FDG PET/CT to Predict Recurrence of Early Breast Invasive Ductal Carcinoma

Abstract

This study investigated the prognostic value of FDG PET/CT radiomic features for predicting recurrence in patients with early breast invasive ductal carcinoma (IDC). The medical records of consecutive patients who were newly diagnosed with primary breast IDC after curative surgery were reviewed. Patients who received any neoadjuvant treatment before surgery were not included. FDG PET/CT radiomic features, such as a maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), skewness, kurtosis, entropy, and uniformity, were measured for the primary breast tumor using LIFEx software to evaluate recurrence-free survival (RFS). A total of 124 patients with early breast IDC were evaluated. Eleven patients had a recurrence (8.9%). Univariate survival analysis identified large tumor size (>2 cm, p = 0.045), high Ki-67 expression (≥30%, p = 0.017), high AJCC prognostic stage (≥II, p = 0.044), high SUVmax (≥5.0, p = 0.002), high MTV (≥3.25 mL, p = 0.044), high TLG (≥10.5, p = 0.004), and high entropy (≥3.15, p = 0.003) as significant predictors of poor RFS. After multivariate survival analysis, only high MTV (p = 0.045) was an independent prognostic predictor. Evaluation of the MTV of the primary tumor by FDG PET/CT in patients with early breast IDC provides useful prognostic information regarding recurrence.

Keywords: FDG PET/CT; early breast invasive ductal carcinoma; metabolic tumor volume; radiomics; recurrence.

Figure 1

Kaplan–Meier analysis of recurrence-free survival (RFS) according to primary tumor metabolic tumor volume (MTV) value.

Figure 2

FDG PET/CT images in patients with early breast invasive ductal carcinoma. (A) A 50-year-old woman with AJCC anatomic stage T2N0M0 (IIA), AJCC prognostic stage IIA, primary tumor size 2.8 cm, SUVmax 7.5 and MTV 1.6 mL (white arrows). No recurrence was found until the last clinical follow-up of 94.6 months. (B) A 59-year-old woman with AJCC anatomic stage T2N0M0 (IIA), AJCC prognostic stage IIA, primary tumor size 2.5 cm, SUVmax 6.2 and MTV 4.4 mL (yellow arrows). Lung metastasis was found after 37.2 months of follow-up.