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. 2025 May 6.
doi: 10.1007/s00259-025-07306-y. Online ahead of print.

Metabolic characterization and radiomics-based composite model for breast cancer immune microenvironment types using 18F-FDG PET/CT

Yuan Gao #  1   2 , Zijian Fu #  1 , Xiaojuan Zhu  3 , Hongfeng Li  4 , Lei Yin  1 , Caixia Wu  1 , Jinzhi Chen  1 , Yulong Chen  1 , Li Liang  3 , Jingming Ye  5 , Ling Xu  6 , Meng Liu  7
Affiliations

Metabolic characterization and radiomics-based composite model for breast cancer immune microenvironment types using 18F-FDG PET/CT

Yuan Gao et al. Eur J Nucl Med Mol Imaging. .

Abstract

Purpose: The intricateness of tumor immune microenvironment types (TIMTs) complicates identifying responders to immune checkpoint inhibitors (ICIs). Our purpose was to explore the metabolic characteristics of TIMTs in breast cancer using 18F-fluorodeoxyglucose (FDG) PET/CT and to establish radiomics-based predictive models for TIMTs.

Methods: Consecutive 207 breast cancer patients (211 primary lesions), who underwent 18F-FDG PET/CT examination from Sep 2022 to Aug 2024 in our hospital, were retrospectively reviewed. The programmed death-ligand 1 (PD-L1) and tumor-infiltrating lymphocytes (TILs) were evaluated for TIMTs: TMIT-I (PD-L1-, TILs-), TMIT-II (PD-L1+, TILs+), TMIT-III (PD-L1-, TILs+), and TMIT-IV (PD-L1+, TILs-). The relationship between metabolic parameters (such as maximum standardized uptake value (SUVmax) and tumor-to-liver SUV ratio (TLR)) and TIMTs was analyzed. Then composite predictive models based on radiomics were further developed.

Results: TIMT-II represented the highest proportion in HER2+ (14/22, 64%) and triple-negative (17/27, 63%) breast cancer. Most metabolic parameters (such as SUVmax and TLR) exhibited significant differences in TIMT-II vs. -I or TIMT-II vs. -III (P < 0.05). TLR (P = 0.03; OR: 1.1) and Nottingham grade (P = 0.006; OR: 3.1) were independent impact factors of TIMT-II. We further developed a composite model that integrated radiomics, metabolic parameter, and clinicopathological data, which demonstrated promising predictive efficacy for TIMT-II (AUC testing set = 0.86).

Conclusion: Metabolic differences existed among different TIMTs, with TIMT-II exhibiting markedly elevated metabolic characteristics. The composite model based on radiomics demonstrated high predictive efficacy for TIMT-II and has the potential to screen ICIs responders.

Keywords: 18F-FDG PET/CT; Breast cancer; Immune checkpoint inhibitors (ICIs); Radiomics; Tumor immune microenvironment types (TIMTs).

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Conflict of interest statement

Declarations. Ethical approval: This single-center prospective clinical trial was performed at Peking University First Hospital, and the study was approved by the institutional ethics committee (2022SR053-001), waiving the need for written informed consent. Consent to participate: All patients provided written informed consent prior to imaging. Consent to publish: Not applicable. Competing interests: The authors have no relevant financial or non-financial interests to disclose.

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