Prognostic Role of Early and End-of-Neoadjuvant Treatment 18F-FDG PET/CT in Patients With Breast Cancer

• Published in: Clinical nuclear medicine 2016-07, Vol.41 (7), p.e313-e322
• Main Authors: García Vicente, Ana María, Amo-Salas, Mariano, Relea Calatayud, Fernanda, Muñoz Sánchez, María del Mar, Pena Pardo, Francisco José, Jiménez Londoño, Germán Andrés, Álvarez Cabellos, Ruth, Espinosa Aunión, Ruth, Soriano Castrejón, Ángel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Disease-Free Survival; Female; Fluorodeoxyglucose F18; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Lymph Nodes - pathology; Middle Aged; Multimodal Imaging; Neoadjuvant Therapy; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Prognosis; Prospective Studies; Radionuclide Imaging - methods; Radiopharmaceuticals; ROC Curve; Sensitivity and Specificity
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/RLU.0000000000001191

AIMTo determine the use of early and final treatment F-FDG PET/CT in the prediction of response to neoadjuvant chemotherapy (NAC) and its role in the prognosis of patients with locally advanced breast cancer (LABC). METHODSOne hundred thirty-two patients underwent a baseline FDG PET/CT (PET-1) after the second course of chemotherapy (PET-2) and after the last course (PET-3). Breast tumors were categorized into molecular phenotypes and risk categories according to the biological prognostic factors obtained by immunohistochemistry. PET/CT scans were semiquantitatively evaluated, obtaining the Δ% SUV1-2 and SUV1-3 in primary tumor and axillary lymph nodes to establish response groups attending to EORTC criteria. Moreover, a binary assessment was obtained classifying the studies as positive or negative. Histopathological response was obtained in breast and lymph node specimens. Overall survival (OS) and disease-free survival (DFS) were obtained after the follow-up. ROC analysis was performed to determine a cutoff value of Δ% SUV1-2 and SUV1-3 for the prediction of response and prognosis. Relations between phenotypes, metabolic behavior, final histopathological response, OS, and DFS were evaluated. RESULTSIn binary analysis, only PET-3 was able to predict histopathological response in lymph nodes. The cutoff values of %Δ SUV1-2 and %Δ SUV1-3 with the best sensitivity and specificity in the prediction of response in breast tumor were 62% (Se70% and Sp69%) and 84% (Se70% and Sp88%). A %ΔSUV1-3 of 74% in breast tumor was a predictor of DFS (AUC = 0.647; P = 0.037, Se52% and Sp66%). Kaplan-Meier analysis revealed significant relations between the binary lymph node assessment of PET-3 with OS (P = 0.016, χ = 5.78) and DFS (P = 0.003, χ = 9.10). CONCLUSIONSEnd-of-treatment F-FDG PET/CT was a predictor of lymph node response and prognosis. Most of metabolic response variables related to histopathological response showed association with the prognosis.