title: Tumour markers and FDG PET/CT for prediction of disease relapse in patients with breast cancer.
abstract: OBJECTIVE
  The aim of the study was to assess the role of CA 15.3, CT and positron emission tomography (PET)/CT in patients with breast cancer and suspected disease relapse after primary treatment.
  
  
  METHODS
  We studied 111 consecutive patients (mean age 61 ± 12 years) with previous breast cancer, already treated and with clinical or biochemical suspicion of disease relapse. All patients underwent CT and (18)F-fluorodeoxyglucose (FDG) PET/CT. In all patients, the value of CA 15.3 was compared to PET/CT and CT. The final diagnosis of relapse was established by invasive and noninvasive follow-up and was compared with CA 15.3, CT and PET/CT results. Univariate and multivariate analyses were used to identify the independent predictors of disease relapse and receiver-operating characteristic (ROC) curve for the identification of optimal CA 15.3 cutoff.
  
  
  RESULTS
  Of all patients, 40 (36%) showed an increased CA 15.3 value, CT was positive in 73 (66%), whereas at PET/CT imaging 64 (58%) showed positive findings for disease relapse. Of 40 patients with increased marker levels, 22 patients had positive CT and 30 positive PET/CT (55 vs 75%, p < 0.001). At the end of follow-up, recurrence occurred in 32 (29%) patients, 16 (50%) of whom showed high levels of CA 15.3. PET/CT predicted relapse in 26 (81%) patients, whereas CT correctly identified 23 (72%). At univariate analysis, recurrence was significantly associated with high CA 15.3 values (p < 0.05) and positive PET/CT (p < 0.005). At multivariable analysis only positive PET/CT remained an independent predictor of disease relapse (p < 0.05). ROC analysis showed an optimal cutoff point for CA 15.3 of 19.1 U/ml (AUC 0.65, p < 0.01) to individuate positive PET/CT.
  
  
  CONCLUSIONS
  FDG PET/CT is more sensitive than CT and CA 15.3 in the evaluation of disease relapse. PET/CT might be considered a complementary imaging technique during follow-up in patients with breast cancer.
authors.affiliation: Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy. laura.evangelista@ioveneto.it
authors.forename: Laura
authors.initials: L
authors.lastname: Evangelista
authors.forename: Zora
authors.initials: Z
authors.lastname: Baretta
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Vinante
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Cervino
authors.forename: Michele
authors.initials: M
authors.lastname: Gregianin
authors.forename: Cristina
authors.initials: C
authors.lastname: Ghiotto
authors.forename: Giorgio
authors.initials: G
authors.lastname: Saladini
authors.forename: Guido
authors.initials: G
authors.lastname: Sotti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001943:Breast Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; D019788:Fluorodeoxyglucose F18