© The Author (2008). Published by Oxford University Press. All rights reserved
Clinicopathological and Prognostic Relevance of Uptake Level using 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Fusion Imaging (18F-FDG PET/CT) in Primary Breast Cancer
1 Department of Surgery, National Defense Medical College, Tokorozawa, Saitama
2 Department of Basic Pathology, National Defense Medical College, Tokorozawa, Saitama
3 Department of Breast Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
4 Department of Basic Traumatology, National Defense Medical College, Tokorozawa, Saitama
5 Department of Biochemistry, National Defense Medical College, Tokorozawa, Saitama
6 Tokorozawa PET diagnostic Imaging clinic, Tokorozawa, Saitama
For reprints and all correspondence: Hitoshi Tsuda, Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan. E-mail: htsuda{at}ndmc.ac.jp
Received January 13, 2008; accepted February 21, 2008
Objective: Using integrated 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT), the clinical significance of 18F-FDG uptake was evaluated in patients with primary breast cancer.
Methods: Clinicopathological correlation with the level of maximum standardized uptake values (SUV) 60 min obtained from preoperative 18F-FDG PET/CT were examined in 152 patients with primary breast cancer. The prognostic impact of the level of SUV was explored using simulated prognosis derived from computed program Adjuvant! in 136 (89%) patients with invasive ductal carcinoma (IDC).
Results: High SUV level was significantly correlated with tumor invasive size (
2 cm) (P <0.0001), higher score of nuclear grade (P <0.0001), nuclear atypia (P <0.0001) and mitosis counts (P <0.0001), negative hormone receptor status (P = 0.001), high score of c-erbB-2 expression (P = 0.006), lymph node metastasis (P = 0.002), and IDC in comparison with invasive lobular carcinoma (P = 0.004). Multivariate analyses showed tumor invasive size, nuclear grade and estrogen receptor negativity were significantly correlated with SUV in primary breast cancer (P <0.0001,<0.0001, and <0.012, respectively), and nuclear grade was significantly correlated with SUV in tumors of invasive size 2 cm or less (P <0.0001). Tumors with high SUV (cutoff value 4.0) showed higher relapse and mortality rate compared to those with low SUV (P <0.0001).
Conclusions: High uptake of 18F-FDG would be predictive of poor prognosis in patients with primary breast cancer, and aggressive features of cancer cells in patients with early breast cancer. 18F-FDG PET/CT could be a useful tool to pretherapeutically predict biological characteristics and baseline risk of breast cancer.
Key Words: breast cancer • 18F-FDG • PET/CT • SUV • prognosis
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