Comparison of standardized uptake value of 18F-FDG-PET-CT with 21-gene recurrence score in estrogen receptor-positive, HER2-negative breast cancer

Abstract

BackgroundWe 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 methodsOne 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.ResultsThe 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).ConclusionsSUV, 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.

Comparisons of tumor-infiltrating lymphocyte levels and the 21-gene recurrence score in ER-positive/HER2-negative breast cancer

“…For immunohistochemistry (IHC), antibodies specific for ER (1:100 clone 6F11; Novocastra, Newcastle upon Tyne, UK), progesterone receptor (PR; clone 16; Novocastra), HER2 (4B5 rabbit monoclonal antibody; Ventana Medical Systems, Tucson, AZ, USA), and Ki-67 (MIB-1; Dako, Glostrup, Denmark) were stained using formalin-fixed, paraffin-embedded tissue sections [ 17 ]. Positivity of ER and PR IHC expression was defined according to the modified Allred system: positive, Allred score 2–8; and negative, Allred score 0–1 [ 18 ]. All tumors included in this study had ER positivity (Allred scores ≥3).…”

Genomic Signature of the Standardized Uptake Value in 18F-Fluorodeoxyglucose Positron Emission Tomography in Breast Cancer

“…Hierarchical clustering analysis with 1424 genes divided the BRC patients into two subgroups according to the SUV: an SUV-high cluster (SHC) and an SUV-low cluster (SLC) ( Figure S1A). When comparing sample clusters divided by SUV-correlated genes and subgroups dichotomized by an SUV cut-off (SUV of ≤ 4 or > 4), as used in our previous studies [1,4], we observed that two criteria demonstrated significantly similar BRC patient classifications (Fisher's exact test; p = 1.71 × 10 −4 ; Figure S1A). No difference between recurrences estimated by these two criteria was observed ( Figure S1B), indicating that SUV-correlated genes reflect the SUV's prognostic characteristic.…”

“…Therefore, understanding glycolysis associated with FDG-PET in malignancy may offer novel therapeutic options that target metabolism in BRC. Previous investigations also showed a significant association between the SUV and prognostic indicators such as estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), or histologic grade in BRC [1,4,5,10,11], indicating a close relationship between tumor aggressiveness and FDG-PET. Despite the metabolic or oncogenic significance of FDG-PET imaging, its characteristics have not been fully explored at the integrative genomics level, which might be because of the complex effects of glucose metabolism on multiple cancer progression steps.…”

“…18 F-fluorodexoyglucose positron emission tomography (FDG-PET) is utilized for predicting tumor behavior molecularly and clinically, because this imaging modality accurately reflects tumor biology [1][2][3][4]. In breast cancer (BRC), numerous investigations have shown the contribution of tumor biology to increased glucose uptake in FDG-PET [5,6] and have demonstrated that the degree of glucose uptake is associated with aggressive tumor characteristics [7,8].…”

Dual time point 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in primary breast cancer

“…The RFS rate of patients with breast cancers of the ER-positive/HER2-negative subtype was significantly lower in the high-SUV max /high-ΔSUV max % group than in the other groups (P = 0.0008). SUV max was shown to be correlated with 21-gene recurrence score in ERpositive/HER2-negative breast cancer [31]. Therefore, SUV-related parameters might be clinically useful, in addition to the 21-gene recurrence score, for the selection of high-risk node-negative luminal breast cancers, although a larger-scale study is necessary.…”