title: Positron emission tomography using [(18)F]-fluorodeoxy-D-glucose to predict the pathologic response of breast cancer to primary chemotherapy.
abstract: OBJECTIVE
  To determine whether [(18)F]-fluorodeoxy-D-glucose ([(18)F]-FDG) positron emission tomography (PET) can predict the pathologic response of primary and metastatic breast cancer to chemotherapy.
  
  
  METHODS
  Thirty patients with noninflammatory, large (> 3 cm), or locally advanced breast cancers received eight doses of primary chemotherapy. Dynamic PET imaging was performed immediately before the first, second, and fifth doses and after the last dose of treatment. Primary tumors and involved axillary lymph nodes were identified, and the [(18)F]-FDG uptake values were calculated (expressed as semiquantitative dose uptake ratio [DUR] and influx constant [K]). Pathologic response was determined after chemotherapy by evaluation of surgical resection specimens.
  
  
  RESULTS
  Thirty-one primary breast lesions were identified. The mean pretreatment DUR values of the eight lesions that achieved a complete microscopic pathologic response were significantly (P =.037) higher than those from less responsive lesions. The mean reduction in DUR after the first pulse of chemotherapy was significantly greater in lesions that achieved a partial (P =.013), complete macroscopic (P =.003), or complete microscopic (P =.001) pathologic response. PET after a single pulse of chemotherapy was able to predict complete pathologic response with a sensitivity of 90% and a specificity of 74%. Eleven patients had pathologic evidence of lymph node metastases. Mean pretreatment DUR values in the metastatic lesions that responded did not differ significantly from those that failed to respond (P =.076). However, mean pretreatment K values were significantly higher in ultimately responsive cancers (P =.037). The mean change in DUR and K after the first pulse of chemotherapy was significantly greater in responding lesions (DUR, P =.038; K, P =.012).
  
  
  CONCLUSIONS
  [(18)F]-FDG PET imaging of primary and metastatic breast cancer after a single pulse of chemotherapy may be of value in the prediction of pathologic treatment response.
authors.affiliation: John Mallard Scottish Positron Emission Tomography Center, Scotland, United Kingdom. i.c.smith@abdn.ac.uk
authors.forename: I C
authors.initials: IC
authors.lastname: Smith
authors.forename: A E
authors.initials: AE
authors.lastname: Welch
authors.forename: A W
authors.initials: AW
authors.lastname: Hutcheon
authors.forename: I D
authors.initials: ID
authors.lastname: Miller
authors.forename: S
authors.initials: S
authors.lastname: Payne
authors.forename: F
authors.initials: F
authors.lastname: Chilcott
authors.forename: S
authors.initials: S
authors.lastname: Waikar
authors.forename: T
authors.initials: T
authors.lastname: Whitaker
authors.forename: A K
authors.initials: AK
authors.lastname: Ah-See
authors.forename: O
authors.initials: O
authors.lastname: Eremin
authors.forename: S D
authors.initials: SD
authors.lastname: Heys
authors.forename: F J
authors.initials: FJ
authors.lastname: Gilbert
authors.forename: P F
authors.initials: PF
authors.lastname: Sharp
mesh_terms: D000328:Adult; D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D001365:Axilla; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D017239:Paclitaxel / Q000031:analogs & derivatives / Q000627:therapeutic use; D011239:Prednisolone / Q000008:administration & dosage; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D043823:Taxoids; D014055:Tomography, Emission-Computed; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D019275:Radiopharmaceuticals; D043823:Taxoids; D019788:Fluorodeoxyglucose F18; D000077143:Docetaxel; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D017239:Paclitaxel