Early Metabolic Response to Neoadjuvant Treatment: FDG PET/CT Criteria according to Breast Cancer Subtype

Groheux, David; Majdoub, Mohamed; Sanna, Alice; Crémoux, Patricia de; Hindié, Elif; Giacchetti, Sylvie; Martineau, Antoine; Roquancourt, Anne de; Merlet, Pascal; Visvikis, Dimitris; Resche-Rigon, Matthieu; Hatt, Mathieu; Espié, Marc

doi:10.1148/radiol.2015141638

Cited by 72 publications

(75 citation statements)

References 40 publications

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“…There was no significant difference in uptake between NG1 and NG2. (19). Triple-negative breast tumors demonstrated the highest mean uptake, followed by ER1/HER22 and lowest uptake in HER21 type though without overall significance likely due to small sample size (Table 3).…”

Section: F-fluciclovine Activity and Histologic Characteristics Of Brmentioning

confidence: 94%

Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

et al. 2016

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The purpose of this study was to explore the uptake of the synthetic amino acid analog PET radiotracer anti-3-18 F-FACBC ( 18 F-fluciclovine) in breast lesions with correlation to histologic and immunohistochemical characteristics. Methods: Twelve women with breast lesions underwent 45-min dynamic PET/CT of the thorax after intravenous administration of 366.3 ± 14.8 (337.44-394.05) MBq of 18 F-fluciclovine. Uptake in the primary lesions at 4 representative time points (5, 17, 29, and 41 min) after injection were correlated with histologic, imaging, and clinical findings. The significance of differences in SUV max and tumor-to-background ratios between malignant and benign tissue were calculated. Correlations of activity to histologic and immunohistochemical cancer subtypes were made including Ki-67 intensity and Nottingham grade (NG). Results: There were 17 breast lesions (4 benign, 13 malignant) including 7 of 13 invasive ductal, 5 of 13 invasive lobular, and 1 of 13 metaplastic carcinomas. There was a significant difference in mean SUV max ± SD of malignant (6.2 ± 3.2, 6.0 ± 3.2, 5.7 ± 2.8, and 5.6 ± 3.0) versus benign (1.3 ± 0.6, 1.2 ± 0.5, 1.2 ± 0.6, and 1.1 ± 0.5) lesions at 5, 17, 29, and 41 min, respectively (all P # 0.0001). Tumor-tobackground (aorta, normal breast, and marrow) ratios were also significantly higher in malignant than benign breast lesions (all P # 0.02). The highest 18 F-fluciclovine activity seems to be present in triplenegative and NG3 subtypes. . In 7 patients, 18 F-fluciclovine PET visualized locoregional and distant spread including that of lobular cancer, though identification of hepatic metastases was limited by physiologic background activity. Conclusion: The uptake characteristics of 18 F-fluciclovine are reflective of the histologic and immunohistochemical characteristics in suspected breast lesions with greater activity in malignant versus benign etiology. The data from this exploratory study may be useful to design future studies using 18 F-fluciclovine PET for breast tumor imaging as well as for detection of locoregional and distant spread.

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Section: F-fluciclovine Activity and Histologic Characteristics Of Brmentioning

confidence: 94%

Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

et al. 2016

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“…The imaging protocol was designed to ensure SUV measurements across all time points. Blood glucose levels were measured in all patients before 18 F-FDG administration; no patient had blood glucose levels exceeding 200 mg/dL. After fasting for at least 6 h, the patients received an intravenous injection of 18 F-FDG (3.7-4.0 MBq/kg).…”

Section: F-fdg Pet/ct Scan Proceduresmentioning

confidence: 99%

“…Presently, 18 F-FDG PET combined with CT is accepted as a noninvasive method for the early evaluation of the response to therapy because decreased glucose metabolism precedes tumor shrinkage (2). However, the expensive technology using 18 F-FDG PET/CT during NAC has precluded its integration into clinical practice (3). Near-infrared optical imaging based on the visualization of the hemodynamic status of the tissue (such as oxyhemoglobin [O 2 Hb] and deoxyhemoglobin [HHb] concentrations) is reportedly promising for determining the physiologic status of tumor-bearing breast tissue and for monitoring early responses (4).…”

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confidence: 97%

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Near-Infrared Diffuse Optical Imaging for Early Prediction of Breast Cancer Response to Neoadjuvant Chemotherapy: A Comparative Study Using ¹⁸F-FDG PET/CT

et al. 2016

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Diffuse optical spectroscopic imaging (DOSI) is used as an indicator of tumor blood volume quantified by tissue hemoglobin concentrations. We aimed to determine whether early changes in tumor total hemoglobin (tHb) concentration can predict a pathologic complete response (pCR) to neoadjuvant chemotherapy in patients with operable breast cancer, and we compared the predictive value of pCR between DOSI and 18 F-FDG PET combined with CT. Methods: Of the 100 patients enrolled, 84 patients were prospectively evaluated for primary objective analysis. Sixty-four of the patients underwent both sequential DOSI scans at baseline after their first and second chemotherapy courses and 18 F-FDG PET/CT at baseline and after their second chemotherapy course. The mean tHb (tHb mean ) concentration and SUV max of the lesion were measured using DOSI and 18 F-FDG PET/CT, respectively, and the percentage change in tHb mean (ΔtHb mean ) and change in SUV max (ΔSUV max ) were calculated. We compared the diagnostic performances of DOSI and 18 F-FDG PET/CT for predicting pCR via the analysis of the receiveroperating-characteristic curves. Results: pCR was achieved in 16 patients, and neoadjuvant chemotherapy caused a significant reduction of ΔtHb mean in pCR compared with non-pCR after the 2 chemotherapy courses. When the tentative ΔtHb mean cutoff values after the first and second courses were used, the ability to predict pCR was as follows: 81.2% sensitivity/47.0% specificity and 93.7% sensitivity/47.7% specificity, respectively. Comparison of the diagnostic performances of DOSI and 18 F-FDG PET/CT revealed areas under the curve of 0.69 and 0.75 of ΔtHb mean after the first and second courses, respectively, which were lower than those of ΔSUV max (0.90). Conclusion: DOSI predicted pCR in patients with breast cancer with moderate accuracy. The diagnostic performance of DOSI was inferior to that of the early metabolic response as monitored by 18 F-FDG PET/CT.

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“…Previous studies found that early changes in tumor glucose metabolism, assessed with 18 F-FDG PET/CT after the first or second course of neoadjuvant chemotherapy, can indicate breast cancer response early (5,6), especially in the aggressive TNBC subtype (7,8).…”

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confidence: 99%

¹⁸F-FDG PET–Derived Tumor Blood Flow Changes After 1 Cycle of Neoadjuvant Chemotherapy Predicts Outcome in Triple-Negative Breast Cancer

et al. 2016

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Previous studies have suggested that early changes in blood flow (BF) in response to neoadjuvant chemotherapy and evaluated with 15 O-water are a surrogate biomarker of outcome in women with breast cancer. This study investigates, in the triple-negative breast cancer subtype, the prognostic relevance of tumor BF changes (DBF) in response to chemotherapy, assessed using a short dynamic 18 F-FDG PET acquisition. Methods: Forty-six consecutive women with triple-negative breast cancer and an indication for neoadjuvant chemotherapy were prospectively included. Women benefited from a baseline 18 F-FDG PET examination with a 2-min chest-centered dynamic acquisition, started at the time of 18 F-FDG injection. Breast tumor perfusion was calculated from this short dynamic image using a first-pass model. This dynamic PET acquisition was repeated after the first cycle of chemotherapy to measure early DBF. Delayed static PET acquisitions were also performed (90 min after 18 F-FDG injection) to measure changes in tumor glucose metabolism (DSUV max ). The association between tumor BF, clinicopathologic characteristics, and patients' overall survival (OS) was evaluated. Results: Median baseline tumor BF was 21 mL/min/100 g (range, 6-46 mL/min/100 g) and did not significantly differ according to tumor size, Scarf-BloomRichardson grade, or Ki-67 expression. Median tumor ΔBF was −30%, with highly scattered values (range, −93% to 1118%). A weak correlation was observed between DBF and ΔSUV max (r 5 10.40, P 5 0.01). The median follow-up was 30 mo (range, 6-73 mo). Eight women developed recurrent disease, 7 of whom died. Low OS was associated with menopausal history (P 5 0.03), persistent or increased tumor vascularization on the interim PET (DBF cutoff 5 −30%; P 5 0.03), non-breast-conserving surgery (P 5 0.04), and the absence of a pathologic complete response (pCR) (P 5 0.01). DBF and pCR provided incremental prognostic stratification: 3-y OS was 100% in pCR women, 87% in no-pCR women but achieving an early tumor BF response, and only 48% in no-pCR/no-BF-response women (DBF cutoff 5 −30%, P , 0.001). Conclusion: This study suggests the clinical usefulness of an early user-and patient-friendly 2-min dynamic acquisition to monitor breast tumor DBF to neoadjuvant chemotherapy using 18 F-FDG PET/CT. Monitoring tumor perfusion and angiogenesis response to treatment seems to be a promising target for PET tracers.

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Early Metabolic Response to Neoadjuvant Treatment: FDG PET/CT Criteria according to Breast Cancer Subtype

Cited by 72 publications

References 40 publications

Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Near-Infrared Diffuse Optical Imaging for Early Prediction of Breast Cancer Response to Neoadjuvant Chemotherapy: A Comparative Study Using ¹⁸F-FDG PET/CT

¹⁸F-FDG PET–Derived Tumor Blood Flow Changes After 1 Cycle of Neoadjuvant Chemotherapy Predicts Outcome in Triple-Negative Breast Cancer

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Early Metabolic Response to Neoadjuvant Treatment: FDG PET/CT Criteria according to Breast Cancer Subtype

Cited by 72 publications

References 40 publications

Anti-3-18F-FACBC (18F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Anti-3-18F-FACBC (18F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Near-Infrared Diffuse Optical Imaging for Early Prediction of Breast Cancer Response to Neoadjuvant Chemotherapy: A Comparative Study Using 18F-FDG PET/CT

18F-FDG PET–Derived Tumor Blood Flow Changes After 1 Cycle of Neoadjuvant Chemotherapy Predicts Outcome in Triple-Negative Breast Cancer

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Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Near-Infrared Diffuse Optical Imaging for Early Prediction of Breast Cancer Response to Neoadjuvant Chemotherapy: A Comparative Study Using ¹⁸F-FDG PET/CT

¹⁸F-FDG PET–Derived Tumor Blood Flow Changes After 1 Cycle of Neoadjuvant Chemotherapy Predicts Outcome in Triple-Negative Breast Cancer