Basal 18 F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography as a prognostic biomarker in patients with locally advanced breast cancer

Current guidelines do not systematically recommend 18F-FDG PET/CT for breast cancer staging; and the recommendations and level of evidence supporting its use in different groups of patients vary among guidelines. This review summarizes the evidence about the role of 18F-FDG PET/CT in breast cancer staging and the therapeutic and prognostic impact accumulated in the last decade. Other related aspects, such as the association of metabolic information with biology and prognosis are considered and evidence-based recommendations for the use of 18F-FDG PET/CT in breast cancer staging are offered. We systematically searched MEDLINE for articles reporting studies with at least 30 patients related to clinical questions following the Problem/Population, Intervention, Comparison, and Outcome framework. We critically reviewed the selected articles and elaborated evidence tables structuring the summarized information into methodology, results, and limitations. The level of evidence and the grades of recommendation for the use of 18F-FDG PET/CT in different contexts are summarized. Level III evidence supports the use of 18F-FDG PET/CT for initial staging in patients with recently diagnosed breast cancer; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a weak recommendation in this population. In patients with locally advanced breast cancer, level II evidence supports the use of 18F-FDG PET/CT for initial staging; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a strong recommendation in this population. In patients with recently diagnosed breast cancer, the metabolic information from baseline 18F-FDG PET/CT is associated with tumor biology and has prognostic implications, supported by level II evidence. In conclusion, 18F-FDG PET/CT is not recommended for staging all patients with early breast cancer, although evidence of improved regional and systemic staging supports its use in locally advanced breast cancer. Baseline tumor glycolytic activity is associated with tumor biology and prognosis.

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“…Evidence level III, weak recommendation . 14,17–28,36–46 For more information, see Tables 4, 5, and 7.…”

Section: Resultsmentioning

confidence: 99%

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

et al. 2017

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“…Prior studies have gone as far as to correlate a lower SUV max with an improved DFS (Kadoya et al , 2013; Aogi et al , 2015; Garcia Vicente et al , 2015) and OS (Aogi et al , 2015; Garcia Vicente et al , 2015). This suggests a link between SUV max and tumour biology and/or phenotype.…”

Section: Discussionmentioning

confidence: 99%

PET/MR in invasive ductal breast cancer: correlation between imaging markers and histological phenotype

et al. 2017

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Background:Differences in genetics and receptor expression (phenotypes) of invasive ductal breast cancer (IDC) impact on prognosis and treatment response. Immunohistochemistry (IHC), the most used technique for IDC phenotyping, has some limitations including its invasiveness. We explored the possibility of contrast-enhanced positron emission tomography magnetic resonance (CE-FDG PET/MR) to discriminate IDC phenotypes.Methods:21 IDC patients with IHC assessment of oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor-2 (HER2), and antigen Ki-67 (Ki67) underwent CE-FDG PET/MR. Magnetic resonance-perfusion biomarkers, apparent diffusion coefficient (ADC), and standard uptake value (SUV) were compared with IHC markers and phenotypes, using a Student's t-test and one-way ANOVA.Results:ER/PR− tumours demonstrated higher Kepmean and SUVmax than ER or PR+ tumours. HER2− tumours displayed higher ADCmean, Kepmean, and SUVmax than HER2+tumours. Only ADCmean discriminated Ki67⩽14% tumours (lower ADCmean) from Ki67>14% tumours. PET/MR biomarkers correlated with IHC phenotype in 13 out of 21 patients (62% P=0.001).Conclusions:Positron emission tomography magnetic resonance might non-invasively help discriminate IDC phenotypes, helping to optimise individual therapy options.

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“…Fluorine 18 ( 18 F) fluorodeoxyglucose (FDG)–combined positron emission tomography (PET) and computed tomography (CT) (PET/CT) is based on the abnormally high rate of glucose metabolism found in cancer cells. It is widely used in diagnostic imaging of many malignant tumours [ 14 – 16 ]. Although previous studies showed that 18 F-FDG PET had relatively low sensitivity in the assessment of nodal status in early-stage CRC, it showed better performance than conventional imaging methods, including CT [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative PET/CT ¹⁸F-FDG Standardized Uptake by Lymph Nodes as a Significant Prognostic Factor in Patients with Colorectal Cancer

Chen

Zhou

Huang

et al. 2018

Contrast Media & Molecular Imaging

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Purpose We evaluated the prognostic value of preoperative 18F-FDG uptake by suspected lymph nodes (LNs) using 18F-FDG PET/CT in colorectal cancer patients. Methods Patients with CRC underwent 18F-FDG PET/CT before radical surgery. We used Cox proportional hazards regression to examine the relationship between recurrence and the 18F-FDG maximum standardized uptake value (SUVmax) in the suspected LNs (SUVLN) on 18F-FDG PET/CT. Results Clinical data, treatment modalities, and results from 90 CR C patients were reviewed. The median follow-up was 19 months (range 3 to 72 months). Receiver operating characteristic analysis identified SUVLN 1.15 was the optimal cut-off value for predicting recurrence. SUVLN correlated with tumour size (P=0.045), lymph node metastasis (P=0.03), and recurrence (P < 0.0001). Univariate analysis showed significant associations between recurrence and SUVLN (P=0.017), and tumour grade (P=0.013). Multivariate analysis identified SUVLN (P < 0.0001), and tumour grade (P=0.005) as independent risk factors for recurrence. Patients with SUVLN ≤ 1.15 and SUVLN > 0.15 differed significantly in terms of recurrence (P < 0.0001). Conclusion Preoperative SUVLN measured by 18F-FDG PET/CT was significantly associated with recurrence and had significant prognostic value for recurrence-free survival in patients with colorectal cancer.

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Basal 18 F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography as a prognostic biomarker in patients with locally advanced breast cancer

Abstract: PET imaging with (18) F-FDG offers prognostic information for LABC that can be obtained preoperatively and noninvasively.

Cited by 26 publications

References 30 publications

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

PET/MR in invasive ductal breast cancer: correlation between imaging markers and histological phenotype

Preoperative PET/CT ¹⁸F-FDG Standardized Uptake by Lymph Nodes as a Significant Prognostic Factor in Patients with Colorectal Cancer

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Basal 18 F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography as a prognostic biomarker in patients with locally advanced breast cancer

Abstract: PET imaging with (18) F-FDG offers prognostic information for LABC that can be obtained preoperatively and noninvasively.

Cited by 26 publications

References 30 publications

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

PET/MR in invasive ductal breast cancer: correlation between imaging markers and histological phenotype

Preoperative PET/CT 18F-FDG Standardized Uptake by Lymph Nodes as a Significant Prognostic Factor in Patients with Colorectal Cancer

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Preoperative PET/CT ¹⁸F-FDG Standardized Uptake by Lymph Nodes as a Significant Prognostic Factor in Patients with Colorectal Cancer