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. 2023 Aug 24;12(17):5487.
doi: 10.3390/jcm12175487.

Clinical Utility of Pre-Therapeutic [18F]FDG PET/CT Imaging for Predicting Outcomes in Breast Cancer

Sophia Najid  1 , Romain-David Seban  2 , Laurence Champion  2 , Alexandre De Moura  3   4 , Clara Sebbag  3   4 , Hélène Salaün  3   4 , Luc Cabel  3   4 , Claire Bonneau  5
Affiliations

Clinical Utility of Pre-Therapeutic [18F]FDG PET/CT Imaging for Predicting Outcomes in Breast Cancer

Sophia Najid et al. J Clin Med. .

Abstract

Background: [18F]FDG PET/CT is used for staging and could also provide information associated with clinical outcomes. The objective of this study was to determine the clinical utility of biomarkers measured using [18F]FDG PET/CT to predict the absence of pathological complete response (no-pCR) and recurrence.

Methods: In this retrospective study, we included patients with non-special-type breast carcinoma who underwent [18F]FDG PET/CT before neoadjuvant chemotherapy between 2011 and 2019. Clinicopathological data were collected. Tumor SUVmax and total metabolic tumor volume (TMTV) were measured from PET images. The association between biomarkers and no-pCR was studied using logistic regression. The cut-off value was determined using the area under the ROC Curve. To predict 3-year recurrence-free survival (RFS), we used a multivariable Cox model, and the cut-off value was determined using time-dependent ROC and predictiveness curves.

Results: Two hundred and eighty-six patients were included in the analysis. One hundred and twelve patients had a pCR (39.2%). The pCR rate was significantly higher in patients with a high nuclear grade (p < 0.01), HER2+ and TNBC subtypes (p < 0.01), high Ki67 (p < 0.01), and low TMTV (p < 0.01). A high TMTV value (>9.0 cm3) was significantly associated with no-pCR in the whole cohort (OR = 2.4, 95% CI: 1.3-4.2, p < 0.01). After a median follow-up of 4.5 years, 65 patients experienced recurrence and 39 patients died. High TMTV (>13.5 cm3) was associated with shorter RFS (HR = 4.0, 95% CI: 1.9-8.4, p < 0.01).

Conclusion: High TMTV in pre-therapeutic imaging is associated with no-pCR and recurrence. It can help in identifying high-risk patients and be considered as an intensified or alternative adjuvant therapy for closely monitoring patients.

Keywords: PET/CT imaging; breast cancer; neoadjuvant chemotherapy; pathological complete response; total metabolic tumor volume.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow Chart.
Figure 2
Figure 2
Kaplan–Meier curves according to TMTV with a cut-off value of 13.5 cm3 (A), of 28.1 cm3 (B), and according to pathological complete response (C). The p values obtained are those of the log rank test.
Figure 3
Figure 3
Association between the value of TMTV on pre-therapeutic [18F]FDG PET/CT and pathological response on the surgical specimen after surgery.
See this image and copyright information in PMC

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