title: Early and delayed prediction of axillary lymph node neoadjuvant response by (18)F-FDG PET/CT in patients with locally advanced breast cancer.
abstract: OBJECTIVE
  To determine the utility of (18)F-FDG (FDG) PET/CT performed in an early and delayed phase during neoadjuvant chemotherapy in the prediction of lymph node histopathological response in patients with locally advanced breast cancer.
  
  
  METHODS
  FDG PET/CT studies performed in 76 patients (mean age 53 years) at baseline (PET-1), after the second course of chemotherapy (PET-2) and after the last course of chemotherapy (PET-3) were prospectively analysed. Inclusion criteria were lymph node involvement detected by PET/CT and non-sentinel node biopsy before or after the baseline PET/CT scan. Following the recommendations of the 12th International Breast Conference (St. Gallen), the patients were divided into five subgroups in relation to biological prognostic factors by immunohistochemistry. For diagnosis visual and semiquantitative analyses was performed. Absence of detectable lymph node uptake on the PET-2 or PET-3 scan with respect to the PET-1 scan was considered metabolic complete response (mCR). Lymph nodes were histopathologically classified according the lymph node regression grade and in response groups as pathological complete response (pCR) or not pCR (type A/D or B/C of the Smith grading system, respectively). ROC analysis was performed to determine a cut-off value of Δ% SUV1-2 and SUV1-3 for prediction of nodal status after chemotherapy. An association between mCR and pCR was found (Cohen's kappa analysis), and associations between phenotypes and metabolic behaviour and the final histopathological status were also found.
  
  
  RESULTS
  Lymph node pCR was seen in 34 patients. The sensitivity, specificity, and positive and negative predictive values of PET-2 and PET-3 in establishing the final status of the axilla after chemotherapy were 52 %, 45 %, 50 % and 47 %, and 33 %, 84 %, 67 % and 56 %, respectively. No significant relationship was observed between mCR on PET-2 and PET-3 and pCR (p = 0.31 and 0.99, respectively). Lymph node metabolism on PET-1 was not able to predict the final histopathological status, whereas basal carcinomas showed a higher rate of pCR (70.6 %) than the other groups (p = 0.03).
  
  
  CONCLUSIONS
  FDG PET/CT seems to have limitations in both the early and delayed evaluation of lymph node status after chemotherapy, with reduced predictive values.
authors.affiliation: Nuclear Medicine Department, University General Hospital, C/ Obispo Rafael Torija s/n., 13005, Ciudad Real, Spain, angarvice@yahoo.es.
authors.forename: Ana María
authors.initials: AM
authors.lastname: García Vicente
authors.forename: Ángel
authors.initials: Á
authors.lastname: Soriano Castrejón
authors.forename: Alberto
authors.initials: A
authors.lastname: León Martín
authors.forename: Fernanda
authors.initials: F
authors.lastname: Relea Calatayud
authors.forename: María Del Mar
authors.initials: Mdel M
authors.lastname: Muñoz Sánchez
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Cruz Mora
authors.forename: Germán Andrés
authors.initials: GA
authors.lastname: Jiménez Londoño
authors.forename: Ruth
authors.initials: R
authors.lastname: Espinosa Aunión
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000187:drug effects* / Q000473:pathology; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18
references.citation: Breast. 2003 Oct;12(5):320-7
references.pmid: 14659147
references.citation: Cancer. 2009 Mar 15;115(6):1194-202
references.pmid: 19156919
references.citation: Breast Cancer Res Treat. 2007 Mar;102(1):75-84
references.pmid: 16897427
references.citation: J Clin Oncol. 2008 Feb 10;26(5):712-20
references.pmid: 18258978
references.citation: J Clin Oncol. 2006 May 1;24(13):2019-27
references.pmid: 16606972
references.citation: J Nucl Med. 1996 Jun;37(6):931-8
references.pmid: 8683314
references.citation: Eur J Nucl Med Mol Imaging. 2007 Dec;34(12):1915-24
references.pmid: 17579854
references.citation: Eur J Nucl Med Mol Imaging. 2011 Jul;38(7):1381-2
references.pmid: 21424260
references.citation: Eur J Cancer. 2011 Sep;47(14):2084-90
references.pmid: 21737257
references.citation: J Clin Oncol. 2006 Dec 1;24(34):5366-72
references.pmid: 17088570
references.citation: Eur J Nucl Med Mol Imaging. 2011 Mar;38(3):419-25
references.pmid: 21072510
references.citation: Rev Esp Med Nucl Imagen Mol. 2012 Nov-Dec;31(6):308-14
references.pmid: 23084013
references.citation: J Nucl Med. 2003 Nov;44(11):1806-14
references.pmid: 14602864
references.citation: J Clin Oncol. 2002 Mar 15;20(6):1456-66
references.pmid: 11896092
references.citation: Eur J Nucl Med Mol Imaging. 2010 Oct;37(10):1834-41
references.pmid: 20533032
references.citation: Rev Esp Med Nucl. 2009 Mar-Apr;28(2):85-9
references.pmid: 19406058
references.citation: Eur J Nucl Med Mol Imaging. 2013 Jan;40(1):72-9
references.pmid: 23053321
references.citation: Eur J Nucl Med Mol Imaging. 2011 Jun;38(6):1029-36
references.pmid: 21308372
references.citation: Rev Esp Med Nucl Imagen Mol. 2014 Jan-Feb;33(1):1-5
references.pmid: 23707190
references.citation: Semin Oncol. 1998 Apr;25(2 Suppl 3):31-5
references.pmid: 9566205
references.citation: J Nucl Med. 2005 Jul;46(7):1144-50
references.pmid: 16000283
references.citation: Ann Oncol. 2011 Aug;22(8):1736-47
references.pmid: 21709140
references.citation: J Clin Oncol. 2000 Apr;18(8):1676-88
references.pmid: 10764428
references.citation: Eur J Nucl Med Mol Imaging. 2010 Jun;37(6):1069-76
references.pmid: 20130860
references.citation: Ann Oncol. 2007 Mar;18(3):473-8
references.pmid: 17164229
references.citation: Cancer. 2010 Feb 15;116(4):805-13
references.pmid: 20052718
references.citation: Eur J Nucl Med Mol Imaging. 2010 Oct;37(10):1992-3
references.pmid: 20700738
references.citation: Eur J Nucl Med Mol Imaging. 2004 Jun;31 Suppl 1:S103-11
references.pmid: 15103507
references.citation: J Clin Oncol. 2008 Mar 10;26(8):1275-81
references.pmid: 18250347
references.citation: CA Cancer J Clin. 2007 Jan-Feb;57(1):43-66
references.pmid: 17237035
references.citation: Eur J Nucl Med Mol Imaging. 2009 Oct;36(10):1551-7
references.pmid: 19326117
references.citation: J Clin Oncol. 2002 Mar 1;20(5):1304-10
references.pmid: 11870173