Correlation between semiquantitative and volumetric 18F-FDG PET/computed tomography parameters and Ki-67 expression in breast cancer

Abstract

Objectives To evaluate the relationship between semiquantitative and volumetric parameters on 18F-FDG PET/computed tomography (CT), including maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), tumor to liver ratio (TLR) and tumor to mediastinum ratio (TMR) with the level of Ki-67 expression in breast cancer. Patient and methods We retrospectively reviewed 105 female patients with newly diagnosed breast cancer who underwent baseline 18F-FDG PET/CT and had immunohistochemical staining to determine the level of Ki-67 expression. The following PET parameters were measured (SUVmax, SUVmean, MTV, TLG, TLR and TMR) and correlated with level of Ki-67 expression. Results Significant moderate positive correlations were found between the PET parameters (primary SUVmax, SUVmean, TLG, TLR and TMR) and level of Ki-67 expression. The primary SUVmax had the highest correlation coefficient (r = 0.461) followed by TMR (r = 0.455) and P value of <0.001 for both. In ROC analysis, primary SUVmax had the largest area under the curve (0.806, P = 0.0001), with sensitivity of 76.5 % and specificity of 75% for prediction of high Ki-67 level. In univariate analysis, all PET parameters, patient age, tumor grade, molecular subtype, estrogen receptor and progesterone receptor status were significantly associated with Ki-67 level. In multivariate regression analysis, only tumor grade [odds ratio (OR) = 20.460, 95% confidence interval (CI): 11.360–29.559, P = <0.0001], molecular subtype (OR = −21.894, 95% CI: −37.921 to −5.866, P = 0.008), SUVmax (OR = 2.299, 95% CI: 0.703–3.895, P = 0.005) and TLR (OR = −4.908, 95% CI: −9.476 to −0.340, P = 0.035) were found to be the strongest independent predictor factors for the level of Ki-67 expression and hence proliferative activity of malignant cells in breast cancer. Conclusion The semiquantitative parameters and volumetric 18F-FDG PET/CT parameter, that is, TLG correlated well with proliferation marker Ki-67 in breast cancer. 18F-FDG PET/CT imaging can be used as a useful noninvasive diagnostic tool in imaging cellular proliferation and hence may substitute for in vitro testing of molecular markers in the diagnoses and staging of breast cancer.

PET/CT Radiomics Integrated with Clinical Indexes as A Tool to Predict Ki67 in Breast Cancer: A Pilot Study

“…Our study showed that multiple semi-quantitative parameters on 18 F-FDG PET/CT images correlate with Ki67 expression, which is in accordance with the previous studies 17,18 . Therefore, we constructed a nomogram incorporating seven radiomics and four clinical features for predicting Ki67 expression in BC.…”

Associations of whole-body 18F-FDG PET/CT parameters and SCC-Ag level with overall survival in patients with cervical cancer

“…A retrospective study by Sookha et al ., [18] recognised the complementary effect of 18 F-FDG PET/CT and SCC-Ag level, which can improve the accuracy of recurrence diagnosis, thus providing effective information for re-staging of cervical cancer recurrence and facilitating selection of appropriate treatment methods. Although assessment of SCC-Ag level is not recommended as a detection method in the guidelines for diagnosis and treatment of cervical SCC [18], an increase in SCC-Ag level is associated with advanced International Federation of Gynaecology and Obstetrics stage, tumour recurrence, and lymph node and distant metastases [18–23]. The present study also showed that the prognosis of cervical SCC patients with a higher SCC-Ag level was generally poor ( P = 0.004).…”

State of the Art in 2022 PET/CT in Breast Cancer: A Review

“…Similarly, in some conditions with low FDG uptake, there are false-negative PET/CT results. Such conditions include small lesions, low Ki-67 expression, and histology of invasive lobular carcinoma [6,64,65]. Lastly, the factors that may contribute to low PET/CT specificity in patients with high levels of tumor markers include reconstruction artifacts, degenerative bone disease, breast expansion, and lung inflammation [38].…”