title: Journal Club: Diagnostic value of (18)F-FDG PET/CT and MRI in predicting the clinicopathologic subtypes of invasive breast cancer.
abstract: OBJECTIVE
  The purpose of this study was to assess the diagnostic value of (18)F-FDG PET/CT and MRI in predicting the clinicopathologic subtypes of breast cancer.
  
  
  METHODS
  The cases of 89 patients with mass-type invasive breast cancer who underwent FDG PET/CT and MRI before therapy were retrospectively analyzed. Eight imaging variables-maximum standardized uptake value (SUVmax), apparent diffusion coefficient, size, shape, margin, intratumoral enhancement, dynamic kinetics, and high intratumoral signal intensity on T2-weighted images-were compared with results for the pathologic markers Ki-67 antibody, estrogen receptor (ER), progesterone receptor (PR), and ERBB2 (formerly HER2 or HER2/neu). The diagnostic performance of the imaging variables for sub-typing was evaluated, and the predictors of the subtypes were elucidated.
  
  
  RESULTS
  Higher SUVmax was significantly associated with a high Ki-67 index (p < 0.0001), ER-negative status (p = 0.0001), and PR-negative status (p = 0.047). Significant correlation was also found between size and ER status (p = 0.002) and between shape and PR status (p = 0.044). The AUC exceeded 0.7 only in identification of the luminal A sub-type by application of cutoff values for SUVmax (AUC, 0.751). When smaller tumors were excluded, AUC increased (AUC, 0.803 for tumors > 16 mm). Multivariate analysis showed that SUVmax was the sole independent predictor of luminal A subtype (odds ratio per SD, 0.291; p < 0.0001). SUVmax was significantly lower for luminal A (4.4 ± 2.2) than non-luminal A (8.1 ± 4.4; p < 0.0001) tumors. A cutoff value of 5.4 yielded 79% sensitivity and 68% specificity for prediction that a tumor was the luminal A subtype.
  
  
  CONCLUSIONS
  FDG PET/CT findings may contribute to differentiation of the luminal A and non-luminal A subtypes of invasive breast cancer.
authors: 1 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors: Kanae Kawai
authors: KK
authors: Miyake
authors: Yuji
authors: Y
authors: Nakamoto
authors: Shotaro
authors: S
authors: Kanao
authors: Shiro
authors: S
authors: Tanaka
authors: Tomoharu
authors: T
authors: Sugie
authors: Yoshiki
authors: Y
authors: Mikami
authors: Masakazu
authors: M
authors: Toi
authors: Kaori
authors: K
authors: Togashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D064847:Multimodal Imaging; D009361:Neoplasm Invasiveness / Q000175:diagnosis* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: FDG PET/CT; MRI; SUVmax; clinicopathologic subtypes; invasive breast cancer; standardized uptake value