Utility of 18F FDG-PET/CT for predicting prognosis of luminal-type breast cancer

Abstract

Postoperative prognosis is better for hormonal receptor-positive breast cancer than for other phenotypes; however, there are no definitive predictive factors for relapse or survival. This study aimed to evaluate the maximum standardized uptake value (SUVmax) on 18F-fluoro-2-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) and clinicopathological characteristics as possible predictors of postoperative relapse-free survival (RFS) and overall survival (OS) in hormonal receptor-positive breast cancer patients. We evaluated 262 patients with Stage I–III breast cancer diagnosed as luminal type (luminal A, 166; luminal B, 96 patients) who underwent preoperative FDG-PET/CT between January 2006 and December 2011 at two institutions. The relationships among SUVmax and clinicopathological factors (age, clinical T/N stage, nuclear grade, lymph node metastasis and vascular invasion) were evaluated. A phantom study was performed to correct differences in PET/CT analysis between two institutions. The patients were divided according to the SUVmax cutoff on receiver operating characteristic (ROC) analysis for OS (≤6.0 group vs. >6.0 group, AUC = 0.742). Clinical T-factor and nuclear grade were significantly correlated with SUVmax (p < 0.0001 and p = 0.0092, respectively). In the uni- and multivariate analyses using the Cox model for relapse, SUVmax was significant (p = 0.013 and p = 0.055, respectively) among characteristics. RFS curves showed that prognosis was significantly better for the SUVmax ≤ 6.0 group than for the SUVmax > 6.0 group (p = 0.004). Similarly, SUVmax was significant for OS (p = 0.007 and p = 0.008). OS was significantly different between the SUVmax ≤ 6.0 and >6.0 groups (p < 0.001). SUVmax was useful for predicting outcomes in patients with luminal-type breast cancer.

Basal 18 F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography as a prognostic biomarker in patients with locally advanced breast cancer

“…With regard to the biological subtypes, previous studies have described relationships between tumour metabolism and prognosis in hormonal receptor positive and luminal HER2 negative BC [20,21]. In the present study, a separate ROC curve analysis of the three biological categories did not improve the prognostic performance of semiquantitave metabolic values obtained in the global sample, although we observed that HER2 positive and basal tumours displayed higher SUV T with respect to luminal HER2 negative tumours.…”

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.…”

Is 18FDG uptake useful to decide on chemotherapy in ER+/HER2- breast cancer?

“…In the univariate and multivariate analyses, SUV max was identified as the only significant factor for overall survival (SUV max cutoff value of 6). Patient's age, Clinical T score, clinical N score and nuclear grade were not predictive for overall survival [10].…”

“…In a recent preliminary report, the same team also suggested that SUV max of 4 to be used as a cutoff value to estimate the Oncotype DX RS (to separate low-tointermediate from high RS) [9]. In the study by Aogi et al [10], 262 stage I-III luminal BC patients (187 with T1 tumour) had 18 FDG-PET/CT before initial therapy. In the univariate and multivariate analyses, SUV max was identified as the only significant factor for overall survival (SUV max cutoff value of 6).…”

“…The studies from Lee [7], Ahn [8,9] and Aogi [10] are focused on early stage BC. Partial volume effect can affect SUV values.…”