title: Usefulness of Combined Metabolic-Volumetric Indices of (18)F-FDG PET/CT for the Early Prediction of Neoadjuvant Chemotherapy Outcomes in Breast Cancer.
abstract: OBJECTIVE
  The purpose of this study was to investigate the usefulness of metabolic-volumetric indices of (18)F- fluorodeoxy-D-glucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) for the evaluation of neoadjuvant chemotherapy outcomes in breast cancer.
  
  
  METHODS
  Twenty-four patients with locally advanced breast cancer were enrolled in the study. They underwent baseline (18)F-FDG PET/CT scan and received four or six cycles of neoadjuvant chemotherapy, interim (18)F-FDG PET/CT was done after second cycle of chemotherapy. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary lesions were calculated. Reduction rates of these parameters were obtained between baseline and interim (18)F-FDG PET/CT. Chemotherapy outcomes were assessed using tumor size reduction rate and histological grading system (Miller and Payne system). Reduction rates of SUVmax, MTV, and TLG correlated with chemotherapy outcomes.
  
  
  RESULTS
  MTV and TLG reduction rates showed significant correlation with tumor size reduction rate (R = 0.68, P = 0.0004; R = 0.62, P = 0.002, respectively). However, SUVmax reduction rate showed no significant correlation. MTV and TLG reduction rates were significantly higher in responders than nonresponders, as determined by Miller and Payne system (P < 0.0007, P < 0.002). However, SUVmax reduction rate showed no significant difference. On ROC analysis, the area under the MTV and TLG curves was 0.886, and that of SUVmax was 0.743. Sensitivity, specificity, positive predictive value, and negative predictive value to predict histopathologic response were the same for MTV and TLG, and the values were 100 %, 85.7 %, 83.3 %, and 100 %, respectively (at the reduction rate of 93.2 % for MTV, and 95.8 % for TLG).
  
  
  CONCLUSIONS
  Changes of metabolic-volumetric indices successfully reflected the neoadjuvant chemotherapy outcomes. MTV and TLG could be robust indices in discriminating pathologic responder as SUVmax, after neoadjuvant chemotherapy.
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea ; Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
authors.forename: Hyung-Jun
authors.initials: HJ
authors.lastname: Im
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea ; Department of Nuclear Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Borame-gil 41, Dongjak-gu, Seoul, 156-707 Korea.
authors.forename: Yu Kyeong
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea ; Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
authors.forename: Yong-Il
authors.initials: YI
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea ; Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggyi Korea.
authors.forename: Won Woo
authors.initials: WW
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea ; Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggyi Korea.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Kim
keywords: 18F-FDG PET/CT; Breast cancer; Metabolic tumor volume; Neoadjuvant chemotherapy; Total lesion glycolysis