Subtype-Guided 18 F-FDG PET/CT in Tailoring Axillary Surgery Among Patients with Node-Positive Breast Cancer Treated with Neoadjuvant Chemotherapy: A Feasibility Study

• Published in: The oncologist (Dayton, Ohio) Ohio), 2020-04, Vol.25 (4), p.e626
• Main Authors: Wu, Siyu, Wang, Yujie, Li, Jianwei, Zhang, Na, Mo, Miao, Klimberg, Suzanne, Kaklamani, Virginia, Cochet, Alexandre, Shao, Zhiming, Cheng, Jingyi, Liu, Guangyu
• Format: Article
• Language: English
• Subjects: Life Sciences
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2019-0583

The purpose of this study was to investigate the value of [F]-fluorodeoxyglucose ( F-FDG) positron emission tomography/computed tomography (PET/CT) in tailoring axillary surgery by predicting nodal response among patients with node-positive breast cancer after neoadjuvant chemotherapy (NAC). One hundred thirty-three patients with breast cancer with biopsy-confirmed nodal metastasis were prospectively enrolled. F-FDG PET/CT scan was performed before NAC (a second one after two cycles with baseline maximum standardized uptake value [SUV ] ≥2.5), and a subset of patients underwent targeted axillary dissection (TAD). All the patients underwent axillary lymph node dissection (ALND). The accuracy was calculated by a comparison with the final pathologic results. With the cutoff value of 2.5 for baseline SUV and 78.4% for change in SUV , sequential F-FDG PET/CT scans demonstrated a sensitivity of 79.0% and specificity of 71.4% in predicting axillary pathologic complete response with an area under curve (AUC) of 0.75 (95% confidence interval, 0.65-0.84). Explorative subgroup analyses indicated little value for estrogen receptor (ER)-negative, human epidermal growth factor receptor 2 (HER2)-positive patients (AUC, 0.55; sensitivity, 56.5%; specificity, 50.0%). Application of F-FDG PET/CT could spare 19 patients from supplementary ALNDs and reduce one of three false-negative cases in TAD among the remaining patients without ER-negative/HER2-positive subtype. Application of the subtype-guided F-FDG PET/CT could accurately predict nodal response and aid in tailoring axillary surgery among patients with node-positive breast cancer after NAC, which includes identifying candidates appropriate for TAD or directly proceeding to ALND. This approach might help to avoid false-negative events in TAD. This feasibility study showed that [F]-fluorodeoxyglucose ( F-FDG) positron emission tomography/computed tomography (PET/CT) could accurately predict nodal response after neoadjuvant chemotherapy (NAC) among patients with breast cancer with initial nodal metastasis except in estrogen receptor-negative, human epidermal growth factor receptor 2-positive subtype. Furthermore, the incorporation of F-FDG PET/CT can tailor subsequent axillary surgery by identifying patients with residual nodal disease, thus sparing those patients supplementary axillary lymph node dissection. Finally, we have proposed a possibly feasible flowchart involving F-FDG PET/CT that might be applied in post-NAC a