.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburger Str., 06097 Halle, Germany.
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15
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Iakovou I, Giannoula E, Gkantaifi A, Levva S, Frangos S. Positron emission tomography in breast cancer: 18F- FDG and other radiopharmaceuticals. Eur J Hybrid Imaging 2018. [DOI: 10.1186/s41824-018-0039-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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16
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Miyake KK, Nakamoto Y, Saji S, Sugie T, Kurihara K, Kanao S, Ikeda DM, Toi M, Togashi K. Impact of physiological hormonal fluctuations on 18F-fluorodeoxyglucose uptake in breast cancer. Breast Cancer Res Treat 2018; 169:437-446. [PMID: 29423901 DOI: 10.1007/s10549-018-4711-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/03/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Premenopausal physiologic steroid levels change cyclically, in contrast to steady state low levels seen in postmenopausal patients. The purpose of this study was to evaluate whether 18F-fluorodeoxyglucose (18F-FDG) uptake in breast cancer is influenced by physiological hormonal fluctuations. METHODS A total of 160 primary invasive breast cancers from 155 females (54 premenopausal, 101 postmenopausal) who underwent 18F-FDG positron emission tomography/computed tomography before therapy were retrospectively analyzed. The maximal standardized uptake values (SUVmax) of tumors were compared with menstrual phases and menopausal status according to the following subgroups: 'luminal A-like,' 'luminal B-like,' and 'non-luminal.' Additionally, the effect of estradiol (E2) on 18F-FDG uptake in breast cancer cells was evaluated in vitro. RESULTS Among premenopausal patients, SUVmax during the periovulatory-luteal phase was significantly higher than that during the follicular phase in luminal A-like tumors (n = 25, p = 0.004), while it did not differ between the follicular phase and the periovulatory-luteal phase in luminal B-like (n = 24) and non-luminal tumors (n = 7). Multiple regression analysis showed menstrual phase, tumor size, and Ki-67 index are independent predictors for SUVmax in premenopausal luminal A-like tumors. There were no significant differences in SUVmax between pre- and postmenopausal patients in any of the subgroups. In in vitro studies, uptake in estrogen receptor-positive cells was significantly augmented when E2 concentration was increased from 0.01 to ≥ 1 nM. CONCLUSIONS Our data suggest that 18F-FDG uptake may be impacted by physiological hormonal fluctuations during menstrual cycle in luminal A-like cancers, and that E2 could be partly responsible for these events.
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Affiliation(s)
- Kanae K Miyake
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan.
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan
| | - Shigehira Saji
- Department of Medical Oncology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Tomoharu Sugie
- Department of Breast Surgery, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan
- Breast Surgery, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata City, Osaka, 573-1191, Japan
| | - Kensuke Kurihara
- Department of Radiology, Kyoto-Katsura Hospital, 17-Banchi, Yamada Hirao-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8256, Japan
| | - Shotaro Kanao
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan
- Department of Radiology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Room 2234, Stanford, CA, 94305, USA
| | - Debra M Ikeda
- Department of Radiology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Room 2234, Stanford, CA, 94305, USA
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto City, Kyoto, 606-8507, Japan
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17
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Bhagat PN, Jadhav SH, Chattopadhyay S, Paknikar KM. Carbon nanospheres mediated nuclear delivery of SMAR1 protein (DNA binding domain) controls breast tumor in mice model. Nanomedicine (Lond) 2018; 13:353-372. [DOI: 10.2217/nnm-2017-0298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate anticancer activity of the DNA binding domain of SMAR1 (His 5) in vitro and in vivo. Materials & methods: His 5 was conjugated to hydrothermally synthesized carbon nanospheres (CNs). Anticancer activity of CNs-His 5 was evaluated in vitro and in vivo. Results: CNs- His 5 significantly reduced cyclin D1 levels in MDA-MB-231 cells. Tumor bearing Balb/c mice injected with CNs-His 5 showed approximately 62% tumor regression and significantly reduced 18FDG uptake. Caspases assay and IHC staining confirmed tumor growth inhibition, which could be attributed to apoptotic, antiproliferative and antiangiogenic activities of His 5. Conclusion: DNA binding domain of the SMAR1 protein (His 5) has potent anticancer activity and its CNs mediated delivery could control breast tumor in mice model.
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Affiliation(s)
- Prasad N Bhagat
- Agharkar Research Institute, G. G. Agarkar Road, Pune 411004, Maharashtra, India
| | - Sachin H Jadhav
- Agharkar Research Institute, G. G. Agarkar Road, Pune 411004, Maharashtra, India
| | - Samit Chattopadhyay
- National Centre for Cell Science, S.P. Pune University Campus, Ganeshkhind Road, Pune 411007, Maharashtra, India
| | - Kishore M Paknikar
- Agharkar Research Institute, G. G. Agarkar Road, Pune 411004, Maharashtra, India
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18
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Dubey IP, Jain A, Chauhan MS, Kumar R, Agarwal S, Kishore B, Vishnoi MG, Paliwal D, John AR, Kumar N, Sharma A, Pandit AG. Tumor characteristics and metabolic quantification in carcinoma breast: An institutional experience. Indian J Cancer 2017; 54:333-339. [PMID: 29199717 DOI: 10.4103/ijc.ijc_121_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In India, carcinoma breast is the most common cancer among urban women population and second most common cancer after carcinoma cervix in rural areas. One in 22 women in India develops carcinoma of the breast in their lifetime. Fluorine-18-fluoro-2-deoxy-D-glucose (18F-FDG) uptake in breast cancer usually indicates the degree of tumor metabolism and hence can predict its behavior and prognosis. On the other hand, the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2) or neu state of breast cancer is a biomarker that provides important prognostic information in addition to predicting response to therapy. AIMS The main objective of this study is to assess whether a correlation exists between 18F-FDG uptake in untreated cases of breast cancer, their receptor status (ER, PR, and HER-2 or neu), tumor histology, and tumor size. SUBJECTS AND METHODS Sixty consecutive female patients, with biopsy-proven primary breast cancer, were enrolled in this prospective study for whom 18F-FDG positron emission tomography-computed tomography scan was done in the Department of Nuclear Medicine. Results obtained were analyzed using appropriate statistical tests (t-test and Pearson Chi-square tests), and interpretation was made with 95% confidence level. RESULTS In our series, a positive correlation between tumor size, high tumor grade, and standardized uptake value (SUV) was found. Tumors with positive receptor status for estrogen, progesterone, and HER-2/neu receptors had statistically insignificant lower maximum SUV (SUVmax) values than their negative counterparts. Triple-negative breast tumors (ER-, PR-, and no overexpression of HER-2/neu) are currently a subject of major interest because of their aggressiveness, poor prognosis, and lack of targeted therapy. Based on receptor status when the SUVmaxof the group with triple-negative receptor status (ER-/PR-/HER-2/neu-) was compared to rest of the patient group, it was seen that patients with negative receptor status had significantly higher mean SUVmaxvalues. CONCLUSIONS We have inferred that in patients with breast cancer, various biological parameters such as tumor size, grade, histology, and hormonal receptor status have different impact on tumor metabolic activity.
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Affiliation(s)
- I P Dubey
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - A Jain
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - M S Chauhan
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - R Kumar
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - S Agarwal
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - B Kishore
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - M G Vishnoi
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - D Paliwal
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - A R John
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - N Kumar
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - A Sharma
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
| | - A G Pandit
- Department of Nuclear Medicine, Army Hospital (Research and Referral), New Delhi, India
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19
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Köroğlu R, Köksal İ, Şimşek FS, Gezer F, Kekilli E, Ünal B. Considering the Relationship between Quantitative Parameters and Prognostic Factors in Breast Cancer: Can Mean Standardized Uptake Value be an Alternative to Maximum Standardized Uptake Value? World J Nucl Med 2017; 16:275-280. [PMID: 29033675 PMCID: PMC5639443 DOI: 10.4103/1450-1147.215485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It was aimed to investigate the correlation between maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and retention index (RI), which represents the quantitative evaluation of the uptake of 18F-fluoro-2-deoxy-D-glucose (18F-FDG) used in positron emission tomography (PET) and clinicopathologic as well as biologic prognostic factors. Forty-one women with breast cancer who were histopathologically diagnosed were included in this study. Neoadjuvant chemotherapy was applied to all patients before PET/computed tomography (CT). After FDG injection, PET/CT screening was applied within the 1st h (PET-1) and in the 2nd h (PET-2). SUVmax, SUVmean, SUVmax RI, and SUVmean RI of every image were calculated qualitatively and semiquantitatively. The correlation between quantitative and semiquantitative PET parameters and biologic as well as clinicopathologic prognosis factors was evaluated. Statistically, significant positive correlation was found between lymph nodes (LNs), which were evaluated by clinical picture, clinical stage as well as histopathologically and quantitative PET parameters (SUVmax1, SUVmax2,, RImax, SUVmean1, SUVmean2, RImean) (P < 0.05). While statistically significant correlation with RImax was detected only by LN (histopathological), correlations with RImean were detected by clinical picture, clinical stage, metabolic stage, and LN (histopathological). Statistically, significant correlation was found between RImax and estrogen receptor in patients who were histopathologically diagnosed with invasive ductal carcinoma (n = 34) (P < 0.05). We detected correlations between biologic and clinicopathologic prognostic factors and SUVmax as well as SUVmean values in breast carcinoma. SUVmean values may provide important knowledge when the correlation between prognostic factors and PET parameters is investigated even if they are not used routinely.
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Affiliation(s)
- Reyhan Köroğlu
- Department of Nuclear Medicine, Faculty of Medicine, Karabuk University, Karabuk, Turkey
| | - İsmail Köksal
- Department of Nuclear Medicine, Malatya State Hospital, Malatya, Turkey
| | - Fikri Selçuk Şimşek
- Department of Nuclear Medicine, Elazig Education and Research Hospital, Elazig, Turkey
| | - Fatma Gezer
- Department of Anesthesiology and Reanimation, Education and Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Ersoy Kekilli
- Department of Nuclear Medicin, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Bülent Ünal
- Department of Oncologic Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey
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20
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Nishimukai A, Inoue N, Kira A, Takeda M, Morimoto K, Araki K, Kitajima K, Watanabe T, Hirota S, Katagiri T, Nakamori S, Akazawa K, Miyoshi Y. Tumor size and proliferative marker geminin rather than Ki67 expression levels significantly associated with maximum uptake of 18F-deoxyglucose levels on positron emission tomography for breast cancers. PLoS One 2017; 12:e0184508. [PMID: 28886153 PMCID: PMC5590948 DOI: 10.1371/journal.pone.0184508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/27/2017] [Indexed: 01/19/2023] Open
Abstract
It has been well established that maximum standardized uptake value (SUVmax) for 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) is clinically useful for evaluating treatment efficacy as well as predicting prognosis of breast cancer patients. Although SUVmax reflects increased glucose uptake and metabolism possibly induced by activation of growth factor signaling or TP53 dysfunction, tumor characteristics of SUVmax-high breast cancers remain to be elucidated. For the present study, we used immunohistochemical staining to investigate expressions of phospho-ribosomal protein S6 (pS6, downstream molecule of phosphatidyl inositol 3-kinase/Akt/mammalian target of the rapamycin/S6K pathway) and phosphor-p44/42 mitogen-activated protein kinase (pMAPK). Expression levels of TP53 and proliferative marker geminin as well as Ki67 were also examined by means of immunostaining in 163 invasive breast cancers. Cutoff values were set at 10% for pS6, 20% for pMAPK and TP53, and 4% for geminin. The SUVmax levels were significantly higher in the pS6-positive (p = 0.0173), TP53-positive (p = 0.0207) and geminin-high cancers (p<0.0001), but there was no significant association between pMAPK expression levels and SUVmax levels. Multivariable analysis showed that a high geminin level (odds ratio: 6.497, 95% confidence interval: 2.427–19.202, p = 0.0001) and large tumor size (6.438, 2.224–20.946, p = 0.0005) were significantly and independently associated with SUVmax-high. Univariable but not multivariable analysis indicated that Ki67-high significantly correlated with SUVmax-high. Twenty of 23 (87.0%) breast cancers with tumor size >2cm and geminin-high showed SUVmax-high, while only 6 of 49 (12.2%) breast cancers ≤2cm in size and with low geminin levels were SUVmax-high. In conclusion, we could determine that breast cancers with a large tumor and a geminin-high rather than Ki67-high proliferative marker were significantly associated with high levels of SUVmax. These findings may signify that SUVmax reflects tumor characteristics with high proliferative activity but not activation of mTOR/S6K and MAPK pathways or increased glucose metabolism due to dysfunction of TP53.
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Affiliation(s)
- Arisa Nishimukai
- Department of Surgery, Division of Breast and Endocrine, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Natsuko Inoue
- Department of Surgery, Division of Breast and Endocrine, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Ayako Kira
- Department of Surgery, Division of Breast and Endocrine, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Masashi Takeda
- Department of Pathology, Yao Municipal Hospital, Yao City, Osaka, Japan
| | - Koji Morimoto
- Department of the Science of Living, Osaka Women’s Junior College, Fujiidera City, Osaka, Japan
- Department of Surgery, National Hospital Organization Osaka National Hospital, Chuo-ku, Osaka, Japan
| | - Kazuhiro Araki
- Department of Surgery, Division of Breast and Endocrine, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Kazuhiro Kitajima
- Department of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Takahiro Watanabe
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Toyomasa Katagiri
- Division of Genome Medicine, Institute for Genome Research, Tokushima University, Kuramoto-cho, Tokushima, Japan
| | - Shoji Nakamori
- Department of Surgery, National Hospital Organization Osaka National Hospital, Chuo-ku, Osaka, Japan
| | - Kouhei Akazawa
- Department of Medical Informatics, Niigata University Medical & Dental Hospital, Chuo-ku, Niigata, Japan
| | - Yasuo Miyoshi
- Department of Surgery, Division of Breast and Endocrine, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
- * E-mail:
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Lee J, Lee EJ, Moon SH, Kim S, Hyun SH, Cho YS, Choi JY, Kim BT, Lee KH. Strong association of epidermal growth factor receptor status with breast cancer FDG uptake. Eur J Nucl Med Mol Imaging 2017; 44:1438-1447. [PMID: 28488029 DOI: 10.1007/s00259-017-3705-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 04/10/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE Imaging tumor FDG uptake could complement breast cancer biomarkers of risk and treatment response. Although breast cancer FDG uptake is reputedly influenced by major biomarker states, the role of epidermal growth factor receptor (EGFR) expression remains largely unexplored. METHODS This is a retrospective study that included 499 patients with primary breast cancer at initial presentation. Tumor FDG uptake was measured on pretreatment PET/CT as maximum standardized uptake value (SUVmax), and biomarkers were assessed by immunohistochemistry of tumor tissue. Regression analysis was performed for predictors of high tumor FDG uptake (SUVmax ≥ 8.6). RESULTS SUVmax was higher in ER- (36.5%; 11.2 ± 6.0 vs. 8.3 ± 5.3), PR- (42.3%; 10.9 ± 6.0 vs. 8.2 ± 5.2), and triple-negative tumors (19.8%; 12.0 ± 6.9 vs. 8.7 ± 5.2; all p < 0.0001). EGFR expression (28.5%) was more frequent in ER-, PR-, triple-negative, cytokeratin 5/6 (CK5/6) + and mutant P53 (mP53) + tumors (all p < 0.0001). EGFR+ was associated with higher SUVmax among all tumors (11.9 ± 6.0 vs. 8.3 ± 5.3), ER- tumors (p < 0.0001), PR- and + tumors (p < 0.0001 and 0.027), hormone receptor- and + tumors (p < 0.0001 and 0.004), human epidermal growth factor receptor 2 (HER2)- and + tumors (p < 0.0001 and 0.006), non-triple negative tumors (p < 0.0001), CK5/6- and + tumors (p = 0.021 and <0.0001), and mP53- and + tumors (p < 0.0001 and 0.008). Tumors had high FDG uptake in 73.2% of EGFR+ and 40.6% of EGFR- tumors. On regression analysis, significant multivariate predictors of high tumor FDG uptake were large size, EGFR+ and CK5/6+ for the entire subjects, and EGFR+ and CK5/6+ for ER- and hormone receptor negative subgroups. High FDG uptake was able to sub-stratify EGFR+ tumors that were more likely to be ER- and CK5/6+, and EGFR- tumors more likely to be mP53 +. CONCLUSIONS Primary breast tumor FDG uptake is strongly influenced by EGFR status beyond that by other major biomarkers including hormone receptor and HER2 status, and EGFR expression is a strong independent predictor of high breast tumor FDG uptake.
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Affiliation(s)
- Joohee Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Eun Jeong Lee
- Department of Nuclear Medicine, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul, 131-795, South Korea.
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Seokhwi Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Young Seok Cho
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
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Ahn SG, Lee JH, Lee HW, Jeon TJ, Ryu YH, Kim KM, Sohn J, Yun M, Lee SA, Jeong J, Kim SI. Comparison of standardized uptake value of 18F-FDG-PET-CT with 21-gene recurrence score in estrogen receptor-positive, HER2-negative breast cancer. PLoS One 2017; 12:e0175048. [PMID: 28419166 PMCID: PMC5395149 DOI: 10.1371/journal.pone.0175048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/20/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We investigated the relationship between 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG-PET-CT) standardized uptake value (SUV) and 21-gene recurrence score (RS) in estrogen receptor (ER)-positive/HER2-negative breast cancer. MATERIALS AND METHODS One hundred sixty-seven patients were identified among those who underwent preoperative 18F-FDG-PET-CT and had RS. Maximum SUV was obtained from 18F-FDG-PET-CT; the cut-off point was 4. RESULTS The continuous RS and SUV correlated positively (Pearson's R = 0.555; P < 0.001). An inverse correlation was found between progesterone receptor (PR) expression by reverse transcriptase-polymerase chain reaction, and SUV (Pearson's R = -0.408; P < 0.001). Good agreement between dichotomized RS (<26 vs. ≥26) and SUV (<4 vs. ≥4) was observed in 137 of 167 patients (82.0%; 95% confidence interval [CI], 76.2-87.9). Among patients with low SUV, 114 of 115 (99.1% [95% CI, 97.4-100.0]) had tumors with lower RS (<26). Although 23 of 52 women (44.2% [95% CI, 30.7-57.7]) with high SUV had higher RS (≥26), all 13 women with high RS (≥31) had high-SUV tumors. Most cases with disagreements between SUV and RS (n = 30) were classified as high SUV/lower RS (n = 29). The discordant group had higher grade or elevated Ki67 expression (≥20%) compared with the low SUV/lower RS group (n = 109), but higher PR expression compared with the high SUV/higher RS group (n = 23). Multiple logistic regression analysis showed that high SUV were associated with higher RS (≥26). CONCLUSIONS SUV, as a biologic parameter represented using a continuous variable, was found to associate with RS in ER-positive, HER2-negative breast cancer. Further studies may reveal the biology underlying the discordance between the markers.
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Affiliation(s)
- Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Lee
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hak Woo Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Joo Jeon
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kun Min Kim
- Division of Medical Oncology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joohyuk Sohn
- Division of Medical Oncology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Ah Lee
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Seung Il Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract
Breast cancer is a major disease with high morbidity and mortality in women. As a highly heterogeneous tumor, it contains different molecular subtypes: luminal A, luminal B, human epidermal growth factor 2-positive, and triple-negative subtypes. As each subtype has unique features, it may not be universal to the optimal treatment and expected response for individual patients. Therefore, it is critical to identify different breast cancer subtypes. Targeting subcellular levels, molecular imaging, especially PET and single photon emission computed tomography, has become a promising means to identify breast cancer subtypes and monitor treatment. Different biological processes between various subtypes, including changes correlated with receptor expression, cell proliferation, or glucose metabolism, have the potential for imaging with PET and single photon emission computed tomography radiopharmaceuticals. Receptor imaging, with radiopharmaceuticals targeting estrogen receptor, progesterone receptor, or human epidermal growth factor 2, is available to distinguish receptor-positive tumors from receptor-negative ones. Cell proliferation imaging with fluorine-18 fluorothymidine PET aids identification of luminal A and B subtypes on the basis of the correlation with the immunohistochemical biomarker Ki-67. Glucose metabolism imaging with fluorine-18 fluorodeoxyglucose PET may have potential to discriminate triple-negative subtypes from others. With increasing numbers of novel radiopharmaceuticals, noninvasive molecular imaging will be applied widely for the identification of different subtypes and provide more in-vivo information on individualized management of breast cancer patients.
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Wangerin KA, Muzi M, Peterson LM, Linden HM, Novakova A, Mankoff DA, Kinahan PE. A virtual clinical trial comparing static versus dynamic PET imaging in measuring response to breast cancer therapy. Phys Med Biol 2017; 62:3639-3655. [PMID: 28191877 DOI: 10.1088/1361-6560/aa6023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We developed a method to evaluate variations in the PET imaging process in order to characterize the relative ability of static and dynamic metrics to measure breast cancer response to therapy in a clinical trial setting. We performed a virtual clinical trial by generating 540 independent and identically distributed PET imaging study realizations for each of 22 original dynamic fluorodeoxyglucose (18F-FDG) breast cancer patient studies pre- and post-therapy. Each noise realization accounted for known sources of uncertainty in the imaging process, such as biological variability and SUV uptake time. Four definitions of SUV were analyzed, which were SUVmax, SUVmean, SUVpeak, and SUV50%. We performed a ROC analysis on the resulting SUV and kinetic parameter uncertainty distributions to assess the impact of the variability on the measurement capabilities of each metric. The kinetic macro parameter, K i , showed more variability than SUV (mean CV K i = 17%, SUV = 13%), but K i pre- and post-therapy distributions also showed increased separation compared to the SUV pre- and post-therapy distributions (mean normalized difference K i = 0.54, SUV = 0.27). For the patients who did not show perfect separation between the pre- and post-therapy parameter uncertainty distributions (ROC AUC < 1), dynamic imaging outperformed SUV in distinguishing metabolic change in response to therapy, ranging from 12 to 14 of 16 patients over all SUV definitions and uptake time scenarios (p < 0.05). For the patient cohort in this study, which is comprised of non-high-grade ER+ tumors, K i outperformed SUV in an ROC analysis of the parameter uncertainty distributions pre- and post-therapy. This methodology can be applied to different scenarios with the ability to inform the design of clinical trials using PET imaging.
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Affiliation(s)
- Kristen A Wangerin
- Department of Bioengineering, University of Washington, 3720 15th Avenue NE, Seattle, 98195 WA, United States of America
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25
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Metabolic Tumor Burden Assessed by Dual Time Point [18F]FDG PET/CT in Locally Advanced Breast Cancer: Relation with Tumor Biology. Mol Imaging Biol 2016; 19:636-644. [DOI: 10.1007/s11307-016-1034-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Higuchi T, Nishimukai A, Ozawa H, Fujimoto Y, Yanai A, Miyagawa Y, Murase K, Imamura M, Takatsuka Y, Kitajima K, Fukushima K, Miyoshi Y. Prognostic significance of preoperative 18F-FDG PET/CT for breast cancer subtypes. Breast 2016; 30:5-12. [DOI: 10.1016/j.breast.2016.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/27/2016] [Accepted: 08/06/2016] [Indexed: 02/07/2023] Open
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27
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Lee SS, Bae SK, Park YS, Park JS, Kim TH, Yoon HK, Ahn HJ, Lee SM. Correlation of Molecular Subtypes of Invasive Ductal Carcinoma of Breast with Glucose Metabolism in FDG PET/CT: Based on the Recommendations of the St. Gallen Consensus Meeting 2013. Nucl Med Mol Imaging 2016; 51:79-85. [PMID: 28250861 DOI: 10.1007/s13139-016-0444-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/30/2016] [Accepted: 07/23/2016] [Indexed: 01/14/2023] Open
Abstract
PURPOSE This study aimed to investigate the relationship between the SUVmax of primary breast cancer lesions and the molecular subtypes based on the recommendations of the St. Gallen consensus meeting 2013. METHODS Clinical records of patients who underwent F-18 FDG PET/CT for initial staging of invasive ductal carcinoma (IDC) of the breast were reviewed. A total of 183 patients were included. SUVmax was correlated with the molecular subtypes defined by the St. Gallen Consensus Meeting 2013, i.e., luminal A-like (LA), luminal B-like HER2 negative (LBHER2-), luminal B-like HER2 positive (LBHER2+), HER2 positive (HER2+), and triple negative (TN), and with the clinicohistopathologic characteristics. RESULTS The molecular subtype was LA in 38 patients, LBHER2- in 72, LBHER2+ in 21, HER2+ in 30, and TN in 22. The mean SUVmax in the LA, LBHER2-, LBHER2+, HER2+, and TN groups were 4.5 ± 2.3, 7.2 ± 4.9, 7.2 ± 4.3, 10.2 ± 5.5, and 8.8 ± 7.1, respectively. Although SUVmax differed significantly among these subtypes (p < 0.001), the values showed a wide overlap. Optimal cut-off SUVmax to differentiate LA from LBHER2-, LBHER2+, HER2+ and TN were 5.9, 5.8, 7.5, and 10.2 respectively, with area under curve (AUC) of 0.648, 0.709, 0.833, and 0.697 respectively. The cut-off value of 5.9 yielded the highest accuracy for differentiation between the LA and non-LA subtypes, with sensitivity, specificity, and AUC of 79.4 %, 57.9 %, and 0.704 respectively. CONCLUSION The SUVmax showed a significant correlation with the molecular subtype. Although SUVmax measurements could be used along with immunohistochemical analysis for differentiating between molecular subtypes, its application to individual patients may be limited due to the wide overlaps in SUVmax.
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Affiliation(s)
- Sun Seong Lee
- Department of Nuclear Medicine, Busan Paik Hospital, University of Inje College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392 Republic of Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Haundae Paik Hospital, University of Inje College of Medicine, 875 Haeun-daero, Haeundae-gu, Busan, 48108 Republic of Korea
| | - Yun Soo Park
- Department of Nuclear Medicine, Busan Paik Hospital, University of Inje College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392 Republic of Korea
| | - Ji Sun Park
- Department of Nuclear Medicine, Busan Paik Hospital, University of Inje College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392 Republic of Korea
| | - Tae Hyun Kim
- Department of Surgery, Busan Paik Hospital, University of Inje College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392 Republic of Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Busan Paik Hospital, University of Inje College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392 Republic of Korea
| | - Hyo Jung Ahn
- Department of Pathology, Busan Paik Hospital, University of Inje College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392 Republic of Korea
| | - Seok Mo Lee
- Department of Nuclear Medicine, Busan Paik Hospital, University of Inje College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, 47392 Republic of Korea
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Tan TH, Boey CY, Lee BN. Role of Pre-therapeutic (18)F-FDG PET/CT in Guiding the Treatment Strategy and Predicting Prognosis in Patients with Esophageal Carcinoma. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2016; 4:59-65. [PMID: 27408893 PMCID: PMC4938875 DOI: 10.7508/aojnmb.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the role of pre-therapeutic (18)fluorine-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET-CT) and maximum standardized uptake value (SUVmax) in guiding the treatment strategy and predicting the prognosis of esophageal carcinoma, using the survival data of the patients. METHODS The present retrospective, cohort study was performed on 40 consecutive patients with esophageal carcinoma (confirmed by endoscopic biopsy), who underwent pre-operative (18)F-FDG PET-CT staging between January 2009 and June 2014. All the patients underwent contrast-enhanced CT and non-contrasted (18)F-FDG PET-CT evaluations. The patients were followed-up over 12 months to assess the changes in therapeutic strategies. Survival analysis was done considering the primary tumor SUVmax, using the Kaplan-Meier product-limit method. RESULTS In a total of 40 patients, (18)F-FDG PET-CT scan led to changes in disease stage in 26 (65.0%) cases, with upstaging and downstaging reported in 10 (25.0%) and 16 (40.0%) patients, respectively. The management strategy changed from palliative to curative in 10 out of 24 patients and from curative to palliative in 7 out of 16 cases. Based on the (18)F-FDG PET-CT scan alone, the median survival of patients in the palliative group was 4.0 (95% CI 3.0-5.0) months, whereas the median survival in the curative group has not been reached, based on the 12-month follow-up. Selection of treatment strategy on the basis of (18)F-FDG PET/CT alone was significantly associated with the survival outcomes at nine months (P=0.03) and marginally significant at 12 months (P=0.03). On the basis of SUVmax, the relation between survival and SUVmax was not statistically significant. CONCLUSION (18)F-FDG PET/CT scan had a significant impact on stage stratification and subsequently, selection of a stage-specific treatment approach and the overall survival outcome in patients with esophageal carcinoma. However, pre-treatment SUVmax failed to stablish its usefulness in the assessment of patient prognosis and survival outcome.
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Affiliation(s)
- Teik Hin Tan
- Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia
| | - Ching Yeen Boey
- Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia
| | - Boon Nang Lee
- Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia
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29
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Ductal carcinoma in situ and ductal carcinoma in situ with microinvasion: correlation of FDG uptake with histological and biological prognostic factors. Breast Cancer 2016; 24:353-361. [PMID: 27312540 DOI: 10.1007/s12282-016-0710-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Several studies investigated the correlation between the intensity of fluorodeoxyglucose (FDG) uptake and some histological and biological characteristics in breast cancer. Ductal carcinoma in situ (DCIS) is generally thought to be a precursor lesion of invasive breast cancer. The aim of this study was to assess the correlation between FDG uptake values on positron emission tomography/computed tomography (PET/CT) with histological and biological prognostic factors in DCIS and ductal carcinoma in situ with microinvasion (DCIS-Mi). MATERIALS AND METHODS PET/CT images for initial staging of confirmed DCIS and DCIS-Mi patients, taken between July 2004 and December 2009, were reviewed retrospectively. Maximum standardized uptake values (SUVmax) and tumor background count density ratio on PET/CT were compared with tumor characteristics. Histological and biological prognostic factors included tumor size, nuclear grade, Van Nuys Prognostic Index, estrogen receptor, progesterone receptor, HER2, and Ki-67 index. RESULTS In total, 87 lesions from 83 patients (all females; mean age 51 ± 9 years) were studied. The Van Nuys Prognostic Index group was 1 in 25 lesions, 2 in 36, and 3 in 26. On statistical analysis, significant differences in SUVmax and tumor background count density ratio were seen between the Van Nuys Prognostic Index groups and according to tumor size and HER2. The correlation between SUVmax and Ki-67 was significant. However, the correlation between tumor background count density ratio and Ki-67 was not statistically significant. CONCLUSION In DCIS and DCIS-Mi cases, significant correlations were found between increased FDG uptake and several histological and biological factors for poor prognosis (tumor size, Van Nuys Prognostic Index, and HER2).
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30
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Lee SH, Ha S, An HJ, Lee JS, Han W, Im SA, Ryu HS, Kim WH, Chang JM, Cho N, Moon WK, Cheon GJ. Association between partial-volume corrected SUVmax and Oncotype DX recurrence score in early-stage, ER-positive/HER2-negative invasive breast cancer. Eur J Nucl Med Mol Imaging 2016; 43:1574-84. [PMID: 27209424 DOI: 10.1007/s00259-016-3418-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/05/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE Oncotype DX, a 21-gene expression assay, provides a recurrence score (RS) which predicts prognosis and the benefit from adjuvant chemotherapy in patients with early-stage, estrogen receptor-positive (ER-positive), and human epidermal growth factor receptor 2-negative (HER2-negative) invasive breast cancer. However, Oncotype DX tests are expensive and not readily available in all institutions. The purpose of this study was to investigate whether metabolic parameters on (18)F-FDG PET/CT are associated with the Oncotype DX RS and whether (18)F-FDG PET/CT can be used to predict the Oncotype DX RS. METHODS The study group comprised 38 women with stage I/II, ER-positive/HER2-negative invasive breast cancer who underwent pretreatment (18)F-FDG PET/CT and Oncotype DX testing. On PET/CT, maximum (SUVmax) and average standardized uptake values, metabolic tumor volume, and total lesion glycolysis were measured. Partial volume-corrected SUVmax (PVC-SUVmax) determined using the recovery coefficient method was also evaluated. Oncotype DX RS (0 - 100) was categorized as low (<18), intermediate (18 - 30), or high (≥31). The associations between metabolic parameters and RS were analyzed. Multivariate logistic regression was used to identify significant independent predictors of low versus intermediate-to-high RS. RESULTS Of the 38 patients, 22 (58 %) had a low RS, 13 (34 %) had an intermediate RS, and 3 (8 %) had a high RS. In the analysis with 38 index tumors, PVC-SUVmax was higher in tumors in patients with intermediate-to-high RS than in those with low RS (5.68 vs. 4.06; P = 0.067, marginally significant). High PVC-SUVmax (≥4.96) was significantly associated with intermediate-to-high RS (odds ratio, OR, 10.556; P = 0.004) in univariate analysis. In multivariate analysis with clinicopathologic factors, PVC-SUVmax ≥4.96 (OR 8.459; P = 0.013) was a significant independent predictor of intermediate-to-high RS. CONCLUSIONS High PVC-SUVmax on (18)F-FDG PET/CT was significantly associated with an intermediate-to-high Oncotype DX RS. PVC metabolic parameters on (18)F-FDG PET/CT can be used to predict the Oncotype DX RS in patients with early-stage, ER-positive/HER2-negative breast cancer.
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Affiliation(s)
- Su Hyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seunggyun Ha
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine or College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Hyun Joon An
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Sung Lee
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Han Suk Ryu
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Won Hwa Kim
- Department of Radiology, Kyungpook National University Hospital, Daegu, South Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. .,Radiation Medicine Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. .,Radiation Medicine Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
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Basu S, Kumar R, Mavi A, Alavi A. Exploring Tumor Biology with Fluorodeoxyglucose-Positron Emission Tomography Imaging in Breast Carcinoma. PET Clin 2016; 4:381-9. [PMID: 27157307 DOI: 10.1016/j.cpet.2009.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article reviews the promising application of fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging in exploring tumor biology of breast carcinoma based upon the authors' experience and also reviews current literature on this topic. The interest in this novel aspect of breast PET imaging has gained momentum in recent years as more is understood about the molecular subtypes and heterogeneous behavior of breast cancer. With the development of newer targeted therapies, oncologists are realizing the need for a means of accurate prediction and assessment of treatment response early in the course of therapy. Hence the studies on FDG-PET imaging in exploring the tumor biology of breast carcinoma have focused on: tumor histologic subtypes, hormonal receptor expression, disease burden at diagnosis, tumor proliferation index, and other molecular parameters. The correlation of various PET tracer parameters (eg, 15O-water PET-derived blood flow measurements and 18F-FDG-PET derived glucose metabolism rate parameters) is also of considerable interest. To summarize, the utility of FDG-PET/CT imaging on this aspect of breast carcinoma imaging holds considerable promise in disease characterization, and it can be foreseen that it will soon aid in guiding and adapting newer therapeutic regimens.
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Affiliation(s)
- Sandip Basu
- Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Parel, Mumbai, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ayşe Mavi
- Department of Nuclear Medicine, Yeditepe University Hospital, Istanbul, Turkey
| | - Abass Alavi
- Nuclear Medicine Section, Radiology Department, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Garcia Vicente A, Soriano Castrejón A, Amo-Salas M, Lopez Fidalgo J, Muñoz Sanchez M, Alvarez Cabellos R, Espinosa Aunion R, Muñoz Madero V. Glycolytic activity in breast cancer using 18 F-FDG PET/CT as prognostic predictor: A molecular phenotype approach. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Moon H, Noh WC, Kim HA, Kim EK, Park KW, Lee SS, Choi JH, Han KW, Byun BH, Lim I, Kim BI, Choi CW, Lim SM. The Relationship Between Estrogen Receptor, Progesterone Receptor and Human Epidermal Growth Factor Receptor 2 Expression of Breast Cancer and the Retention Index in Dual Phase (18)F-FDG PET/CT. Nucl Med Mol Imaging 2016; 50:246-54. [PMID: 27540429 DOI: 10.1007/s13139-016-0412-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 03/11/2016] [Accepted: 03/16/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study investigates the correlation of retention index (RI) using the dual phase FDG PET/CT scan with the breast cancer biomarkers. METHODS A total of 55 patients with breast cancer underwent dual phase FDG PET/CT scans (60 and 120 min after FDG injection) before treatment. SUVmax and SUVmean of the primary breast tumors were measured, then the percent change of SUVmax and SUVmean between the two scans were calculated, and denoted as RImax and RImean, respectively. After the surgical resection of the breast tumor, the status of biomarkers (ER, PR, and HER-2) was evaluated in the postsurgical specimen. RESULTS RImean was significantly higher in ER (-) (median, 16.2; IQR, 10.8-21.0) or HER-2 (+) (median, 16.1; IQR, 10.7-21.6) tumors than in ER (+) tumors (median, 9.9; IQR, 5.5-15.3) or HER-2 (-) tumors (median, 10.5; IQR, 5.5-16.1). However, there were no significant differences of SUVmax or RImax according to the ER or HER-2 status. There were no significant differences of any PET parameters between PR (+) and PR (-) tumors. Based off ROC curve analyses, RImean predicted the ER (+) tumors (AUC, 0.699; p = 0.006), and HER-2 (+) tumors (AUC, 0.674; p = 0.022), but not the PR (+) tumors. However, neither SUVmax nor RImax predicted ER (+), PR (+), or HER-2 (+) tumors. CONCLUSIONS Retention index of SUVmean can reflect the ER and HER-2 status of breast cancers. Higher retention index of SUVmean might associate with lower ER expression and higher HER-2 expression.
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Affiliation(s)
- Hansol Moon
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Woo Chul Noh
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Republic of Korea
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Republic of Korea
| | - Eun-Kyu Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Republic of Korea
| | - Ko Woon Park
- Department of Radiology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Republic of Korea
| | - Seung Sook Lee
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, Republic of Korea ; Department of Pathology, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Joon Ho Choi
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Kyung Woo Han
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Byung Hyun Byun
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Ilhan Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Byung Il Kim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Chang Woon Choi
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
| | - Sang Moo Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706 Republic of Korea
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Ahn SG, Park JT, Lee HM, Lee HW, Jeon TJ, Han K, Lee SA, Dong SM, Ryu YH, Son EJ, Jeong J. Standardized uptake value of ¹⁸F-fluorodeoxyglucose positron emission tomography for prediction of tumor recurrence in breast cancer beyond tumor burden. Breast Cancer Res 2015; 16:502. [PMID: 25551703 PMCID: PMC4308858 DOI: 10.1186/s13058-014-0502-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) can reveal the metabolic activity of malignant tumors. Recent advances gained from molecular studies suggest that tumor biology can be a good predictor of prognosis in breast cancer. We compared the ability of maximum standardized uptake values (SUVmax) derived by FDG-PET with tumor burden in predicting tumor recurrence for patients with breast cancer. Methods 496 patients with breast cancer who underwent preoperative FDG-PET between April 2004 and May 2009 were retrospectively identified. SUVmax was obtained by FDG-PET, and the cutoff point was defined using a time-dependent receiver operating characteristic curve for recurrence-free survival (RFS). The primary endpoint was RFS. Results In multivariate analysis for RFS, SUVmax carried independent prognostic significance (hazard ratio, 2.39; 95% confidence interval, 1.20 to 4.76; P = 0.012). When the patients were classified into four groups according to the combined factors of tumor size (≤2 cm versus >2 cm) and SUVmax (<4 versus ≥4), RFS differed significantly (P < 0.001). Similarly, SUVmax had prognostic value in combination with nodal status (negative versus positive) or stage (I versus II and III) (P < 0.001 and P = 0.001, respectively). In hormone receptor–positive disease, SUVmax remained a significant prognostic factor for RFS based on multivariate analysis. Conclusions Our results highlight the prognostic value of FDG-PET in prediction of tumor relapse for patients with breast cancer. Particularly in patients with hormone receptor–positive disease, the tumor metabolic information provided by FDG-PET is more significantly correlated with prognosis than tumor burden. Electronic supplementary material The online version of this article (doi:10.1186/s13058-014-0502-y) contains supplementary material, which is available to authorized users.
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Glycolytic activity in breast cancer using 18F-FDG PET/CT as prognostic predictor: A molecular phenotype approach. Rev Esp Med Nucl Imagen Mol 2015; 35:152-8. [PMID: 26522003 DOI: 10.1016/j.remn.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/28/2015] [Accepted: 08/05/2015] [Indexed: 11/20/2022]
Abstract
AIM To explore the relationship between basal (18)F-FDG uptake in breast tumors and survival in patients with breast cancer (BC) using a molecular phenotype approach. MATERIAL AND METHODS This prospective and multicentre study included 193 women diagnosed with BC. All patients underwent an (18)F-FDG PET/CT prior to treatment. Maximum standardized uptake value (SUVmax) in tumor (T), lymph nodes (N), and the N/T index was obtained in all the cases. Metabolic stage was established. As regards biological prognostic parameters, tumors were classified into molecular sub-types and risk categories. Overall survival (OS) and disease free survival (DFS) were obtained. An analysis was performed on the relationship between semi-quantitative metabolic parameters with molecular phenotypes and risk categories. The effect of molecular sub-type and risk categories in prognosis was analyzed using Kaplan-Meier and univariate and multivariate tests. RESULTS Statistical differences were found in both SUVT and SUVN, according to the molecular sub-types and risk classifications, with higher semi-quantitative values in more biologically aggressive tumors. No statistical differences were observed with respect to the N/T index. Kaplan-Meier analysis revealed that risk categories were significantly related to DFS and OS. In the multivariate analysis, metabolic stage and risk phenotype showed a significant association with DFS. CONCLUSION High-risk phenotype category showed a worst prognosis with respect to the other categories with higher SUVmax in primary tumor and lymph nodes.
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Abstract
Nodular fasciitis (NF) is a common benign soft tissue tumor. However, F-FDG PET/CT findings of NF are limited. Two cases of NF are described that mimic soft tissue metastasis on F-FDG PET/CT during surveillance. F-FDG PET/CT is well documented in the surveillance of malignancy and increasing worldwide. There are growing chances of encountering FDG-avid nonmalignant soft tissue lesion. Nodular fasciitis could be considered as possible diagnosis on F-FDG PET/CT if a solitary well- circumscribed ovoid hypermetabolic soft tissue lesion is located in a muscle, intermuscular space, or adjacent tendon, especially in patients with a clinically low probability of tumor recurrence or metastasis.
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Correlation of the value of 18F-FDG uptake, described by SUVmax, SUVavg, metabolic tumour volume and total lesion glycolysis, to clinicopathological prognostic factors and biological subtypes in breast cancer. Nucl Med Commun 2015; 36:28-37. [PMID: 25299471 DOI: 10.1097/mnm.0000000000000217] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to observe the relationships between different metabolic parameters and clinicopathological features (CPFs) or immunohistochemically defined biological subtypes (IHC-BS) in breast cancer. MATERIALS AND METHODS Eighty-two women (83 lesions, tumour size>15 mm) underwent PET/computed tomography imaging after a core biopsy. Maximum and average standardized uptake values (SUVmax, SUVavg), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) in the primary tumour were calculated and compared with CPFs and IHC-BS. Tumours with oestrogen receptor (ER) positivity were separately investigated in relation to their progesterone receptor (PR) status. RESULTS Significant correlation was found between all metabolic parameters and high nuclear grade or ER status or IHC-BS. All parameters were higher in PR(-) and triple-negative cases than in PR(+) and non-triple-negative tumours, and the correlation was significant for most of the metabolic parameters (except for SUVavg in the case of PR status and MTV in the case of triple negativity). Significant correlation was found only for SUVmax regarding the human epidermal growth factor receptor 2 (HER2) status. There was moderate correlation between the Ki67 expression and the SUVmax or SUVavg. All metabolic parameters were higher in ER(+)/PR(-)/HER2(-) lesions compared with ER(+)/PR(+)/HER2(-) cancers. However, ER(+)/PR(-)/HER2(+) tumours had lower SUVmax and SUVavg compared with ER(+)/PR(+)/HER2(+) lesions. CONCLUSION Our study confirms that the fluorine-18 fluorodeoxyglucose uptake in primary tumour is associated with distinct CPFs or IHC-BS in breast cancer. SUVmax may reflect tumour metabolism more reliably compared with SUVavg, MTV or total lesion glycolysis. Our preliminary results suggest different biological properties in ER(+) tumours with different PR statuses.
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García Vicente AM, Soriano Castrejón Á, López-Fidalgo JF, Amo-Salas M, Muñoz Sanchez MDM, Álvarez Cabellos R, Espinosa Aunión R. Basal 18 F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography as a prognostic biomarker in patients with locally advanced breast cancer. Eur J Nucl Med Mol Imaging 2015; 42:1804-13. [DOI: 10.1007/s00259-015-3102-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/28/2015] [Indexed: 01/19/2023]
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Deng SM, Zhang W, Zhang B, Chen YY, Li JH, Wu YW. Correlation between the Uptake of 18F-Fluorodeoxyglucose (18F-FDG) and the Expression of Proliferation-Associated Antigen Ki-67 in Cancer Patients: A Meta-Analysis. PLoS One 2015; 10:e0129028. [PMID: 26038827 PMCID: PMC4454667 DOI: 10.1371/journal.pone.0129028] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/04/2015] [Indexed: 12/22/2022] Open
Abstract
Objective To study the correlation between 18F-FDG uptake and cell proliferation in cancer patients by meta-analysis of published articles. Methods We searched PubMed (MEDLINE included), EMBASE, and Cochrane Database of Systematic Review, and selected research articles on the relationship between 18F-FDG uptake and Ki-67 expression (published between August 1, 1994-August 1, 2014), according to the literature inclusion and exclusion criteria. The publishing language was limited to English. The quality of included articles was evaluated according to the Quality Assessment of Diagnosis Accuracy Studies-2 (QUADAS-2). The correlation coefficient (r) was extracted from the included articles and processed by Fisher's r-to-z transformation. The combined correlation coefficient (r) and the 95% confidence interval (CI) were calculated with STATA 11.0 software under a random-effects model. Begg's test was used to analyze the existence of publication bias and draw funnel plot, and the sources of heterogeneity were explored by sensitivity and subgroup analyses. Results According to the inclusion and exclusion criteria, 79 articles were finally included, including 81 studies involving a total of 3242 patients. All the studies had a combined r of 0.44 (95% CI, 0.41-0.46), but with a significant heterogeneity (I2 = 80.9%, P<0.01). Subgroup analysis for different tumor types indicated that most subgroups showed a reduced heterogeneity. Malignant melanoma (n = 1) had the minimum correlation coefficient (-0.22) between 18F-FDG uptake and Ki-67 expression, while the thymic epithelial tumors (TETs; n = 2) showed the maximum correlation coefficient of 0.81. The analytical results confirmed that correlation between 18F-FDG uptake and Ki-67 expression was extremely significant in TETs, significant in gastrointestinal stromal tumors (GISTs), moderate in patients with lung, breast, bone and soft tissue, pancreatic, oral, thoracic, and uterine and ovarian cancers, average in brain, esophageal and colorectal cancers, and poor in head and neck, thyroid, gastric and malignant melanoma tumors. Subgroup analysis indicated that positron emission tomography (PET) or PET/CT imaging technology or Ki-67 and standardized uptake value (SUV) measurement technology did not significantly affect the results of r values, and Begg's test showed no significant publication bias. Conclusion In cancer patients, 18F-FDG uptake showed a moderate positive correlation with tumor cell proliferation. Different tumor types exhibited varied degree of correlation, and the correlation was significant in TETs and GSTs. However, our results need further validation by clinical trials with a large sample of different tumor types.
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Affiliation(s)
- Sheng-ming Deng
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China
| | - Wei Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bin Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, China
- * E-mail:
| | - Yin-yin Chen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ji-hui Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi-wei Wu
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
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Tőkés T, Szentmártoni G, Torgyík L, Kajáry K, Lengyel Z, Györke T, Molnár BÁ, Tőkés AM, Kulka J, Dank M. Response evaluation after primary systemic therapy of Her2 positive breast cancer – an observational cross-sectional study. Croat Med J 2015; 56:128-38. [PMID: 25891872 PMCID: PMC4410165 DOI: 10.3325/cmj.2015.56.128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim To evaluate (I) trastuzumab-containing primary systemic therapy (PST) in human epidermal growth factor receptor 2 (Her2) overexpressing breast carcinomas; (II) compare the patients who achieved and those who did not achieve pathological complete remission (pCR), and (III) analyze the accuracy of different clinical-imaging modalities in tumor response monitoring. Methods 188 patients who received PST between 2008 and 2014 were reviewed and 43 Her2 overexpressing breast cancer patients (28 Luminal B/Her2-positive and 15 Her2-positive) were enrolled. 26 patients received mostly taxane-based PST without trastuzumab (Group 1) and 17 patients received trastuzumab-containing PST (Group 2). We compared the concordance between pCR and complete remission (CR) defined by breast-ultrasound, CR defined by standard 18F-fluoro-deoxy-glucose positron emission tomography and computerized tomography (FDG-PET/CT) criteria (Method 1) and CR defined by a novel, breast cancer specific FDG-PET/CT criteria (Method 2). Sensitivity (sens), specificity (spec), and positive (PPV) and negative predictive values (NPV) were calculated. Results 10 patients (38.5%) in Group 1 and 8 (47%) in Group 2 achieved pCR. pCR was significantly more frequent in Her2-positive than in Luminal B/Her2-positive tumors in both Group 1 (P = 0.043) and Group 2 (P = 0.029). PET/CT evaluated by the breast cancer specific criteria (PET/CT Method 2) differentiated pCR from non-pCR more accurately in both groups (Group 1: sens = 77.8%, spec = 100%, PPV = 100%, NPV = 71.4%; Group 2: sens = 87.5%, spec = 62.5%, PPV = 70%, NPV = 83.3%) than standard PET/CT criteria (Method 1) (Group 1: sens = 22.2% spec = 100% PPV = 100% NPV = 41.7%; in Group 2: sens = 37.5%, spec = 87.5%, PPV = 75% NPV = 58.3%) or breast ultrasound (Group 1, sens = 83.3% spec = 25% PPV = 62.5% NPV = 50%; Group 2, sens = 100% spec = 12.5% PPV = 41.6% NPV = 100%). Conclusion The benefit of targeted treatment with trastuzumab-containing PST in Her2 overexpressing breast cancer was defined in terms of pCR rate. Luminal B/Her2-positive subtype needs further subdivision to identify patients who would benefit from PST. Combined evaluation of tumor response by our novel, breast cancer specific FDG-PET/CT criteria accurately differentiated pCR from non-pCR patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Magdolna Dank
- Magdolna Dank, Semmelweis University, 1st Dept. of Internal Medicine, Oncological Division, Tömő street 25-29. 4th floor, Budapest, Hungary, H- 1083.,
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Chang CC, Tu HP, Chen YW, Lin CY, Hou MF. Tumour and lymph node uptakes on dual-phased 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography correlate with prognostic parameters in breast cancer. J Int Med Res 2014; 42:1209-21. [PMID: 25339454 DOI: 10.1177/0300060514549785] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine correlations between the uptake of 2-deoxy-2-[18F]fluoro-D-glucose (FDG) by primary tumours and axillary lymph nodes, and clinical and biological tumour prognostic parameters, in patients with newly diagnosed breast cancer. METHODS Newly diagnosed breast cancer patients who had received a dual-phased FDG positron emission tomography/computed tomography scan for pretreatment staging were enrolled retrospectively. Maximal standardized uptake values at 1 h (SUV1), 2 h (SUV2), and retention indices (RI) of the tumours and ipsilateral axillary lymph nodes were measured. SUV and RI were compared with clinical and biological prognostic parameters. RESULTS A total of 32 patients participated in the study. Tumour FDG uptake correlated with histological grade and tumour size. FDG uptake in axillary lymph nodes correlated positively with lymph node status, metastasis status and clinical stage. RI values for the tumour and lymph nodes were significantly positively correlated with human epidermal growth factor receptor-2 positivity. CONCLUSIONS FDG uptake in tumours and lymph nodes showed correlations with some clinical and biological parameters, and may serve as a predictive marker of tumour biological behaviour in breast cancer.
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Affiliation(s)
- Chin-Chuan Chang
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Wen Chen
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Yang Lin
- Department of Nuclear Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Feng Hou
- Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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Journal Club: Diagnostic value of (18)F-FDG PET/CT and MRI in predicting the clinicopathologic subtypes of invasive breast cancer. AJR Am J Roentgenol 2014; 203:272-9. [PMID: 25055259 DOI: 10.2214/ajr.13.11971] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the diagnostic value of (18)F-FDG PET/CT and MRI in predicting the clinicopathologic subtypes of breast cancer. MATERIALS AND METHODS The cases of 89 patients with mass-type invasive breast cancer who underwent FDG PET/CT and MRI before therapy were retrospectively analyzed. Eight imaging variables-maximum standardized uptake value (SUVmax), apparent diffusion coefficient, size, shape, margin, intratumoral enhancement, dynamic kinetics, and high intratumoral signal intensity on T2-weighted images-were compared with results for the pathologic markers Ki-67 antibody, estrogen receptor (ER), progesterone receptor (PR), and ERBB2 (formerly HER2 or HER2/neu). The diagnostic performance of the imaging variables for sub-typing was evaluated, and the predictors of the subtypes were elucidated. RESULTS Higher SUVmax was significantly associated with a high Ki-67 index (p < 0.0001), ER-negative status (p = 0.0001), and PR-negative status (p = 0.047). Significant correlation was also found between size and ER status (p = 0.002) and between shape and PR status (p = 0.044). The AUC exceeded 0.7 only in identification of the luminal A sub-type by application of cutoff values for SUVmax (AUC, 0.751). When smaller tumors were excluded, AUC increased (AUC, 0.803 for tumors > 16 mm). Multivariate analysis showed that SUVmax was the sole independent predictor of luminal A subtype (odds ratio per SD, 0.291; p < 0.0001). SUVmax was significantly lower for luminal A (4.4 ± 2.2) than non-luminal A (8.1 ± 4.4; p < 0.0001) tumors. A cutoff value of 5.4 yielded 79% sensitivity and 68% specificity for prediction that a tumor was the luminal A subtype. CONCLUSION FDG PET/CT findings may contribute to differentiation of the luminal A and non-luminal A subtypes of invasive breast cancer.
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Ahn SG, Lee M, Jeon TJ, Han K, Lee HM, Lee SA, Ryu YH, Son EJ, Jeong J. [18F]-fluorodeoxyglucose positron emission tomography can contribute to discriminate patients with poor prognosis in hormone receptor-positive breast cancer. PLoS One 2014; 9:e105905. [PMID: 25167062 PMCID: PMC4148332 DOI: 10.1371/journal.pone.0105905] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/23/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients with hormone receptor-positive breast cancer typically show favorable survival. However, identifying individuals at high risk of recurrence among these patients is a crucial issue. We tested the hypothesis that [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) scans can help predict prognosis in patients with hormone receptor-positive breast cancer. METHODS Between April 2004 and December 2008, 305 patients with hormone receptor-positive breast cancer who underwent FGD-PET were enrolled. Patients with luminal B subtype were identified by positivity for human epidermal growth factor receptor-2 (HER2) or high Ki67 (≥14%) according to criteria recently recommended by the St. Gallen panelists. The cut-off value of SUVmax was defined using the time-dependent receiver operator characteristic curve for recurrence-free survival (RFS). RESULTS At a median follow up of 6.23 years, continuous SUVmax was a significant prognostic factor with a hazard ratio (HR) of 1.21 (p = 0.021). The cut-off value of SUVmax was defined as 4. Patients with luminal B subtype (n = 82) or high SUVmax (n = 107) showed a reduced RFS (p = 0.031 and 0.002, respectively). In multivariate analysis for RFS, SUVmax carried independent prognostic significance (p = 0.012) whereas classification with immunohistochemical markers did not (p = 0.274). The Harell c-index was 0.729. High SUVmax was significantly associated with larger tumor size, positive nodes, HER2 positivity, high Ki67 (≥14%), high tumor grade, and luminal B subtype. CONCLUSIONS Among patients with hormone receptor-positive breast cancer, FDG-PET can help discriminate patients at high risk of tumor relapse.
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Affiliation(s)
- Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minkyung Lee
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Joo Jeon
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Biostatistics collaboration unit, Gangnam Medical Research Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hak Min Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ah Lee
- Department of Surgery, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Kang CM, Cho A, Kim H, Chung YE, Hwang HK, Choi SH, Lee WJ. Clinical correlations with (18)FDG PET scan patterns in solid pseudopapillary tumors of the pancreas: still a surgical enigma? Pancreatology 2014; 14:515-23. [PMID: 25256437 DOI: 10.1016/j.pan.2014.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 06/07/2014] [Accepted: 08/12/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are limited numbers of PET studies of solid pseudopapillary tumors (SPT) of the pancreas. MATERIALS AND METHODS We reviewed the medical records of 37 patients who underwent resection of pancreatic SPT and had been preoperatively evaluated by (18)F-FDG PET or PET/CT scan. Immunohistochemical analysis of glucose transporter-1 (GLUT-1) and hexokinase II (HK-II) was performed. RESULTS SPT could be categorized into five types according to the morphologic characteristics observed in PET images. Type I (hot FDG uptake in the entire tumor portion) was the most frequent (13, 34.2%), followed by type IV (focal uptake, 12, 31.6%), II (focal defect, 8, 21.1%), III (multiple and geographic uptake, 3, 7.9%), and V (total defective type, 1, 2.6%). The SUVmax in the solid portion of the SPT was 5.3 ± 4.1. The clinical pattern of FDG uptake in SPT was not associated with histopathologic features suggesting malignant potential. The SUVmax of SPT followed a pattern according to pattern of FDG uptake (R(2) = 0.203, p = 0.055), and was significantly associated with adjusted tumor volume (p = 0.001). GLUT-1 was not expressed in SPT, and only eight patients (12.3%) showed mild to moderate expression of HK-II, which was associated with the clinical pattern of SPT in PET images (p < 0.05). CONCLUSION SPT of the pancreas could be categorized according to the morphologic patterns observed in PET images. The clinical significance of FDG uptake, glucose metabolism, and clinical usefulness of PET scan in SPT need to be further investigated, and thus this tumor remains a surgical enigma.
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Affiliation(s)
- Chang Moo Kang
- Department of Surgery, Yonsei University College of Medicine Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Republic of Korea.
| | - Arthur Cho
- Department of Radiology, Yonsei University College of Medicine Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Republic of Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Republic of Korea
| | - Young Eun Chung
- Department of Radiology, Yonsei University College of Medicine Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Republic of Korea
| | - Ho Kyoung Hwang
- Department of Surgery, Yonsei University College of Medicine Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Republic of Korea
| | - Sung Hoon Choi
- Department of Surgery, Bundang CHA Hospital, CHA University College of Medicine, Seongnam, Republic of Korea
| | - Woo Jung Lee
- Department of Surgery, Yonsei University College of Medicine Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Republic of Korea.
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Using (18)F-FLT PET to distinguish between malignant and benign breast lesions with suspicious findings in mammography and breast ultrasound. Ann Nucl Med 2014; 28:941-9. [PMID: 25139471 DOI: 10.1007/s12149-014-0889-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the diagnostic performance of 3'-deoxy-3'-[(18)F]fluorothymidine ((18)F-FLT) PET in women with suspicious breast findings on conventional imaging (mammography and breast ultrasound). METHODS Twenty-eight women with suspicious findings on conventional imaging were enrolled. A whole-body PET/CT in the supine position (first PET) was performed 60 min after intravenous injection of 0.07 mCi/kg (18)F-FLT, followed by a regional PET of the breast in the prone position (second PET). For each lesion, the SUVmax of the first PET (SUV1) and second PET (SUV2) were measured. For the receiver operating characteristic (ROC) analysis of the diagnostic parameters, of the cutoff points with sensitivities >90 %, we chose the one with highest specificity as the optimal cutoff point to obtain the corresponding sensitivity and specificity. RESULTS A total of 34 breast lesions (21 benign, 13 malignant) were analyzed. The SUV1 and SUV2 of the malignant lesions (median values 4.6 vs. 4.4, respectively) were higher than those of the benign lesions that had medians of 1.2 and 1.0, respectively (P = 0.0001). The area under the ROC curve (AUC) of SUV1 (0.905) showed no significant difference from that of SUV2 (0.912) (P = 0.77). The sensitivity and specificity using SUV1 = 1.24 as cutoff were 92.3 and 52.4 %, and those using SUV2 = 1.5 as cutoff were 92.3 and 66.7 %, respectively. CONCLUSION (18)F-FLT PET showed acceptable diagnostic performance for suspicious breast findings on conventional imaging, and SUV2 showed higher specificity than SUV1.
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Elias SG, Adams A, Wisner DJ, Esserman LJ, van't Veer LJ, Mali WPTM, Gilhuijs KGA, Hylton NM. Imaging features of HER2 overexpression in breast cancer: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2014; 23:1464-83. [PMID: 24807204 DOI: 10.1158/1055-9965.epi-13-1170] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breast cancer imaging phenotype is diverse and may relate to molecular alterations driving cancer behavior. We systematically reviewed and meta-analyzed relations between breast cancer imaging features and human epidermal growth factor receptor type 2 (HER2) overexpression as a marker of breast cancer aggressiveness. MEDLINE and EMBASE were searched for mammography, breast ultrasound, magnetic resonance imaging (MRI), and/or [(18)F]fluorodeoxyglucose positron emission tomography studies through February 2013. Of 68 imaging features that could be pooled (85 articles, 23,255 cancers; random-effects meta-analysis), 11 significantly related to HER2 overexpression. Results based on five or more studies and robustness in subgroup analyses were as follows: the presence of microcalcifications on mammography [pooled odds ratio (pOR), 3.14; 95% confidence interval (CI), 2.46-4.00] or ultrasound (mass-associated pOR, 2.95; 95% CI, 2.34-3.71), branching or fine linear microcalcifications (pOR, 2.11; 95% CI, 1.07-4.14) or extremely dense breasts on mammography (pOR, 1.37; 95% CI, 1.07-1.76), and washout (pOR, 1.57; 95% CI, 1.11-2.21) or fast initial kinetics (pOR, 2.60; 95% CI, 1.43-4.73) on MRI all increased the chance of HER2 overexpression. Maximum [(18)F]fluorodeoxyglucose standardized uptake value (SUVmax) was higher upon HER2 overexpression (pooled mean difference, +0.76; 95% CI, 0.10-1.42). These results show that several imaging features relate to HER2 overexpression, lending credibility to the hypothesis that imaging phenotype reflects cancer behavior. This implies prognostic relevance, which is especially relevant as imaging is readily available during diagnostic work-up.
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Affiliation(s)
| | - Arthur Adams
- Department of Radiology, University Medical Center Utrecht, Utrecht
| | | | | | - Laura J van't Veer
- Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | | | - Kenneth G A Gilhuijs
- Department of Radiology, University Medical Center Utrecht, Utrecht; Department of Radiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Departments of
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Agresti R, Crippa F, Sandri M, Martelli G, Tagliabue E, Alessi A, Pellitteri C, Maccauro M, Maugeri I, Barbara P, Rampa M, Moscaroli A, Ferraris C, Carcangiu ML, Bianchi G, Greco M, Bombardieri E. Different biological and prognostic breast cancer populations identified by FDG-PET in sentinel node-positive patients: results and clinical implications after eight-years follow-up. Breast 2014; 23:334-40. [PMID: 24485802 DOI: 10.1016/j.breast.2014.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 12/23/2013] [Accepted: 01/05/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sentinel node (SN) biopsy is the standard method to evaluate axillary node involvement in breast cancer (BC). Positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (FDG-PET) provides a non-invasive tool to evaluate regional nodes in BC in a metabolic-dependent, biomolecular-related way. In 1999, we initiated a prospective non-randomized study to compare these two methods and to test the hypothesis that FDG-PET results reflect biomolecular characteristics of the primary tumor, thereby yielding valuable prognostic information. PATIENTS AND METHODS A total of 145 cT1N0 BC patients, aged 24-70 years, underwent FDG-PET and lymphoscintigraphy before surgery. SN biopsy was followed in all cases by complete axillary dissection. Pathologic evaluation in tissue sections for involvement of the SN and other non-SN nodes served as the basis of the comparison between FDG-PET imaging and SN biopsy. RESULTS FDG-PET and SN biopsy sensitivity was 72.6% and 88.7%, respectively, and negative predictive values were 80.5% and 92.2%, respectively. A subgroup of more aggressive tumors (ER-GIII, Her2+) was found mainly in the FDG-PET true-positive (FDG-PET+) patients, whereas LuminalA, Mib1 low-rate BCs were significantly undetected (p = 0.009) in FDG-PET false-negative (FDG-PET-) patients. Kaplan-Meier survival estimates after a median follow-up of more than 8 years showed significantly worse overall survival for FDG-PET+ patients in node-positive (N+) patients (p = 0.035) as compared to N+/FDG-PET- patients, which overlapped with survival curves of N- and FDG-PET+ or - patients. CONCLUSIONS Our findings suggest that FDG-PET results reflect intrinsic biologic features of primary BC tumors and have prognostic value with respect to nodal metastases. FDG-PET false negative cases appear to identify less aggressive indolent metastases. The possibility to identify a subgroup of N+ BC patients with an outcome comparable with N- BC patients could reduce the surgical and adjuvant therapeutic intervention.
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Affiliation(s)
- Roberto Agresti
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Flavio Crippa
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Sandri
- Molecular Targeting Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriele Martelli
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elda Tagliabue
- Molecular Targeting Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Alessi
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Pellitteri
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Maccauro
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Maugeri
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Padovano Barbara
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Rampa
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Moscaroli
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Ferraris
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Giulia Bianchi
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Greco
- Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emilio Bombardieri
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Correlation of 18F-fluorodeoxyglucose uptake with histopathological prognostic factors in breast carcinoma. Nucl Med Commun 2013; 34:1055-67. [DOI: 10.1097/mnm.0b013e3283658369] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kalinyak JE, Berg WA, Schilling K, Madsen KS, Narayanan D, Tartar M. Breast cancer detection using high-resolution breast PET compared to whole-body PET or PET/CT. Eur J Nucl Med Mol Imaging 2013; 41:260-75. [PMID: 24085500 DOI: 10.1007/s00259-013-2553-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 08/19/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the performance characteristics of positron emission mammography (PEM) with those of whole-body PET (WBPET) and PET/CT in women with newly diagnosed breast cancer. METHODS A total of 178 women consented to PEM for presurgical planning in an IRB-approved protocol and also underwent either WBPET (n = 69) or PET/CT (n = 109) imaging, as per usual care at three centers. Tumor detection sensitivity, positive predictive values, and (18)F-fluorodeoxyglucose (FDG) uptake were compared between the modalities. The effects of tumor size, type, and grade on detection were examined. The chi-squared or Fisher's exact tests were used to compare distributions between groups, and McNemar's test was used to compare distributions for paired data within subject groups, i.e. PEM versus WBPET or PEM versus PET/CT. RESULTS The mean age of the women was 59 ± 12 years (median 60 years, range 26-89 years), with a mean invasive index tumor size of 1.6 ± 0.8 cm (median 1.5 cm, range 0.5-4.0 cm). PEM detected more index tumors (61/66, 92%) than WBPET (37/66, 56%; p < 0.001) or PET/CT (95/109, 87% vs. 104/109, 95% for PEM; p < 0.029). Sensitivity for the detection of additional ipsilateral malignancies was also greater with PEM (7/15, 47%) than with WBPET (1/15, 6.7%; p = 0.014) or PET/CT (3/23, 13% vs. 13/23, 57% for PEM; p = 0.003). Index tumor detection decreased with decreasing invasive tumor size for both WBPET (p = 0.002) and PET/CT (p < 0.001); PEM was not significantly affected (p = 0.20). FDG uptake, quantified in terms of maximum PEM uptake value, was lowest in ductal carcinoma in situ (median 1.5, range 0.7-3.0) and invasive lobular carcinoma (median 1.5, range 0.7-3.4), and highest in grade III invasive ductal carcinoma (median 3.1, range 1.4-12.9). CONCLUSION PEM was more sensitive than either WBPET or PET/CT in showing index and additional ipsilateral breast tumors and remained highly sensitive for tumors smaller than 1 cm.
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O JH, Choi WH, Han EJ, Choi EK, Chae BJ, Park YG, Kim SH. The Prognostic Value of (18)F-FDG PET/CT for Early Recurrence in Operable Breast Cancer: Comparison with TNM Stage. Nucl Med Mol Imaging 2013; 47:263-7. [PMID: 24900122 DOI: 10.1007/s13139-013-0232-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 08/12/2013] [Accepted: 08/16/2013] [Indexed: 12/30/2022] Open
Abstract
PURPOSE We evaluated whether the maximum standardized uptake values (SUVmax) of primary tumor from the initial staging by (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) of patients with breast cancer could identify patients at risk for early recurrence within 2 years, particularly in comparison to the American Joint Committee on Cancer (AJCC) stage. METHODS We reviewed the staging (18)F-FDG PET/CT images of patients with primary breast cancer and their medical records. The SUVmax of the primary tumor was measured. The presence or absence of FDG uptake in the axillary lymph node (ALN) was also assessed. The patient's pathologic primary tumor stage (pT), pathologic regional lymph node stage (pN), stage grouping, age, estrogen receptor (ER) and progesterone receptor (PR) status, and neoadjuvant chemotherapy history were evaluated with the FDG uptake parameters for recurrence within 2 years following the end of first-line therapy. RESULTS Recurrence within 2 years was present in 9.1 % (n = 40) out of the 441 patients assessed. The FDG uptake in ALN, pT, pN, stage grouping and neoadjuvant chemotherapy history were prognostic for early recurrence, while primary tumor SUVmax, age, and ER or PR status were not significant on logistic regression. On multivariate analysis, only the stage grouping (odds ratio 2.79; 95 % CI 1.73, 4.48; p < 0.0001) and neoadjuvant chemotherapy history (odds ratio 2.70; 95 % CI 1.22, 5.98; p = 0.0141) could identify patients at increased risk for recurrence within 2 years. CONCLUSIONS Primary tumor FDG uptake measured by SUVmax, and visual assessment of FDG uptake in the ALN in the initial staging PET/CT of patients with breast cancer may not have additional prognostic value compared with the AJCC stage grouping for early recurrence.
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Affiliation(s)
- Joo Hyun O
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seocho-gu Banpo-dong 505, Seoul, Republic of Korea 137-701
| | - Woo Hee Choi
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seocho-gu Banpo-dong 505, Seoul, Republic of Korea 137-701
| | - Eun Ji Han
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seocho-gu Banpo-dong 505, Seoul, Republic of Korea 137-701
| | - Eun-Kyoung Choi
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seocho-gu Banpo-dong 505, Seoul, Republic of Korea 137-701
| | - Byung Joo Chae
- Department of Surgery, The Catholic University of Korea, Seoul, Korea
| | - Yong-Gyu Park
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea
| | - Sung Hoon Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seocho-gu Banpo-dong 505, Seoul, Republic of Korea 137-701
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