Relation of FDG uptake of breast cancer and the histologic and the biologic characteristics of the tumor

Abstract Background Breast cancer is considered the most common type of cancer and the second leading cause of cancer-related death among women. The prognostic factors including histological type, tumor nuclear grade, tumor size, and preoperative tumor-nodes-metastasis (TNM), hormone receptor and immunohistochemical molecular markers in the specimens, define the prognosis and survival rate. Early diagnosis and accurate follow-up of these patients affect the management. 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) has proved to be an effective and accurate imaging technique for a variety of diagnostic oncology tasks in breast cancer, lymph node staging, staging and restaging of recurrent and metastatic disease, and treatment follow up. Sufficient knowledge of the initial characteristics of breast tumors that may affect 18F-FDG uptake is essential for optimal use and interpretation of 18FFDG PET/CT imaging. Several pioneering studies have investigated the correlation between the affinity to 18F-FDG uptake and some of the histological and biological characteristics such as tumor type, grade, hormonal receptor status and HER2 status. Objective To correlate the relation of 18F-fluoro-2-deoxy-D-gIucose (18F-FDG) positron emission tomography/ computed tomography (PET/CT) uptake in breast cancer to histopathological and biological characteristics. Methods A prospective descriptive study over the course of 6 months from August 2019 till February 2020. It included twenty five patients with pathologically proven breast carcinoma referred to the Radiology department, Ain Shams University Hospitals/ Private centers for a preoperative 18FDG PET/CT scan. Results For the tumors in 25 women, the mean SUVmax was 4.75±2.55. Primary tumor 18FFDG uptake ratio was correlated with patients' age (P = 0.032), tumor size (P = 0.034), histological grade (P=O.OI 8), estrogen and progesterone negativity (P = 0.012), Her2/neu positivity (P = 0.012), high Ki-67 level (>10%) (P = 0.024), axillary lymph node involvement (P = 0.038) and distant metastasis (P = 0.039). High Ki-67 level (Pearson Correlation Coefficient= 0.457; 95% confidence interval; P = 0.037) and tumor size (Pearson Correlation Coefficient =0.458; 95% confidence interval, P = 0.021) were determining factors for high 18F-FDG uptake values. The histological type (P = 0.525) was not significantly correlated with 18F-FDG uptake. Conclusion FDG PET imaging was used to estimate tumor biologic behavior of breast cancer such as histopathologic grading, immunohistochemistry, axillary lymph node status and distant metastasis. SUVmax correlated with several of pathological prognostic factors may have potential for predicting the prognosis of breast cancer. 18F-FDG PET/CT could be a useful tool to pretherapeutically predict biological characteristics and baseline risk of breast cancer Increased 18FFDG uptake on PET/CT was correlated with a high Ki-67 proliferation index and larger tumor size. These results suggest a potential role of 18F-FDG PET/CT in identifying tumor aggressiveness.

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Early and delayed prediction of axillary lymph node neoadjuvant response by 18F-FDG PET/CT in patients with locally advanced breast cancer

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-013-2657-7 ◽

2014 ◽

Vol 41 (7) ◽

pp. 1309-1318 ◽

Cited By ~ 10

Author(s):

Ana María García Vicente ◽

Ángel Soriano Castrejón ◽

Alberto León Martín ◽

Fernanda Relea Calatayud ◽

María del Mar Muñoz Sánchez ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Fdg Pet ◽

Axillary Lymph Node ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Axillary Lymph ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Lymphoscintigraphy in breast cancer patients after neoadjuvant chemotherapy

Nuklearmedizin ◽

10.3413/nukmed-0320-10-05 ◽

2011 ◽

Vol 50 (01) ◽

pp. 33-38 ◽

Cited By ~ 6

Author(s):

R. Reitsamer ◽

J. Holzmannhofer ◽

G. Rendl ◽

C. Pirich ◽

C. Kronberger ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Fdg Pet ◽

Lymphatic Mapping ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

SummaryThe aim of this study was to evaluate the diagnostic value of lymphatic mapping by lymphoscintigraphy in breast cancer patients undergoing neoadjuvant chemotherapy (NCTX). We assessed the association between clinicopathological factors and nonvisualized sentinel nodes during preoperative lymphoscintigraphy. As secondary aims, we analyzed whether post NCTX axillary ultrasonography and fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (F18-FDG-PET/CT) might be useful for staging in case of nonvisualized sentinel nodes. Patients, methods: 61 patients with newly diagnosed, invasive breast cancer potentially eligible for NCTX were included in this substudy of a prospective trial on the monitoring of NCTX with 18F-FDG PET/CT. In all patients, lymphoscintigraphy was performed prior to sentinel lymph node biopsy (SLNB). 42 patients received neoadjuvant chemotherapy. 19 patients did not receive NCTX. After SLNB, mastectomy or lumpectomy (breast-conserving surgery) combined with level I and II axillary lymph node dissection were performed. Cases of nonvisualized sentinel nodes were analyzed with respect to tumour and patient characteristics and the results of ultrasonography and 18F-FDG-PET/CT before and after NCTX. Results: Lymphoscintigram successfully identified at least one sN in 55 patients (i.e. identification rate of 90%). The risk of failure to identify the sN was associated statistically with a positive clinical nodal status prior to NCTX (p = 0.021). There was no statistical difference between patients with visualized and nonvisualized sN with respect to age, tumour grade, tumour size, pathological lymph node status or tumour histology. In patients without NCTX the sN identification rate was 100% versus 86% in patients with NCTX (n.s.). The FNR of patients with NCTX was 9.1%. Post NCTX axillary ultrasonography or FDG-PET/CT did not provide accurate information about the lymph node status in case of failing lymphatic mapping. Conclusion: On the basis of our findings, SLNB can not yet be recommended as a reliable staging method in breast cancer patients undergoing neoadjuvant chemotherapy. Patients with clinically positive axillary lymph nodes have a higher chance of unsuccessful lymphatic mapping by lymphoscintigraphy. Performing SLNB before NCTX in clinically node-negative patients may identify the subset of patients in whom axillary lymph node dissection can be omitted. Post NCTX axillary ultrasonography and 18F-FDG-PET/CT can not be suggested as valid axillary staging methods in case of a failed lymphatic mapping.

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Comparison of serum NEDD-9, CA 15-3, and CEA levels and PET metabolic parameters in breast cancer patients with 18 F-FDG PET / CT

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.5.673 ◽

2020 ◽

Vol 66 (5) ◽

pp. 673-679

Author(s):

Esra Arslan ◽

Hale Aral ◽

Tamer Aksoy ◽

Çiğdem Usul Afşar ◽

Senem Karabulut ◽

...

Keyword(s):

Breast Cancer ◽

Fdg Pet ◽

Serum Levels ◽

Breast Cancer Patients ◽

Ki 67 ◽

Fdg Uptake ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

The Relationship

SUMMARY OBJECTIVE Analyze the over expression of neural precursor cell expressed developmentally down-regulated protein 9 (NEDD-9) deregulated associated with a poor prognosis in various carcinomas. Our objective was to investigate the relationship between the levels of NEDD-9, CA 15-3, and CEA and PET (SUVmax, MTV40, TLG40) with the clinical parameters of patients with breast cancer (BC). METHODS One hundred and eleven patients (82 BC patients who underwent 18F-FDG PET/CT and 29 healthy controls) were evaluated. SUVmax, MTV, and TLG of the primary tumor were compared with the molecular and histopathological subtypes. 18F-FDG, MTV, and TLG were evaluated based on the clinical data, i.e., nodal involvement, distant metastasis, ER and PR status, Ki-67, serum levels of NEDD-9, CA15-3, and CEA. We compared the NEDD-9 in the BC and healthy control groups. RESULTS The mean ± SD of SUVmax in the 82 patients was 13.0 ± 8.6. A statistically significant relationship (p = 0.022) was found between the molecular subtypes and 18F-FDG uptake. The relationship between 18F-FDG uptake and TLG measured in patients <50 years, ER-PR negativity, and HER2 positivity were statistically significant (p=0.015, 0.007, 0.046, and 0.001, respectively). MTV40, TLG40, and CA 15-3 in metastatic patients were statistically significant (p=0.004, 0.005, and 0.003, respectively). NEDD-9 in the BC group was significantly higher than in the healthy group (p=0.017). There was a positive correlation between SUVmax and Ki67 and CA 15-3; MTV40 and CEA; CA 15-3, CEA, SUVmax, and MTV40; a negative correlation was found between CEA, TLG40, and age. CONCLUSION The use of SUVmax, MTV40, and TLG40 parameters with NEDD-9 and tumor markers has been shown to provide a high diagnostic, predictive, and prognostic value for the management of BC. This is considered to be the basis of interventions focused on the treatment objectives related to NEDD-9.

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The role of FDG-PET-CT in the evaluation of primary systemic therapy in breast cancer: links between metabolic and pathological remission

Orvosi Hetilap ◽

10.1556/oh.2012.29495 ◽

2012 ◽

Vol 153 (49) ◽

pp. 1958-1964 ◽

Cited By ~ 2

Author(s):

Tímea Tőkés ◽

Krisztián Somlai ◽

Borbála Székely ◽

Janina Kulka ◽

Gyöngyvér Szentmártoni ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Fdg Pet ◽

Axillary Lymph Node ◽

Primary Tumour ◽

Axillary Lymph ◽

Proliferation Marker ◽

Ki 67 ◽

Pet Ct ◽

Fdg Pet Ct

Introduction: FDG-PET-CT is highly sensitive in detection of viable tumour tissue, giving an importance for that in oncological diagnostics. Aim: The authors analysed retrospectively the relationship between metabolic response and changes in Ki-67, a proliferation marker. Methods: Staging FDG-PET-CT scans (before and after therapy) SUVs (Standardized Uptake Value), and morphological changes in the primary tumour and axillary lymph node region were evaluated in 30 patients with breast cancer. Calculated ΔSUV were compared with Ki-67 proliferation marker (measured in biopsies and surgical specimens). Results: The decrease of SUV and size were significant in the primary tumour and the axillary lymph node region. Decrease of Ki-67 was significant. Significant correlation was found between Ki-67 and SUV before therapy, initial Ki-67 and ΔSUV, and ΔKi-67 and ΔSUV. Conclusions: The metabolic changes were more sensitive in the measurement of the therapeutic response than morphological remission, and they correlated well with the pathological response, in not standardized clinical conditions even. Orv. Hetil., 2012, 153, 1958–1964.

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Diagnostic Performance of FDG-PET/CT Scan as Compared to US-Guided FNA in Prediction of Axillary Lymph Node Involvement in Breast Cancer Patients

Frontiers in Oncology ◽

10.3389/fonc.2021.740336 ◽

2021 ◽

Vol 11 ◽

Author(s):

Hazem I. Assi ◽

Ibrahim A. Alameh ◽

Jessica Khoury ◽

Maroun Bou Zerdan ◽

Vanessa Akiki ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Fdg Pet ◽

Diagnostic Performance ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Fdg Uptake ◽

Pet Ct ◽

Fdg Pet Ct

PurposeThe aim of this study was to evaluate the diagnostic ability of 2-deoxy-2-[fluorine-18]fluoro-d-glucose (18F-FDG) PET/non-contrast CT compared with those of ultrasound (US)-guided fine needle aspiration (FNA) for axillary lymph node (ALN) staging in breast cancer patients.Patients and MethodsPreoperative 18F-FDG PET/non-contrast CT was performed in 268 women with breast cancer, as well as ALN dissection or sentinel lymph node (SLN) biopsy. One hundred sixty-four patients underwent US-guided FNA in combination with 18F-FDG PET/CT. The diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. The receiver operating characteristic (ROC) curves were compared to evaluate the diagnostic ability of several imaging modalities.ResultsAxillary 18F-FDG uptake was positive in 180 patients, and 125 patients had axillary metastases according to the final pathology obtained by ALN dissection and/or SLN dissection. Of the patients with positive 18F-FDG uptake in the axilla, 21% had false-positive results, whereas 79% were truly positive. Eighty-eight patients had negative 18F-FDG uptake in the axilla, among which 25% were false-negative. 18F-FDG-PET/CT had a sensitivity of 86.59% and a specificity of 63.46% in the assessment of ALN metastasis; on the other hand, US-guided FNA had a sensitivity of 91.67% and a specificity of 87.50%. The mean primary cancer size (p = 0.04) and tumor grade (p = 0.04) in combination were the only factors associated with the accuracy of 18F-FDG PET/CT for detecting metastatic ALNs.ConclusionThe diagnostic performance of 18F-FDG PET/CT for the detection of axillary node metastasis in breast cancer patients was not significantly different from that of US-guided FNA. Combining 18F-FDG PET/CT with US-guided FNA or SLN biopsy could improve the diagnostic performance compared to 18F-FDG PET/CT alone.

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Diagnostic performance of 18F-FDG PET/CT, ultrasonography and MRI

Nuklearmedizin ◽

10.3413/nukmed-0605-13-06 ◽

2014 ◽

Vol 53 (03) ◽

pp. 89-94 ◽

Cited By ~ 17

Author(s):

D. H. Lee ◽

J.-K Yoon ◽

S. J. Lee ◽

T. H. Kim ◽

D. K. Kang ◽

...

Keyword(s):

Lymph Node ◽

Fdg Pet ◽

Axillary Lymph Node ◽

Diagnostic Performance ◽

Axillary Lymph ◽

Diagnostic Ability ◽

Node Metastasis ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

SummaryThe aim of this study was to evaluate the diagnostic abilities of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) compared with those of ultrasonography and magnetic resonance imaging (MRI) for axillary lymph node staging in breast cancer patients. Patients, methods: Pre- operative 18F-FDG PET/non-contrast CT, ultrasonography and MRI were performed in 215 women with breast cancer. Axillary lymph node dissection was performed in all patients and the diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. ROC curves were compared to evaluate the diagnostic ability of several imaging modalities (i. e., ultrasonography, MRI and 18F-FDG PET/CT). Results: In total, 132 patients (61.4%) had axillary lymph node metastasis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of axillary lymph node metastasis were 72.3%, 77.3%, 66.7%, 81.6%, 75.3% for ultrasonography, 67.5%, 78.0%, 65.9%, 79.2%, 74.0% for MRI, and 62.7%, 88.6%, 77.6%, 79.1%, 78.6% for 18F-FDG PET/CT, respectively. There was no significant difference in diagnostic ability among the imaging modalities (i.e., ultrasonography, MRI and 18F-FDG PET/CT). The diagnostic ability of 18F-FDG PET/CT was significantly improved by combination with MRI (p = 0.0002) or ultrasonography (p < 0.0001). The combination of 18F-FDG PET/CT with ultrasonography had a similar diagnostic ability to that of all three modalities combined (18F-FDG PET/CT+ultraso- nography+MRI, p = 0.05). Conclusion: The diagnostic performance of 18F-FDG PET/CT for detection of axillary node metastasis was not significantly different from that of ultrasonography or MRI in breast cancer patients. Combining 18F-FDG PET/CT with ultrasonography or MRI could improve the diagnostic performance compared to 18F-FDG PET/CT alone.

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