title: Prognostic Role of Early and End-of-Neoadjuvant Treatment 18F-FDG PET/CT in Patients With Breast Cancer.
abstract: OBJECTIVE
  To determine the use of early and final treatment F-FDG PET/CT in the prediction of response to neoadjuvant chemotherapy (NAC) and its role in the prognosis of patients with locally advanced breast cancer (LABC).
  
  
  METHODS
  One hundred thirty-two patients underwent a baseline FDG PET/CT (PET-1) after the second course of chemotherapy (PET-2) and after the last course (PET-3). Breast tumors were categorized into molecular phenotypes and risk categories according to the biological prognostic factors obtained by immunohistochemistry. PET/CT scans were semiquantitatively evaluated, obtaining the Δ% SUV1-2 and SUV1-3 in primary tumor and axillary lymph nodes to establish response groups attending to EORTC criteria. Moreover, a binary assessment was obtained classifying the studies as positive or negative. Histopathological response was obtained in breast and lymph node specimens. Overall survival (OS) and disease-free survival (DFS) were obtained after the follow-up. ROC analysis was performed to determine a cutoff value of Δ% SUV1-2 and SUV1-3 for the prediction of response and prognosis. Relations between phenotypes, metabolic behavior, final histopathological response, OS, and DFS were evaluated.
  
  
  RESULTS
  In binary analysis, only PET-3 was able to predict histopathological response in lymph nodes. The cutoff values of %Δ SUV1-2 and %Δ SUV1-3 with the best sensitivity and specificity in the prediction of response in breast tumor were 62% (Se: 70% and Sp: 69%) and 84% (Se: 70% and Sp: 88%). A %ΔSUV1-3 of 74% in breast tumor was a predictor of DFS (AUC = 0.647; P = 0.037, Se: 52% and Sp: 66%). Kaplan-Meier analysis revealed significant relations between the binary lymph node assessment of PET-3 with OS (P = 0.016, χ = 5.78) and DFS (P = 0.003, χ = 9.10).
  
  
  CONCLUSIONS
  End-of-treatment F-FDG PET/CT was a predictor of lymph node response and prognosis. Most of metabolic response variables related to histopathological response showed association with the prognosis.
authors.affiliation: From the *Nuclear Medicine Department, University General Hospital. Ciudad Real; †Department of Mathematics, University of Castilla-La Mancha. Ciudad Real; ‡Department of Pathology, University General Hospital. Ciudad Real; §Oncology Department, Virgen de la Luz Hospital. Cuenca; ∥Oncology Department, Virgen de la Salud Hospital. Toledo; and ¶Oncology Department, La Mancha Centro Hospital, Alcázar de San Juan. Ciudad Real, Spain.
authors.forename: Ana María
authors.initials: AM
authors.lastname: García Vicente
authors.forename: Mariano
authors.initials: M
authors.lastname: Amo-Salas
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: Francisco José
authors.initials: FJ
authors.lastname: Pena Pardo
authors.forename: Germán Andrés
authors.initials: GA
authors.lastname: Jiménez Londoño
authors.forename: Ruth
authors.initials: R
authors.lastname: Álvarez Cabellos
authors.forename: Ruth
authors.initials: R
authors.lastname: Espinosa Aunión
authors.forename: Ángel
authors.initials: Á
authors.lastname: Soriano Castrejón
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D011877:Radionuclide Imaging / Q000379:methods; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18