Monitoring of Early Response to Neoadjuvant Chemotherapy in Stage II and III Breast Cancer by [<sup>18</sup>F]Fluorodeoxyglucose Positron Emission Tomography

Rousseau, Caroline; Devillers, Anne; Sagan, Christine; Ferrer, Ludovic; Bridji, B.; Campion, Loı̈c; Ricaud, Myriam; Bourbouloux, Emmanuelle; Doutriaux, Isabelle; Clouet, Martine; Berton‐Rigaud, Dominique; Bouriel, C.; Delecroix, Valérie; Garin, Étienne; Rouquette, S.; Resche, I.; Kerbrat, Pierre; Chatal, Jean François; Campone, Mario

doi:10.1200/jco.2006.05.7406

Cited by 288 publications

(236 citation statements)

References 22 publications

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“…Sample size was calculated to assess the efficacy of PET-derived parameters in predicting response with an AUC of approximately 0.85 considered significantly different from the null hypothesis value of 0.5 (indicating no discriminating power), with type I and II errors levels of 0.05, leading to a required size of 31 patients per group, 29 assuming a rate of pathologic response (total þ partial responses) of 50% based on previously published data. 9 For each PET parameter, the correlation between the response and the absolute values at baseline and after the second cycle, as well as the evolution (D) between baseline and the second cycle, was evaluated using the Mann-Whitney U test. The predictive performance regarding the identification of nonresponders was evaluated using receiver operating characteristic (ROC) analysis.…”

Section: Discussionmentioning

confidence: 99%

“…8 Because a pCR is rare in ERþ/HER2À breast cancer, we chose to consider both pCRs and partial responses (>50% therapeutic effect according to the Sataloff scale), which also was used by Rousseau and colleagues. 9 We acknowledge that this definition of response is somewhat arbitrary and less meaningful than an assessment of clinical outcome. However, correlation of changes in PET parameters with outcomes would have been challenging, requiring long-term follow-up, because recurrences in ERþ/HER2À often occur late, several years after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…7 Also, an early change in 18 F-FDG uptake is a potential predictive biomarker of response to NAC. [8][9][10][11][12] However, at baseline, as demonstrated in recent studies, ER-positive tumors are usually characterized by rather low standardized uptake values (SUVs) because of lower 18 F-FDG uptake compared with other breast cancer phenotypes. 8,10,11,13 Because of this limitation and because of incomplete regression when ERþ/HER2À tumors are treated by NAC, PET parameters taking into account volume measurements may be of interest in this specific subgroup.…”

Section: Introductionmentioning

confidence: 99%

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Estrogen receptor‐positive/human epidermal growth factor receptor 2‐negative breast tumors

Groheux

Hatt

Hindié

et al. 2013

Cancer

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BACKGROUND:The objective of this prospective study was to evaluate the ability of 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) to predict chemosensitivity in patients with estrogen receptor (ER)-positive/ human epidermal growth factor receptor 2 (HER2)-negative breast cancer. METHODS: Sixty-four consecutive patients underwent 18 F-FDG PET/CT scanning at baseline and after the second course of neoadjuvant chemotherapy (NAC). The evolution (D) between the 2 scans of image parameters (maximum standardized uptake value [SUV max ], SUV mean , metabolic tumor volume, and total lesion glycolysis [TLG]) was measured. Correlations between early changes in PET-derived parameters and pathologic response observed in surgical specimens after the completion of 8 courses of NAC were estimated with Mann-Whitney U tests. Response prediction on the basis of clinical data, histologic type, or molecular markers also was assessed (Fisher exact test). Receiver operating characteristic (ROC) analysis was used to compare the area under the curve (AUC) of each parameter. RESULTS: The best prediction of chemosensitivity was obtained with DTLG (À49% AE 31% in nonresponders vs À73% AE 25% in responders; P <.0001). Among the biologic parameters, only negative progesterone receptor status (57% responders vs 31% nonresponders; P ¼.04) and luminal B subtype (63% responders vs 22% nonresponders; P ¼.02) were predictive of a pathologic response. ROC analysis resulted in an AUC of 0.81, 0.73, 0.71, and 0.63 for DTLG, DSUV max , luminal subtype, and progesterone receptor status, respectively. CONCLUSIONS: When patients responded to NAC, the majority of ER-positive/HER2 negative tumors exhibited partial tumor shrinkage; and the PET parameters that combined volume and activity measurements, such as TLG, offered better accuracy for early prediction than the SUV max . Negative progesterone receptor status and luminal B subtype had weaker predictive power than PET-derived parameters. Cancer KEYWORDS: 18 F-fluorodeoxyglucose, positron emission tomography/computed tomography, maximum standardized uptake value, total lesion glycolysis, estrogen receptor-positive/human epidermal growth factor receptor 2 negative breast cancer, luminal tumor, neoadjuvant chemotherapy, metabolic response, pathologic response, chemosensitivity. INTRODUCTIONNeoadjuvant chemotherapy (NAC) is commonly offered to patients with locally advanced breast cancer and to women with primary operable but large breast cancer. This strategy allows more patients to undergo breast-conserving surgery and provides information on the efficacy of chemotherapy. Breast carcinoma is a heterogeneous class of tumors, and gene-expression profiling has led to the identification of 5 different subtypes with clinical implications (ie, luminal A, luminal B, basal-like, human epidermal growth factor receptor 2 [HER2]-like, and normal-like subtypes). 1 To some degree, these molecular subtypes can be distinguished using immunohistochemistry. 2 Estrogen receptor...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Estrogen receptor‐positive/human epidermal growth factor receptor 2‐negative breast tumors

Groheux

Hatt

Hindié

et al. 2013

Cancer

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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%

“…Second, the definition of what constitutes a good histopathologic response varies. For example, Rousseau et al [73] defined a tumor regression superior to 50 % as a good response, whereas Schwarz-Dose et al [78] considered no residual invasive tumor or only a few scattered foci of microscopic residual tumor to indicate a satisfactory pathologic response. Third, the optimal timing of interim PET remains unclear.…”

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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Methods for quantitative imaging biomarker studies

Toledano

Obuchowski

2016

Handbook for Clinical Trials of Imaging and Image‐Guided Interventions

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Monitoring of Early Response to Neoadjuvant Chemotherapy in Stage II and III Breast Cancer by [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography

Abstract: Pathologic response to neoadjuvant chemotherapy in stage II and III breast cancer can be predicted accurately by FDG PET after two courses of chemotherapy.

Cited by 288 publications

References 22 publications

Estrogen receptor‐positive/human epidermal growth factor receptor 2‐negative breast tumors

Estrogen receptor‐positive/human epidermal growth factor receptor 2‐negative breast tumors

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

Methods for quantitative imaging biomarker studies

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Monitoring of Early Response to Neoadjuvant Chemotherapy in Stage II and III Breast Cancer by [18F]Fluorodeoxyglucose Positron Emission Tomography

Abstract: Pathologic response to neoadjuvant chemotherapy in stage II and III breast cancer can be predicted accurately by FDG PET after two courses of chemotherapy.

Cited by 288 publications

References 22 publications

Estrogen receptor‐positive/human epidermal growth factor receptor 2‐negative breast tumors

Estrogen receptor‐positive/human epidermal growth factor receptor 2‐negative breast tumors

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

Methods for quantitative imaging biomarker studies

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Monitoring of Early Response to Neoadjuvant Chemotherapy in Stage II and III Breast Cancer by [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography