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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 6/2015

01-05-2015 | Original Article

18F-FLT PET/CT as an imaging tool for early prediction of pathological response in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy: a pilot study

Authors: Flavio Crippa, Roberto Agresti, Marco Sandri, Gabriella Mariani, Barbara Padovano, Alessandra Alessi, Giulia Bianchi, Emilio Bombardieri, Ilaria Maugeri, Mario Rampa, Maria Luisa Carcangiu, Giovanna Trecate, Claudio Pascali, Anna Bogni, Gabriele Martelli, Filippo de Braud

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 6/2015

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Abstract

Purpose

We evaluated whether 18F-3′-deoxy-3′-fluorothymidine positron emission tomography (FLT PET) can predict the final postoperative histopathological response in primary breast cancer after the first cycle of neoadjuvant chemotherapy (NCT).

Methods

In this prospective cohort study of 15 patients with locally advanced operable breast cancer, FLT PET evaluations were performed before NCT, after the first cycle of NCT, and at the end of NCT. All patients subsequently underwent surgery. Variables from FLT PET examinations were correlated with postoperative histopathological results.

Results

At baseline, median of maximum standardized uptake values (SUVmax) in the groups showing a complete pathological response (pCR) + residual cancer burden (RCB) I, RCB II or RCB III did not differ significantly for the primary tumour (5.0 vs. 2.9 vs. 8.9, p = 0.293) or for axillary nodes (7.9 vs. 1.6 vs. 7.0, p = 0.363), whereas the Spearman correlation between SUVmax and Ki67 proliferation rate index was significant (r = 0.69, p < 0.001). Analysis of the relative percentage change of SUVmaxin the primary tumour (∆SUVTmax(t 1)) and axillary nodes (∆SUVNmax(t 1)) after the first NCT cycle showed that the power of ∆SUVTmax(t 1) to predict pCR + RCB I responses (AUC = 0.91, p < 0.001) was statistically significant, whereas ∆SUVNmax(t 1) had a moderate ability (AUC = 0.77, p = 0.119) to separate subjects with ΔSUVTmax(t 1) > −52.9 % into two groups: RCB III patients and a heterogeneous group that included RCB I and RCB II patients. A predictive score μ based on ΔSUVTmax(t 1) and ΔSUVNmax(t 1) parameters is proposed.

Conclusion

The preliminary findings of the present study suggest the potential utility of FLT PET scans for early monitoring of response to NCT and to formulate a therapeutic strategy consistent with the estimated efficacy of NCT. However, these results in a small patient population need to be validated in a larger independent cohort.
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Metadata
Title
18F-FLT PET/CT as an imaging tool for early prediction of pathological response in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy: a pilot study
Authors
Flavio Crippa
Roberto Agresti
Marco Sandri
Gabriella Mariani
Barbara Padovano
Alessandra Alessi
Giulia Bianchi
Emilio Bombardieri
Ilaria Maugeri
Mario Rampa
Maria Luisa Carcangiu
Giovanna Trecate
Claudio Pascali
Anna Bogni
Gabriele Martelli
Filippo de Braud
Publication date
01-05-2015
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 6/2015
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-015-2995-8

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