title: 18F-FDG PET/CT to Predict Response to Neoadjuvant Chemotherapy and Prognosis in Inflammatory Breast Cancer.
abstract: The aim of this prospective study was to assess the predictive value of (18)F-FDG PET/CT imaging for pathologic response to neoadjuvant chemotherapy (NACT) and outcome in inflammatory breast cancer (IBC) patients.
  
  
  METHODS
  Twenty-three consecutive patients (51 y ± 12.7) with newly diagnosed IBC, assessed by PET/CT at baseline (PET1), after the third course of NACT (PET2), and before surgery (PET3), were included. The patients were divided into 2 groups according to pathologic response as assessed by the Sataloff classification: pathologic complete response for complete responders (stage TA and NA or NB) and non-pathologic complete response for noncomplete responders (not stage A for tumor or not stage NA or NB for lymph nodes). In addition to maximum standardized uptake value (SUVmax) measurements, a global breast metabolic tumor volume (MTV) was delineated using a semiautomatic segmentation method. Changes in SUVmax and MTV between PET1 and PET2 (ΔSUV1-2; ΔMTV1-2) and PET1 and PET3 (ΔSUV1-3; ΔMTV1-3) were measured.
  
  
  RESULTS
  Mean SUVmax on PET1, PET2, and PET3 did not statistically differ between the 2 pathologic response groups. On receiver-operating-characteristic analysis, a 72% cutoff for ΔSUV1-3 provided the best performance to predict residual disease, with sensitivity, specificity, and accuracy of 61%, 80%, and 65%, respectively. On univariate analysis, the 72% cutoff for ΔSUV1-3 was the best predictor of distant metastasis-free survival (P = 0.05). On multivariate analysis, the 72% cutoff for ΔSUV1-3 was an independent predictor of distant metastasis-free survival (P = 0.01).
  
  
  CONCLUSIONS
  Our results emphasize the good predictive value of change in SUVmax between baseline and before surgery to assess pathologic response and survival in IBC patients undergoing NACT.
authors.affiliation: Service de Médecine Nucléaire, Institut Curie, Saint-Cloud, France laurence.champion@curie.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Champion
authors.affiliation: Service d'Oncologie Médicale, Institut Curie, Saint-Cloud, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Lerebours
authors.affiliation: Service de Médecine Nucléaire, Institut Curie, Saint-Cloud, France Faculté de Médecine, Université Versailles Saint-Quentin, Saint-Quentin-en-Yvelines, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Alberini
authors.affiliation: Service de Biostatistiques, Institut Curie, Saint-Cloud, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Fourme
authors.affiliation: Service de Médecine Nucléaire, Hôpital d'Instruction des Armées, Val de Grâce, Paris, France; and.
authors.forename: Eric
authors.initials: E
authors.lastname: Gontier
authors.affiliation: Service d'Anatomopathologie, Institut Curie, Saint-Cloud, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Bertrand
authors.affiliation: Service de Médecine Nucléaire, Institut Curie, Saint-Cloud, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Wartski
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D019788:Fluorodeoxyglucose F18; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D064847:Multimodal Imaging / Q000379:methods; D020360:Neoadjuvant Therapy; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D015251:Epirubicin; D004317:Doxorubicin; D003520:Cyclophosphamide; D005472:Fluorouracil
keywords: 18F-FDG PET/CT; inflammatory breast cancer; neoadjuvant chemotherapy; survival