Prognostic value of FDG-PET/CT prior to breast cancer treatment - Comparison with MRS and DWI

• Published in: The Journal of nuclear medicine (1978) Vol. 60
• Main Authors: Kitajima, Kazuhiro, Yamano, Toshiko, Miyoshi, Yasuo, Enoki, Takuya, Yamakado, Koichiro
• Format: Journal Article
• Language: English
• Published: New York Society of Nuclear Medicine 01.05.2019
• Subjects: Biopsy; Breast cancer; Cancer therapies; Chemotherapy; Choline; Computed tomography; Diffusion coefficient; Emission analysis; Glycolysis; Lymph nodes; Magnetic resonance imaging; Magnetic resonance spectroscopy; Medical prognosis; Metastases; Metastasis; Positron emission; Positron emission tomography; Progesterone; Rank tests; Survival; Tomography; Tumors
• ISSN: 0161-5505; 1535-5667

Purpose: To investigate the prognostic value of pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), magnetic resonance spectroscopy (MRS), and diffusion weighted imaging (DWI) in breast cancer patients. Materials and Methods: 83 patients with breast cancer larger than 2 cm underwent pretreatment FDG-PET/CT and 3-Tesla breast MRI, followed by neoadjuvant chemotherapy (NAC) and subsequent surgical resection. The relationships of PET parameters [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG)], total choline peak, and mean apparent diffusion coefficient (ADCmean) of the primary tumor and clinicopathologic factors with relapse-free survival (RFS) and overall-survival (OS) were evaluated using log-rank and Cox tests. Results: Within a median overall follow-up period of 36.3 months (16.1-76.9 months), 11 patients had recurrence and 4 died. Receiver operating characteristics curve analysis and log-rank test results showed that patients with high primary tumor SUVmax (≥6.20), MTV (≥5.39), TLG (≥23.23), and total choline peak (≥12.1) values had significantly worse RFS than those with low values (<6.20, <5.39, <23.23, <12.1, respectively) (p=0.0085, p=0.0029, p=0.013, p=0.016, respectively). ADC cut-off value (0.833×10-3) was not significant. Elevated SUVmax, MTV, TLG, and choline peak levels, progesterone receptor (PR) negative, high Ki-67 expression, presence of axillary lymph node metastasis, and advanced TNM staging were also significantly associated with recurrence, while elevated SUVmax and TLG, PR-negative, and axillary node metastasis were significantly associated with death. Conclusions: Prior to NAC, FDG-PET/CT is superior to MRS and DWI regarding recurrence and death prognostic factors, especially primary tumor SUVmax and TLG, in breast cancer patients.