Role of maximum standardized uptake value in fluorodeoxyglucose positron emission tomography/computed tomography predicts malignancy grade and prognosis of operable breast cancer: a multi-institute study

Abstract

The malignant biological behavior of breast cancer remains obscure on diagnostic images, although understanding the grade of such malignancy is important for selecting appropriate treatment. Therefore, malignancy grades in operable breast cancer were evaluated using positron emission tomography/computed tomography (PET/CT) in a multicenter setting. We prospectively examined the features and prognosis of 344 patients (mean age ± SD: 58.0 ± 12.5 years) with clinical stages I–III breast cancer, who underwent surgical intervention without induction therapy between January 2006 and December 2011. Maximum standardized uptake values (maxSUV) obtained from whole-body fluorodeoxyglucose-PET/CT immediately before surgery were assessed to predict the malignant aggressiveness of tumors including the recurrence-free survival of the patients. Variations in maxSUV among institutions, which are limitations of PET assessments in multicenter studies, were adjusted using a phantom study. The median follow up period was 52 months. The patients were divided into groups according to cut-off maxSUV (≤3.0 vs. >3.0) values established from receiver operating characteristic analysis of recurrence (area under the curve = 0.713). A higher maxSUV was significantly associated with a higher T-factor (p < 0.0001), N-factor (p = 0.0049), nuclear grade (p < 0.0001), negative for estrogen (p = 0.0309), and progesterone receptors (p = 0.0063), positive for human epidermal growth factor receptor 2 (p = 0.0012), lymph node metastasis (p = 0.0128), and vascular invasion (p = 0.0110). Multivariate analysis using Cox proportional hazard regression model revealed high maxSUV and negative estrogen receptor status as significantly prognostic factors (p = 0.033 and p = 0.004, respectively). This study demonstrated that maxSUV on PET/CT as well as estrogen receptor status is useful to predict malignancy grades and the prognosis of patients with breast cancer.

Ability of contrast-enhanced ultrasonography to determine clinical responses of breast cancer to neoadjuvant chemotherapy

“…Therefore, this modality is unsuitable for predicting pCR (11,12). Positron emission tomography/computed tomography (PET/CT) is considered useful for diagnosing (13) and assessing the prognosis (14,15) of invasive breast cancer. Although it is also useful for assessing treatment effects (16), the specificity of PET/CT for pCR after chemotherapy is low (17) and the procedure is expensive.…”

Could semiquantitative FDG analysis add information to the prognosis in patients with stage II/III breast cancer undergoing neoadjuvant treatment?

“…The usefulness of semiquantitative PET parameters in breast cancer has previously been reported [5,12,13]. The majority of reports describe the role of SUVmax in predicting response to therapy, but its prognostic meaning is still controversial [14].…”

“…PET/CT has a role in the initial staging of locally advanced breast cancer (LABC) providing better definition of disease extension and in the choice of treatment [3]. Moreover, evaluation of standardized uptake value (SUV) by PET/ CT seems to provide additional prognostic information in operable breast cancer [4,5]. In particular, as recently reported by Baba et al [4], a maximum SUV (SUVmax) ≥4.…”

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

“…Mastectomy performed upon completion of NAC (eight courses) showed no pCR 1 3 controversial. Several authors have suggested that SUV in primary breast cancer [10,[96][97][98][99] or in axillary LN metastasis [34,100] could be predictive of outcome. Jo et al [99] evaluated whether preoperative SUV max of the primary tumor was associated with DFS in 508 patients with invasive ductal breast cancer, along with histological and biological factors such as tumor size, histological grade, or hormonal receptor expression status, and concluded that a high primary tumor SUV max is an independent factor associated with recurrence.…”