title: Prognostic implication of intratumoral metabolic heterogeneity in invasive ductal carcinoma of the breast.
abstract: BACKGROUND
  The purpose of this study was to evaluate the prognostic implication of findings of intratumoral metabolic heterogeneity on pretreatment (18)F-FDG PET/CT scans in patients with invasive ductal carcinoma (IDC) of the breast.
  
  
  METHODS
  One hundred and twenty-three female IDC patients who underwent pretreatment 18F-fluorodeoxyglucose positron-emission tomography/computed tomography ((18)F-FDG PET/CT) scans were retrospectively evaluated in this study. The heterogeneity factor (HF) defined as the derivative (dV/dT) of a volume threshold function from 40% to 80%, was computed for each primary tumor. Other metabolic PET parameters (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], and total lesion glycolysis [TLG]) were measured. The HF was compared with clinicopathologic factors and other PET parameters. Univariate and multivariate analyses for the overall survival (OS) were performed.
  
  
  RESULTS
  The HF ranged from 0.02 to 6.72 (mean, 0.35 ± 0.82) and significantly correlated with MTV (r = 0.955; p < 0.0001) and TLG (r = 0.354; p = 0.0001). The HF was significantly higher (implying more heterogeneity) in tumors with higher T and N stages. The optimal cut-off values for the OS determined using a receiver operating characteristic (ROC) curve were 0.34 for the HF, 5.6 for SUVmax, 8.55 cm(3) for MTV, and 14.43 for TLG. The OS rate among the 123 patients was 86.2%. T stage (1, 2 vs. 3, 4), N stage (0, 1 vs. 2, 3), M stage (0 vs. 1), ER status (+ vs. -), SUVmax (≤ 5.6 vs. > 5.6), MTV (≤ 8.55 cm(3) vs. > 8.55 cm(3)), TLG (≤ 14.43 vs. > 14.43), and HF (< 0.34 vs. ≥ 0.34) affected the OS on univariate analysis. After adjustment for the effects of TNM stage and ER status, the HF and MTV were significant predictors of OS. Among the PET parameters, the best prognostic factor for OS was the HF.
  
  
  CONCLUSIONS
  Intratumoral metabolic heterogeneity correlated closely with the MTV and significantly affected the OS in IDC patients. The HF may act as a robust surrogate marker for the prediction of OS in IDC patients.
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Son
authors.forename: Do-Hoon
authors.initials: DH
authors.lastname: Kim
authors.forename: Chae Moon
authors.initials: CM
authors.lastname: Hong
authors.forename: Choon-Young
authors.initials: CY
authors.lastname: Kim
authors.forename: Shin Young
authors.initials: SY
authors.lastname: Jeong
authors.forename: Sang-Woo
authors.initials: SW
authors.lastname: Lee
authors.forename: Jaetae
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, 50 Samduk-dong 2-ga, Jung-gu, Daegu 700-721, Republic of Korea. abc2000@knu.ac.kr.
authors.forename: Byeong-Cheol
authors.initials: BC
authors.lastname: Ahn
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000401:mortality; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000401:mortality; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
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