Axillary Lymph Node-to-Primary Tumor Standard Uptake Value Ratio on Preoperative¹⁸F-FDG PET/CT: A Prognostic Factor for Invasive Ductal Breast Cancer

Abstract

PurposeThis study assessed the axillary lymph node (ALN)-to-primary tumor maximum standard uptake value (SUVmax) ratio (ALN/T SUV ratio) in invasive ductal breast cancer (IDC) on preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) to determine the effectiveness in predicting recurrence-free survival (RFS).MethodsOne hundred nineteen IDC patients (mean age, 50.5±10.5 years) with pathologically proven ALN involvement without distant metastasis and preoperative FDG PET/CT were enrolled in the study. SUVmax values of the ALN and primary tumor were obtained on FDG PET/CT, and ALN/T SUV ratio was calculated. Several factors were evaluated for their effectiveness in predicting RFS. These included several parameters on FDG PET/CT as well as several clinicopathological parameters: pathologic tumor/node stage; nuclear and histological grade; hormonal state; status with respect to human epidermal growth factor receptor 2, mindbomb E3 ubiquitin protein ligase 1 (MIB-1), and p53; primary tumor size; and ALN size.ResultsAmong 119 patients with breast cancer, 17 patients (14.3%) experienced relapse during follow-up (mean follow-up, 28.4 months). The ALN/T SUV ratio of the group with disease recurrence was higher than that of the group without recurrence (0.97±1.60 and 0.45±0.40, respectively, p=0.005). Univariate analysis showed that the primary tumor SUVmax, ALN SUVmax, ALN/T SUV ratio, ALN status, nuclear and histological grade, estrogen receptor (ER) status, and MIB-1 status were predictors for RFS. Among these variables, ALN/T SUV ratio with hazard ratio of 4.20 (95% confidence interval [CI], 1.74-10.13) and ER status with hazard ratio of 4.33 (95% CI, 1.06-17.71) were predictors for RFS according to multivariate analysis (p=0.002 and p=0.042, respectively).ConclusionOur study demonstrated that ALN/T SUV ratio together with ER status was an independent factor for predicting relapse in IDC with metastatic ALN. ALN/T SUV ratio on preoperative FDG PET/CT may be a useful marker for selecting IDC patients that need adjunct treatment to prevent recurrence.

Prognostic Value of Lymph Node-To-Primary Tumor Standardized Uptake Value Ratio in Esophageal Squamous Cell Carcinoma Treated with Definitive Chemoradiotherapy

“…The strength of the current study is that the SUV LN /SUV Tumor is simple to calculate and may have less inter-scanner variability compared to the SUV LN , and thus SUV LN /SUV Tumor may have better generalizability. In addition, SUV LN /SUV Tumor may reflect the aggressiveness of the primary tumor and the biological interactions between primary tumor and metastatic LNs as indicated by previous studies in other disease sites [22][23][24]26].…”

“…It has been demonstrated that higher SUV LN /SUV Tumor portended lower response to initial chemotherapy and poorer survival (PFS and OS) for patients with nonsmall cell lung cancer [22]. Similarly, it has been observed that SUV LN /SUV Tumor was an independent covariate for predicting relapse in cervical squamous cell carcinoma [26], invasive ductal breast cancer [24], and resectable pancreatic cancer [23].…”

“…The clinical implications of SUV LN /SUV Tumor have been investigated in recent studies in a wide variety of cancers [22][23][24][25][26][36][37][38]. The first established value for its use is to help evaluate the presence of metastatic LN.…”

“…Furthermore, recent studies have demonstrated the prognostic values of standardized uptake value (SUV) of the metastatic lymph nodes (LNs), in addition to the SUV of primary tumor [14][15][16][17][18][19], on both pretreatment [20] and posttreatment PET scans [21] in patients treated with dCRT. Intriguingly, the LN-to-tumor SUV ratio (SUV LN /SUV Tumor ) recently has been shown to have a strong relationship with clinical outcomes in other disease sites, including lung [22], pancreatic [23], breast [24], and gynecologic cancers [25,26]. However, there is currently no published study investigating the relative SUVs of metastatic LNs to that of primary tumor in ESCC.…”

Prognostic Value of Lymph Node to Primary Tumor Standardized Uptake Value Ratio in Unresectable Esophageal Cancer

“…node-to-tumor SUV ratio (NTR), is a promising functional biomarker which could be easily acquired without much change of the established work-flow and easily accessible for a retrospective study. NTR has been evaluated for prediction of axillary macrometastasis and prognosis in breast cancer (11,12), nodal staging in non-small-cell lung cancer (13), and prognosis prediction in cervical and endometrial cancer (14,15). We presumed that NTR may also provide prognostic information in patients with unresectable esophageal SCC.…”