title: Prognostic value of primary tumor SUVmaxon F-18 FDG PET/CT compared with semi-quantitative tumor uptake on Tc-99m sestamibi breast-specific gamma imaging in invasive ductal breast cancer.
abstract: OBJECTIVE
  This study aimed to evaluate the prognostic value of F-18 FDG PET/CT in comparison with Tc-99m sestamibi breast-specific gamma imaging (BSGI) and previously established clinical prognostic parameters of invasive ductal breast carcinoma (IDC).
  
  
  METHODS
  We retrospectively included 157 female IDC patients (mean age 49.2 years, range 29.9-78.9) who underwent PET/CT and BSGI. The maximum standardized uptake value (SUVmax) and tumor to normal background ratios (TNRs) of their primary tumors were measured on PET/CT and BSGI, respectively. Univariate and multivariate survival analyses were performed to evaluate the prognostic value of the measured parameters and other clinical prognostic factors: age, menopausal status, breast density, pathologic tumor size (pTS), axillary nodal status (ANS), nuclear grade, histologic grade, hormone receptor status of estrogen (ER) and progesterone receptors (PR) and HER-2 expression.
  
  
  RESULTS
  Among 157 patients, recurrences occurred in 22 patients (14.0 %). In univariate analyses, pTS (p < 0.0001), ANS (p < 0.0001), nuclear grade (p = 0.0046), histologic grade (p = 0.0001), ER status (p < 0.0001), PR status (p = 0.0037), HER-2 status (p = 0.0007), primary tumor SUVmax(p < 0.0001) and TNR (p = 0.0001) were significant predictors of recurrence. Among them, pTS (p = 0.0172), ANS (p = 0.0416), ER status (p = 0.0375) and primary tumor SUVmax(p = 0.0239) were independent prognostic factors in multivariate regression analysis.
  
  
  CONCLUSIONS
  High primary tumor SUVmaxof PET/CT and high TNR of BSGI were poor prognostic factors in IDC patients; in addition, primary tumor SUVmaxwas an independent prognostic factor along with pTS, ANS and ER status.
authors.affiliation: Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea.
authors.forename: Jang
authors.initials: J
authors.lastname: Yoo
authors.affiliation: Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea.
authors.forename: Hai-Jeon
authors.initials: HJ
authors.lastname: Yoon
authors.affiliation: Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea. kbomsahn@ewha.ac.kr.
authors.forename: Bom Sahn
authors.identifier: http://orcid.org/0000-0003-2520-7182
authors.initials: BS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001692:Biological Transport; D001940:Breast / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D000071060:Breast Density; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000378:metabolism*; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D009928:Organ Specificity; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi / Q000378:metabolism*
chemical_list: D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi
keywords: F-18 FDG PET/CT; Invasive ductal breast carcinoma; Prognostic factor; Recurrence-free survival; Tc-99m sestamibi breast-specific gamma imaging