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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2010

01-01-2010 | Breast Oncology

Prognostic Impact of [18F] FDG-PET in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy

Authors: So-Youn Jung, MD, Seok-Ki Kim, MD, PhD, Byung-Ho Nam, PhD, Sun Young Min, MD, Seung Joo Lee, MD, Chansung Park, MD, Youngmee Kwon, MD, PhD, Eun-A Kim, MD, PhD, Kyoung Lan Ko, MD, PhD, In Hae Park, MD, Keun Seok Lee, MD, PhD, Kyung Hwan Shin, MD, PhD, Seeyoun Lee, MD, PhD, Seok Won Kim, MD, PhD, Han-Sung Kang, MD, PhD, Jungsil Ro, MD

Published in: Annals of Surgical Oncology | Issue 1/2010

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Abstract

Background

This study aimed to evaluate the usefulness of serial [18F] 2-fluoro-2-deoxy-d-glucose–positron emission tomography ([18F] FDG-PET) in potentially operable breast cancer with neoadjuvant chemotherapy.

Methods

Serial positron emission tomography was undertaken in 66 breast cancer patients who comprised a subset of the population in a phase III randomized neoadjuvant trial at National Cancer Center, Korea. We assessed the peak standardized uptake value (SUVp) in the primary tumor and axillary nodes before and after neoadjuvant chemotherapy and calculated the reduction rate (RR) of the SUVp. By means of a receiver operating characteristic curve, we identified an optimal cutoff value for the RR for predicting the pathologic response and evaluated the prognostic power of this cutoff value.

Results

Ten patients (15.2%) experienced a pathologic complete response (pCR) in the primary tumor, and 19 patients (28.8%) experienced a pCR in the axillary nodes. The mean RR of the SUVp in primary tumors was 70.3% ± 28.7%, and this value was significantly different by the pathological response (89.2% ± 11.1% in pCR vs. 66.9% ± 29.6% in non-pCR, P < .001). When 84.8% of the RR was used as a cutoff value for the pCR, sensitivity and specificity was 70.0% and 69.6%, respectively. Ten patients (15.2%) developed recurrent disease at a median follow-up period of 61.5 (range, 13.5–71.8) months. In a univariate analysis, the 5-year disease-free survival (DFS) was correlated with the clinical T stage (91.1% in T1/2 vs. 71.4% in T3/4, P = .02), HER-2 status (77.8% in positive vs. 96.9% in negative, P = .03), and the 84.8% RR of the SUVp in the primary tumor (95.8% vs. 78.5%, P = .04). HER-2 positivity was a significant independent prognosticator in the multivariate analysis (hazard ratio 8.73, 95% confidence interval 1.03–73.84, P = .04). The presence of a pCR in the primary tumor or nodes was not a prognostic factor in this subset of patients. The RR of the SUVp in the axillary nodes was not correlated with the nodal pCR and DFS.

Conclusions

The RR of the SUVp in the primary tumor was correlated with the pathologic response and DFS. This study suggests the possible prognostic value of the RR in positron emission tomography by neoadjuvant chemotherapy.
Appendix
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Metadata
Title
Prognostic Impact of [18F] FDG-PET in Operable Breast Cancer Treated with Neoadjuvant Chemotherapy
Authors
So-Youn Jung, MD
Seok-Ki Kim, MD, PhD
Byung-Ho Nam, PhD
Sun Young Min, MD
Seung Joo Lee, MD
Chansung Park, MD
Youngmee Kwon, MD, PhD
Eun-A Kim, MD, PhD
Kyoung Lan Ko, MD, PhD
In Hae Park, MD
Keun Seok Lee, MD, PhD
Kyung Hwan Shin, MD, PhD
Seeyoun Lee, MD, PhD
Seok Won Kim, MD, PhD
Han-Sung Kang, MD, PhD
Jungsil Ro, MD
Publication date
01-01-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0710-3

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