Neoadjuvant Chemotherapy in Breast Cancer: Prediction of Pathologic Response with PET/CT and Dynamic Contrast-enhanced MR Imaging—Prospective Assessment

Tateishi, Ukihide; Miyake, Makito; Nagaoka, Tomoaki; Terauchi, Takashi; Kubota, Kazunori; Kinoshita, Takayuki; Daisaki, Hiromitsu; Macapinlac, Homer A.

doi:10.1148/radiol.12111177

Cited by 116 publications

(86 citation statements)

References 25 publications

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“…Our results contradict those of the only other study to date comparing the performance of DSUV max and DTLG-a study that reported a higher predictive value for DSUV max (13). In that previous study, DSUV mean , DSUV peak , and DMATV predictive values were not considered.…”

Section: Discussioncontrasting

confidence: 99%

“…These parameters, which allow for a more comprehensive tumor functional level evaluation, include metabolically active tumor volume (MATV) (11) and total lesion glycolysis (TLG), defined as the product of MATV and its associated SUV mean (12). In a recent study that compared SUV max and TLG derived using manual delineation and threshold, SUV max had a better predictive value than TLG in identifying pCR (13).…”

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Comparison Between ¹⁸F-FDG PET Image–Derived Indices for Early Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer

et al. 2013

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The goal of this study was to determine the best predictive factor among image-derived parameters extracted from sequential 18 F-FDG PET scans for early tumor response prediction after 2 cycles of neoadjuvant chemotherapy in breast cancer. Methods: 51 breast cancer patients were included. Responder and nonresponder status was determined by histopathologic examination according to the tumor and node Sataloff scale. PET indices (maximum and mean standardized uptake value [SUV], metabolically active tumor volume, and total lesion glycolysis [TLG]), at baseline and their variation (D) after 2 cycles of neoadjuvant chemotherapy were extracted from the PET images. Their predictive value was investigated using Mann-Whitney U tests and receiver-operating-characteristic analysis. Subgroup analysis was also performed by considering estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, triple-negative, and HER2-positive tumors separately. The impact of partial-volume correction was also investigated using an iterative deconvolution algorithm. Results: There were 24 pathologic nonresponders and 27 responders. None of the baseline PET parameters was correlated with response. After 2 neoadjuvant chemotherapy cycles, the reduction of each parameter was significantly associated with response, the best prediction of response being obtained with DTLG (96% sensitivity, 92% specificity, and 94% accuracy), which had a significantly higher area under the curve (0.91 vs. 0.82, P 5 0.01) than did DSUV max (63% sensitivity, 92% specificity, and 77% accuracy). Subgroup analysis confirmed a significantly higher accuracy for DTLG than DSUV for ER-positive/ HER-negative but not for triple-negative and HER2-positive tumors. Partial-volume correction had no impact on the predictive value of any of the PET image-derived parameters despite significant changes in their absolute values. Conclusion: Our results suggest that the reduction after 2 neoadjuvant chemotherapy cycles of the metabolically active volume of primary tumor measurements such as DTLG predicts histopathologic tumor response with higher accuracy than does DSUV measurements, especially for ER-positive/HER2-negative breast cancer. These results should be confirmed in a larger group of patients as they may potentially increase the clinical value and efficiency of 18 F-FDG PET for early prediction of response to neoadjuvant chemotherapy.

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Section: Discussioncontrasting

confidence: 99%

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Comparison Between ¹⁸F-FDG PET Image–Derived Indices for Early Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer

et al. 2013

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“…33 In addition, all cancer subtypes were mixed (ERþ/HER2À, triple-negative, and HER2-positive), and the endpoint was to predict pCR. 32 The higher predictive value of DTLG over DSUV max that we observed in these ERþ/HER2À tumors may have several explanations. Baseline 18 F-FDG uptake is weaker and the decrease in SUV during NAC is lower than for other phenotypes, 8,10,13 as demonstrated in 1 study (À45% AE 25% and À57% AE 30%, respectively, in the TN and HER2-positive subtypes versus À19% AE 35% in the ERþ/HER2À subtype; P < .0001).…”

Section: Discussionmentioning

confidence: 78%

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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“…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%

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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Neoadjuvant Chemotherapy in Breast Cancer: Prediction of Pathologic Response with PET/CT and Dynamic Contrast-enhanced MR Imaging—Prospective Assessment

Abstract: The sensitivities of %SUV(max) (66.7%), %k(ep) (51.7%), and %AUC(90) (50.0%) at (18)F-FDG PET/CT and DCE MR after two cycles of NAC are not acceptable, but the specificities (96.4%, 92.0%, and 95.2%, respectively) are high for stratification of pCR cases in breast cancer.

Cited by 116 publications

References 25 publications

Comparison Between ¹⁸F-FDG PET Image–Derived Indices for Early Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer

Comparison Between ¹⁸F-FDG PET Image–Derived Indices for Early Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer

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

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Neoadjuvant Chemotherapy in Breast Cancer: Prediction of Pathologic Response with PET/CT and Dynamic Contrast-enhanced MR Imaging—Prospective Assessment

Abstract: The sensitivities of %SUV(max) (66.7%), %k(ep) (51.7%), and %AUC(90) (50.0%) at (18)F-FDG PET/CT and DCE MR after two cycles of NAC are not acceptable, but the specificities (96.4%, 92.0%, and 95.2%, respectively) are high for stratification of pCR cases in breast cancer.

Cited by 116 publications

References 25 publications

Comparison Between 18F-FDG PET Image–Derived Indices for Early Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer

Comparison Between 18F-FDG PET Image–Derived Indices for Early Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer

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

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Comparison Between ¹⁸F-FDG PET Image–Derived Indices for Early Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer

Comparison Between ¹⁸F-FDG PET Image–Derived Indices for Early Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer