HER2-Positive Breast Cancer: Tumor-to-Liver SUV Ratio is the Best Parameter for Detection in F-18 FDG-PET/CT

Noda, Yoshifumi; Goshima, Satoshi; Kawada, Hiroshi; Kawai, Nobuyuki; Koyasu, Hiromi

doi:10.5812/iranjradiol.41928

Cited by 3 publications

(2 citation statements)

References 42 publications

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“…In our study, the mean TLR and TSR had statistically significant relation with the molecular subtype of the breast tumor with P value = 0.018 and 0.061, it was found to be high among the HER2/Neu positive subtype tumors than among triple negative, luminal A and B subtype tumors. This finding agrees with Noda et al [22] who concluded a positive correlation between tumor to liver SUV max of the lesion with the molecular subtype (P = 0.0049) and agreed also with AbdElaal et al [23] who concluded that "the mean TLR values were much higher in Her2neu+, GIII and TN molecular subtype patients (P = 0.002, 0.0476, 0.005 and 0.018 respectively)…”

Section: Discussionsupporting

confidence: 90%

Correlation between tumor to liver SUV ratio and molecular subtypes of invasive breast carcinoma in PET CT

Kiki

Mohamed

ElMaati

et al. 2022

Egypt J Radiol Nucl Med

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Background Breast cancer is known to be one of the most cancer affecting women around the globe and the second most common cancer in general. In third worlds countries, breast cancer is the most cause of cancer death. Early diagnosis and accurate follow-up of these patients affect the management. There are multiple prognostic factors most important one is the immunohistochemical molecular markers in the specimens including human epidermal growth factor, progesterone, and estrogen receptors (HER2, PR, ER). In breast cancer, the HER2 positive molecular subtype is associated with a bad prognosis and aggressive histological features, yet while following neoadjuvant chemotherapy, it achieves an increased pathological complete response rate. 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) has proved to be an effective and accurate imaging technique for lymph node and distant metastasis assessment, tumor staging, restaging of recurrence, treatment response, and follow-up. In breast cancer, tumor molecular subtype, tumor size, proliferation index, and histological grade correlated with 18F-fluoro-2-deoxy-d-glucose (FDG) uptake. This study evaluates the possible correlation between tumor to liver and tumor to spleen (standardized uptake value) SUV max ratio and the four different molecular subtypes in patients with pathologically proven primary breast cancer. Results Tumor to liver and tumor to spleen SUV max ratio (TLR, TSR) was a significant parameter for HER2 molecular subtype identification (P value = 0.0005 and 0.014 respectively) and luminal A molecular subtype identification (P value = 0.016 and 0.037 respectively). The specificity, sensitivity, and area under the receiver operating-characteristic curve (AUC) of TLR parameters for HER2-positive subtype identification were 89.4%, 83.3%, and 0.89, respectively. The specificity, sensitivity, and AUC of the TSR parameter for HER2-positive subtype identification were 57.9%, 100%, and 0.83, respectively. Conclusions TLR and TSR appeared to be valuable for HER2- and luminal A molecular subtype detection. thus, 18F-FDG PET/CT could be a beneficial tool for prediction of tumor biological characteristics that help in management of breast cancer patients.

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Section: Discussionsupporting

confidence: 90%

Correlation between tumor to liver SUV ratio and molecular subtypes of invasive breast carcinoma in PET CT

Kiki

Mohamed

ElMaati

et al. 2022

Egypt J Radiol Nucl Med

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“…Tumor to normal (liver or mediastinum) uptake ratio proved highly reproducible [21]. Tumor to liver ratio (TLR) was superior to SUVmax in predicting colorectal recurrence, occult lymph node metastasis in lung carcinoma, malignant changes in plexiform neurofibromas in cases with neurofibromatosis type 1, and proved to be useful for identification of human epidermal growth factor receptor 2 overexpression (HER2+) subtype breast cancer [22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Correlation between semiquantitative and volumetric 18F-FDG PET/computed tomography parameters and Ki-67 expression in breast cancer

Mohamadien

Sayed

2021

Nuclear Medicine Communications

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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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The influence of receptor expression and clinical subtypes on baseline [18F]FDG uptake in breast cancer: systematic review and meta-analysis

et al. 2023

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Background To quantify the relationship between [18F]FDG uptake of the primary tumour measured by PET-imaging with immunohistochemical (IHC) expression of ER, PR, HER2, Ki-67, and clinical subtypes based on these markers in breast cancer patients. Methods PubMed and Embase were searched for studies that compared SUVmax between breast cancer patients negative and positive for IHC expression of ER, PR, HER2, Ki-67, and clinical subtypes based on these markers. Two reviewers independently screened the studies and extracted the data. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were estimated by using DerSimonian-Laird random-effects models. P values less than or equal to 5% indicated statistically significant results. Results Fifty studies were included in the final analysis. SUVmax is significantly higher in ER-negative (31 studies, SMD 0.66, 0.56–0.77, P < 0.0001), PR-negative (30 studies, SMD 0.56; 0.40–0.71, P < 0.0001), HER2-positive (32 studies, SMD − 0.29, − 0.49 to − 0.10, P = 0.0043) or Ki-67-positive (19 studies, SMD − 0.77; − 0.93 to − 0.61, P < 0.0001) primary tumours compared to their counterparts. The majority of clinical subtypes were either luminal A (LA), luminal B (LB), HER2-positive or triple negative breast cancer (TNBC). LA is associated with significantly lower SUVmax compared to LB (11 studies, SMD − 0.49, − 0.68 to − 0.31, P = 0.0001), HER2-positive (15 studies, SMD − 0.91, − 1.21 to − 0.61, P < 0.0001) and TNBC (17 studies, SMD − 1.21, − 1.57 to − 0.85, P < 0.0001); and LB showed significantly lower uptake compared to TNBC (10 studies, SMD − 0.77, − 1.05 to − 0.49, P = 0.0002). Differences in SUVmax between LB and HER2-positive (9 studies, SMD − 0.32, − 0.88 to 0.24, P = 0.2244), and HER2-positive and TNBC (17 studies, SMD − 0.29, − 0.61 to 0.02, P = 0.0667) are not significant. Conclusion Primary tumour SUVmax is significantly higher in ER-negative, PR-negative, HER2-positive and Ki-67-positive breast cancer patients. Luminal tumours have the lowest and TNBC tumours the highest SUVmax. HER2 overexpression has an intermediate effect.

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HER2-Positive Breast Cancer: Tumor-to-Liver SUV Ratio is the Best Parameter for Detection in F-18 FDG-PET/CT

Abstract: Background/Objectives: The purpose of this study was to assess the efficacy of pain control at a single center in a population of patients with osteoporotic fractures or vertebral metastasis after vertebroplasty (VP).

Cited by 3 publications

References 42 publications

Correlation between tumor to liver SUV ratio and molecular subtypes of invasive breast carcinoma in PET CT

Correlation between tumor to liver SUV ratio and molecular subtypes of invasive breast carcinoma in PET CT

Correlation between semiquantitative and volumetric 18F-FDG PET/computed tomography parameters and Ki-67 expression in breast cancer

The influence of receptor expression and clinical subtypes on baseline [18F]FDG uptake in breast cancer: systematic review and meta-analysis

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