18F-FDG PET/CT for early prediction of response to neoadjuvant chemotherapy in breast cancer

Duch, Joan; Fuster, David; Muñoz, Montserrat; Fernández, Pedro; Paredes, Pilar; Fontanillas, Montserrat; Guzman, Flavia; Rubí, S.; Lomeña, Francisco; Pons, Françesca

doi:10.1007/s00259-009-1116-y

Cited by 108 publications

(70 citation statements)

References 33 publications

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“…In many studies [71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] that have evaluated a possible role for metabolic evaluation with FDG-PET and PET/ CT, investigators demonstrated a correlation between early changes in FDG uptake, mostly in terms of the SUV max value, after one or two courses of chemotherapy and the final pathologic response upon completion of chemotherapy, or patient outcome (Table 4). A review article including 745 patients in 15 studies indicated that the pooled sensitivity and specificity of FDG-PET for early separation of responders from non-responders could reach 80.5 % (95 % CI, 75.9-84.5 %) and 78.8 % (95 % CI, 74.1-83.0 %), respectively [91].…”

Section: Early Treatment Response Assessmentmentioning

confidence: 99%

Present and future role of FDG-PET/CT imaging in the management of breast cancer

Kitajima

Miyoshi

2016

Jpn J Radiol

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by malignant cells, opened a new field in clinical oncologic imaging. Recently, integrated positron emission tomography/computed tomography (PET/CT), in which a full-ringdetector clinical PET scanner and multidetector-row helical CT scanner are combined, has made it possible to acquire both metabolic and anatomic imaging data using a single device in a single diagnostic session, and provides precise anatomic localization of suspicious areas of increased FDG uptake. When used in a clinical setting, FDG-PET/CT leads to a significant improvement in diagnostic accuracy and has had a considerable impact on patient management, including diagnosis, initial staging, optimization of treatment, restaging, monitoring of the response to therapy, and prognostication of various malignant tumors. We herein review the current and future roles of FDG-PET/CT in the management of breast cancer, discussing its usefulness and limitations for imaging in these patients. DiagnosisFDG-PET imaging has poor sensitivity (<50 %) for subcentimeter breast cancers [9,10]. This is due to the limited spatial resolution of PET and, in some cases, by tumor characteristics (e.g., low FDG avidity in grade 1 cancer, ductal carcinoma in situ, or lobular carcinoma) [1,2]. Specificity can also be altered by variations of FDG uptake in certain benign conditions, such as infection, fibroadenoma, ductal adenoma, inflammatory granulomatous mastitis, and fibrocystic changes [3].In order to improve specificity, some authors would obtain a second series of PET images centered on the breast approximately 2 h after FDG injection (dual-time imaging) [4]. Indeed, FDG uptake seems to increase with time in the case of malignancy, while some inflammatory lesions show stable or decreasing uptake [4]. However, dual-time Abstract Integrated positron emission tomography/computed tomography (PET/CT) with 2-[18F]fluoro-2-deoxyd-glucose (FDG) is a useful tool for acquisition of both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session, and has opened a new field in clinical oncologic imaging. FDG-PET/CT has been used successfully for the diagnosis, initial staging, restaging, early treatment response assessment, evaluation of metastatic disease response, and prognostication of breast cancer as well as various malignant tumors. We herein review the current place and role of FDG-PET/CT in the management of breast cancer, focusing on its usefulness and limitations in the imaging of these patients.

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Section: Early Treatment Response Assessmentmentioning

confidence: 99%

Present and future role of FDG-PET/CT imaging in the management of breast cancer

Kitajima

Miyoshi

2016

Jpn J Radiol

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“…In a few papers, determination of tumor blood flow and metabolism with a single injection of FDG was suggested to be an alternative to the less available 15 O-water. Indeed, dynamic FDG-PET can indirectly evaluate blood flow using a two-compartment model [100,102], but it requires an acquisition of 1 hour.…”

Section: Changes In Tumor Blood Flow and Angiogenesismentioning

confidence: 99%

“…Indeed, dynamic FDG-PET can indirectly evaluate blood flow using a two-compartment model [100,102], but it requires an acquisition of 1 hour. Mullani et al [103] used a shorter first-pass method to calculate blood flow by dynamic imaging 2 minutes after FDG injection: it was linearly correlated with the 15 O-water method. Cochet et al [104] demonstrated that, in breast cancer, blood flow determined with this first-pass FDG method was correlated with tumor angiogenesis evaluated by immunohistochemistry.…”

Section: Changes In Tumor Blood Flow and Angiogenesismentioning

confidence: 99%

“…The Seattle group has assessed perfusion in breast cancer using 15 O-labeled water [34,[98][99][100][101]. They determined that blood flow decrease after 2 months of therapy can predict tumor response and outcome in women receiving NAC [99,100].…”

Section: Changes In Tumor Blood Flow and Angiogenesismentioning

confidence: 99%

“…Because glucose metabolism is increased in breast cancer, the monitoring of the metabolic response with FDG-PET has been proposed for the early prediction of pCR [7][8][9][10][11][12][13][14][15]. PET uptake measures can provide a continuous indicator of response and carries information beyond the standard dichotomous evaluations usually used in other response assessments.…”

Section: Fdg-pet In the Neoadjuvant Settingmentioning

confidence: 99%

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Role of Positron Emission Tomography for the Monitoring of Response to Therapy in Breast Cancer

et al. 2015

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This review considers the potential utility of positron emission tomography (PET) tracers in the setting of response monitoring in breast cancer, with a special emphasis on glucose metabolic changes assessed with 18 F-fluorodeoxyglucose (FDG). In the neoadjuvant setting of breast cancer, the metabolic response can predict the final complete pathologic response after the first cycles of chemotherapy. Because tumor metabolic behavior highly depends on cancer subtype, studies are ongoing to define the optimal metabolic criteria of tumor response in each subtype.The recent multicentric randomized AVATAXHER trial has suggested, in the human epidermal growth factor 2-positive subtype, a clinical benefit of early tailoring the neoadjuvant treatment in women with poor metabolic response after the first course of treatment. In the bone-dominant metastatic setting, there is increasing clinical evidence that FDG-PET/computed tomography (CT) is the most accurate imaging modality for assessment of the tumor response to treatment when both metabolic information and morphologic information are considered. Nevertheless, there is a need to define standardized metabolic criteria of response, including the heterogeneity of response among metastases, and to evaluate the costs and health outcome of FDG-PET/CT compared with conventional imaging. New non-FDG radiotracers highlighting specific molecular hallmarks of breast cancer cells have recently emerged in preclinical and clinical studies. These biomarkers can take into account the heterogeneity of tumor biology in metastatic lesions. They may provide valuable clinical information for physicians to select and monitor the effectiveness of novel therapeutics targeting the same molecular pathways of breast tumor. The Oncologist 2015;20:94-104 Implications for Practice:18 F-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is a molecular imaging exam. It can monitor breast cancer response to therapy earlier than the tumor shrinking observed with conventional imaging. This review focuses on the advantages and limits of FDG-PET for early determination of response, both in the neoadjuvant and metastatic settings. It discusses the different PET timing and metabolic criteria to define response that have been evaluated in previous studies. The development of new radiotracers of specific molecular pathways of breast cancer cells is also a challenging and promising research area to monitor the effectiveness of the new target treatments emerging in breast cancer.

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Optimum threshold estimation based on cost function in a multistate diagnostic setting

Skaltsa

Jover

Fuster

2011

Statistics in Medicine

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In the diagnostic area, the usual setting considers two populations: nondiseased and diseased. The use of the standard ROC analysis methodology is well established. Sometimes, however, diagnostic problems inherently include more than two classification states. For example, 'yes, uncertain, no' or 'low, normal, high'. Here we consider a three-normal distribution setting and derive estimators for the optimum thresholds between states based on a cost function. These estimators can be extended for clinical contexts with more than three states. This approach is well known for the two-state setting and its advantage lies in the fact that it accounts for the specific context's properties, such as disease prevalence and classification costs. Here we calculated the variance of the estimators by the use of parametric methods on nonlinear equations and we constructed confidence intervals accounting for possible uncertainty in the threshold estimation. We conducted a simulation study to assess the performance of these estimators and the confidence intervals. Comparisons with the naive threshold estimation method of joining the distributions two-by-two and applying standard ROC techniques proved that the latter method is not reliable for all parameter combinations and should be avoided.

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18F-FDG PET/CT for early prediction of response to neoadjuvant chemotherapy in breast cancer

Abstract: 18F-FDG PET/CT can predict response to neoadjuvant chemotherapy at an early stage.

Cited by 108 publications

References 33 publications

Present and future role of FDG-PET/CT imaging in the management of breast cancer

Present and future role of FDG-PET/CT imaging in the management of breast cancer

Role of Positron Emission Tomography for the Monitoring of Response to Therapy in Breast Cancer

Optimum threshold estimation based on cost function in a multistate diagnostic setting

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