Standardized Uptake Values for Breast Carcinomas Assessed by Fluorodeoxyglucose-Positron Emission Tomography Correlate with Prognostic Factors

Abstract

Several studies have revealed the diagnostic value of fluorodeoxyglucose-positron emission tomography for breast carcinomas. However, breast carcinomas display considerable variation in 18F-labeled 2-fluoro-2-deoxy-D-glucose uptake, and few papers have reported the clinical utility of the standardized uptake values (SUV). The purpose of this study is to investigate the relationship between SUV assessed by positron emission tomography (PET) and the clinicopathological characteristics of breast carcinoma. We reviewed 52 breast carcinomas of 45 patients presented at our department between January 2004 and July 2005. We compared the histopathological findings of the breast carcinomas with the preoperative SUV. Of the 52 breast carcinomas, 49 (94%) were detected by preoperative PET. A positive correlation was found between the SUV and tumor size ( P < 0.01), histological grade ( P < 0.01), the expression of the estrogen receptor ( P < 0.001), progesterone receptor ( P < 0.01), and p53 ( P < 0.01). The number of metastatic axillary lymph nodes (r = 0.73; P < 0.0001) and the MIB-1 labeling rates (r = 0.5; P < 0.01) correlated with the SUV of the breast carcinomas. No relationship existed between the SUV and the following: histological tumor types ( P = 0.07), human epidermal growth factor receptor-2 status ( P = 0.10), and the presence of metastatic lymph nodes ( P = 0.10). The SUV of the breast carcinomas correlate with several histopathological and immunohistochemical prognostic factors. We can obtain information on the degree of malignancy of the carcinoma and prognostic factors by preoperative PET examination.

Association between [18F]fluorodeoxyglucose uptake and prognostic parameters in breast cancer

“…Tumours that were greater than 2 cm in diameter (T2) had significantly higher FDG uptake than those smaller than 2 cm ( P < 0·001). This correlation has been reported by other authors2, 5–7. Tumours classified as grade III showed higher FDG uptake than those classified as I or II.…”

“…In the present study, oestrogen receptor‐negative breast carcinomas had a significantly higher FDG uptake ( P < 0·001); the SUV was negatively related to oestrogen receptor status in the multivariable analysis. A significant association between FDG uptake and oestrogen receptor status was reported by Dehdashti and colleagues13 and in two recent studies6, 7. Basu and co‐workers14 observed that triple‐negative breast tumours (oestrogen receptor negative, progesterone receptor negative and human epidermal growth factor receptor 2 negative) were associated with enhanced FDG uptake commensurate with their aggressive biology; they are also detected with high sensitivity using FDG–PET imaging.…”

“…Tumours classified as grade III showed higher FDG uptake than those classified as I or II. As tumours with high glucose metabolism proliferate actively, and tumours with high proliferation activity usually show high histological grade1, 8, the relationship between the SUV and histological grade is not surprising1, 2, 6, 9–11.…”

“…Many studies have revealed a significant correlation between SUV and Ki‐67 overexpression6, 8, 12 but data for breast cancer show contradictory results. Although Crippa and co‐workers1 found no correlation between the thymidine labelling index and the SUV, they reported a positive correlation between the SUV and Ki‐67 in malignant breast tumours, as did Avril and colleagues8.…”

“…Several authors1, 6, 9 reported a positive correlation between FDG uptake and p53 overexpression, but Buck and co‐workers12 demonstrated that p53 was independent of FDG uptake in breast tumours. No significant correlation was observed between FDG uptake and c‐erbB2 expression in the present study, as in other reports2, 12.…”