title: Role of FDG-PET/CT in evaluating surgical outcomes of operable breast cancer--usefulness for malignant grade of triple-negative breast cancer.
abstract: BACKGROUND
  The aim of this study was to evaluate the significance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for speculating the malignant level and prognostic value of operable breast cancers.
  
  
  METHODS
  Of 578 consecutive patients with primary invasive breast cancer who underwent curative surgery between 2005 and 2010, 311 patients (53.8%) who received FDG-PET/CT before initial therapy were examined.
  
  
  RESULTS
  Receiver operating characteristics (ROC) curve analysis showed the cutoff value of the maximum standardized uptake value (SUVmax) to predict cancer recurrence was 3.8 in all patients and 8.6 in patients with the triple-negative subtype, respectively. In all patients, 3-year DFS rates were 98.8% for patients with a tumor of SUVmax ≤ 3.8 and 91.6% for patients with a tumor of SUVmax > 3.8 (p < 0.001). High value of SUVmax was significantly associated with large tumor size (p < 0.001), lymph node metastasis (p = 0.040), high nuclear grade (p < 0.001), lymphovascular invasion (p = 0.032), negative hormone receptor status (p < 0.001), and positive HER2 status (p = 0.014). Based on the results of multivariate Cox analysis in all patients, high SUVmax (p = 0.001) and negative hormone receptor status (p = 0.005) were significantly associated with poor prognosis. In patients with triple-negative subtype, 3-year DFS rates were 90.9% for patients with a tumor of SUVmax ≤ 8.6 and 42.9% for patients with a tumor of SUVmax > 8.6 (p = 0.002), and high SUVmax was the only significant independent prognostic factor (p = 0.047).
  
  
  CONCLUSIONS
  FDG-PET/CT is useful for predicting malignant behavior and prognosis in patients with operable breast cancer, especially the triple-negative subtype.
authors.affiliation: Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-Ku, Hiroshima City, Hiroshima 734-0037, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ohara
authors.forename: Hideo
authors.initials: H
authors.lastname: Shigematsu
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tsutani
authors.forename: Akiko
authors.initials: A
authors.lastname: Emi
authors.forename: Norio
authors.initials: N
authors.lastname: Masumoto
authors.forename: Shinji
authors.initials: S
authors.lastname: Ozaki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kadoya
authors.forename: Morihito
authors.initials: M
authors.lastname: Okada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging; D060787:Neoplasm Grading; D049268:Positron-Emission Tomography; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D064726:Triple Negative Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: AUC; Breast cancer; CT; DFS; ER; FDG-PET; HER2; IDC; PET/CT; PgR; Prognosis; ROC; SUV(max); Triple-negative breast cancer; [18F]-fluoro-2-deoxyglucose-positron emission tomography; area under the curve; computed tomography; disease-free survival; estrogen receptor; human epidermal growth factor receptor type 2; invasive ductal carcinoma; maximum standardized uptake value; progesterone receptor; receiver operating characteristic