Early metabolic response using FDG PET/CT and molecular phenotypes of breast cancer treated with neoadjuvant chemotherapy

Bhumsuk Keam, Seock-Ah Im, Youngil Koh, Sae-Won Han, Do-Youn Oh, Nariya Cho, Jee Hyun Kim, Wonshik Han, Keon Wook Kang, Woo Kyung Moon, Tae-You Kim, In Ae Park, Dong-Young Noh, June-Key Chung, Yung-Jue Bang, Bhumsuk Keam, Seock-Ah Im, Youngil Koh, Sae-Won Han, Do-Youn Oh, Nariya Cho, Jee Hyun Kim, Wonshik Han, Keon Wook Kang, Woo Kyung Moon, Tae-You Kim, In Ae Park, Dong-Young Noh, June-Key Chung, Yung-Jue Bang

Abstract

Background: This study was aimed 1) to investigate the predictive value of FDG PET/CT (fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography) for histopathologic response and 2) to explore the results of FDG PET/CT by molecular phenotypes of breast cancer patients who received neoadjuvant chemotherapy.

Methods: Seventy-eight stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. FDG PET/CTs were acquired before chemotherapy and after the first cycle of chemotherapy for evaluating early metabolic response.

Results: The mean pre- and post-chemotherapy standard uptake value (SUV) were 7.5 and 3.9, respectively. The early metabolic response provided by FDG PET/CT after one cycle of neoadjuvant chemotherapy was correlated with the histopathologic response after completion of neoadjuvant chemotherapy (P = 0.002). Sensitivity and negative predictive value were 85.7% and 95.1%, respectively. The estrogen receptor negative phenotype had a higher pre-chemotherapy SUV (8.6 vs. 6.4, P = 0.047) and percent change in SUV (48% vs. 30%, P = 0.038). In triple negative breast cancer (TNBC), the pre-chemotherapy SUV was higher than in non-TNBC (9.8 vs. 6.4, P = 0.008).

Conclusions: The early metabolic response using FDG PET/CT could have a predictive value for the assessment of histopathologic non-response of stage II/III breast cancer treated with neoadjuvant chemotherapy. Our findings suggest that the initial SUV and the decline in SUV differed based on the molecular phenotype.

Trial registration: ClinicalTrials.gov NCT01396655.

Figures

Figure 1
Figure 1
Schematic flow of the neoadjuvant chemotherapy and response assessed by FDG PET/CT, breast MRI and chest CT. Abbreviations: DD, docetaxel+doxorubicin; FDG PET, fluorine-18 fluorodeoxyglucose positron emission tomography; CT, computed tomography; MRI, magnetic resonance imaging; USG, ultrasonography.
Figure 2
Figure 2
Receiver-operating characteristics (ROC) analysis, determine optimal cut-off values of ΔSUV%; Area under the curve ROC was 0.79 (95% confidence interval 0.64-0.93).
Figure 3
Figure 3
Box flows comparing serial FDG PET/CT results according to molecular phenotypes based on immunohistochemistry. ER negative phenotype showed higher pre-SUV (A) and Δ SUV% (B) than ER positive phenotype. In patients with high Ki-67 expression, a similar phenomenon was observed in that pre-SUV (C) and Δ SUV% (D) was higher than the low Ki-67 expression group. In triple negative breast cancer (TNBC), pre-SUV (E) was higher than non-TNBC; however, Δ SUV% (F) was not different.

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