Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer.
OBJECTIVE
The aim of this study was to determine the impact of the main clinicopathological and biological prognostic factors of breast cancer on (18)F-fluorodeoxyglucose (FDG) uptake. Only women with tumours larger than 20 mm (T2-T4) were included in order to minimize bias of partial volume effect.


METHODS
In this prospective study, 132 consecutive women received FDG PET/CT imaging before starting neoadjuvant chemotherapy. Maximum standardized uptake values (SUV(max)) were compared to tumour characteristics as assessed on core biopsy.


RESULTS
There was no influence of T and N stage on SUV. Invasive ductal carcinoma showed higher SUV than lobular carcinoma. However, the highest uptake was found for metaplastic tumours, representing 5% of patients in this series. Several biological features usually considered as bad prognostic factors were associated with an increase in FDG uptake: the median of SUV(max) was 9.7 for grade 3 tumours vs 4.8 for the lower grades (p < 0.0001); negativity for oestrogen receptors (ER) was associated with higher SUV (ER+ SUV = 5.5; ER- SUV = 7.6; p = 0.003); triple-negative tumours (oestrogen and progesterone receptor negative, no overexpression of c-erbB-2) had an SUV of 9.2 vs 5.8 for all others (p = 0005); p53 mutated tumours also had significantly higher SUV (7.8 vs 5.0; p < 0.0001). Overexpression of c-erbB-2 had no effect on the SUV value.


CONCLUSIONS
Knowledge of the factors influencing uptake is important when interpreting FDG PET/CT scans. Also, findings that FDG uptake is highest in those patients with poor prognostic features (high grade, hormone receptor negativity, triple negativity, metaplastic tumours) is helpful to determine who are the best candidates for baseline staging.
Department of Nuclear Medicine, Saint-Louis Hospital, Assistance publique Hôpitaux de Paris, Paris, France. dgroheux@yahoo.fr
David
D
Groheux
Sylvie
S
Giacchetti
Jean-Luc
JL
Moretti
Raphael
R
Porcher
Marc
M
Espié
Jacqueline
J
Lehmann-Che
Anne
A
de Roquancourt
Anne-Sophie
AS
Hamy
Caroline
C
Cuvier
Laetitia
L
Vercellino
Elif
E
Hindié
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D011877:Radionuclide Imaging; D047368:Tumor Burden; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism
D016159:Tumor Suppressor Protein p53; D019788:Fluorodeoxyglucose F18