Prognostic Impact of [18F] FDG-PET in operable breast cancer treated with neoadjuvant chemotherapy.
BACKGROUND
This study aimed to evaluate the usefulness of serial [(18)F] 2-fluoro-2-deoxy-D: -glucose-positron emission tomography ([(18)F] FDG-PET) in potentially operable breast cancer with neoadjuvant chemotherapy.


METHODS
Serial positron emission tomography was undertaken in 66 breast cancer patients who comprised a subset of the population in a phase III randomized neoadjuvant trial at National Cancer Center, Korea. We assessed the peak standardized uptake value (SUVp) in the primary tumor and axillary nodes before and after neoadjuvant chemotherapy and calculated the reduction rate (RR) of the SUVp. By means of a receiver operating characteristic curve, we identified an optimal cutoff value for the RR for predicting the pathologic response and evaluated the prognostic power of this cutoff value.


RESULTS
Ten patients (15.2%) experienced a pathologic complete response (pCR) in the primary tumor, and 19 patients (28.8%) experienced a pCR in the axillary nodes. The mean RR of the SUVp in primary tumors was 70.3% +/- 28.7%, and this value was significantly different by the pathological response (89.2% +/- 11.1% in pCR vs. 66.9% +/- 29.6% in non-pCR, P < .001). When 84.8% of the RR was used as a cutoff value for the pCR, sensitivity and specificity was 70.0% and 69.6%, respectively. Ten patients (15.2%) developed recurrent disease at a median follow-up period of 61.5 (range, 13.5-71.8) months. In a univariate analysis, the 5-year disease-free survival (DFS) was correlated with the clinical T stage (91.1% in T1/2 vs. 71.4% in T3/4, P = .02), HER-2 status (77.8% in positive vs. 96.9% in negative, P = .03), and the 84.8% RR of the SUVp in the primary tumor (95.8% vs. 78.5%, P = .04). HER-2 positivity was a significant independent prognosticator in the multivariate analysis (hazard ratio 8.73, 95% confidence interval 1.03-73.84, P = .04). The presence of a pCR in the primary tumor or nodes was not a prognostic factor in this subset of patients. The RR of the SUVp in the axillary nodes was not correlated with the nodal pCR and DFS.


CONCLUSIONS
The RR of the SUVp in the primary tumor was correlated with the pathologic response and DFS. This study suggests the possible prognostic value of the RR in positron emission tomography by neoadjuvant chemotherapy.
Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
So-Youn
SY
Jung
Seok-Ki
SK
Kim
Byung-Ho
BH
Nam
Sun Young
SY
Min
Seung Joo
SJ
Lee
Chansung
C
Park
Youngmee
Y
Kwon
Eun-A
EA
Kim
Kyoung Lan
KL
Ko
In Hae
IH
Park
Keun Seok
KS
Lee
Kyung Hwan
KH
Shin
Seeyoun
S
Lee
Seok Won
SW
Kim
Han-Sung
HS
Kang
Jungsil
J
Ro
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D000069287:Capecitabine; D003520:Cyclophosphamide / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
D019275:Radiopharmaceuticals; D043823:Taxoids; D003841:Deoxycytidine; D019788:Fluorodeoxyglucose F18; D000077143:Docetaxel; D000069287:Capecitabine; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil