Sequential 18F-FDG PET/CT for early prediction of complete pathological response in breast and axilla during neoadjuvant chemotherapy

Koolen, Bas B.; Pengel, Kenneth E.; Wesseling, Jelle; Vogel, Wouter V.; Peeters, Marie‐Jeanne T. F. D. Vrancken; Vincent, Andrew; Gilhuijs, Kenneth G. A.; Rodenhuis, S.; Rutgers, Emiel J. T.; Olmos, Renato A. Valdés

doi:10.1007/s00259-013-2515-7

Cited by 54 publications

(55 citation statements)

References 32 publications

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“…Few studies have evaluated the predictive value of FDG-PET in TNBC treated with NAC. Most of these found a good predictive value of PET in this subtype, after both 1 and 2 cycles of NAC (24,33,34). In the study of Groheux and colleagues, a cutoff of À50% of DSUV max offered the best accuracy in predicting pCR, whereas a À42% cutoff was optimal to predict relapse (24).…”

Section: Biologic Biomarkers Of Tumor Responsementioning

confidence: 99%

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Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Humbert

Riedinger

Charon-Barra

et al. 2015

Clinical Cancer Research

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Purpose: To investigate the value of the metabolic tumor response assessed with 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET), compared with clinicobiologic markers to predict pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in women with triple-negative breast cancer (TNBC).Experimental Design: Fifty consecutive women with TNBC and an indication for NAC were prospectively included. Different pretreatment clinical, biologic, and pathologic biomarkers, including SBR grade, the Ki-67 proliferation index, androgen receptor expression, EGF receptor (EGFR), and cytokeratin 5/6 staining, were assessed. Tumor glucose metabolism at baseline and its change after the first cycle of NAC (DSUV max ) were assessed using FDG-PET.Results: The pCR rate was 42%. High Ki-67 proliferation index (P ¼ 0.016), negative EGFR status (P ¼ 0.042), and high DSUV max (P ¼ 0.002) were significantly associated with pCR. In multivariate logistic regression, both negative EGFR status (OR, 6.4; P ¼ 0.043) and high DSUV max (OR, 7.1; P ¼ 0.014) were independent predictors of pCR. Using a threshold at À50%, tumor DSUV max predicted pCR with a negative, a positive predictive value, and an accuracy of 79%, 70%, and 75%, respectively. Combining a low DSUV max and positive EGFR status could predict non-pCR with an accuracy of 92%.Conclusions: It is important to define the chemosensitivity of TNBC to NAC early. Combining EGFR status and the metabolic response assessed with FDG-PET can help the physician to early predict the probability of achieving pCR or not. Given these results, the interest of response-guided tailoring of the chemotherapy might be tested in multicenter trials.

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Section: Biologic Biomarkers Of Tumor Responsementioning

confidence: 99%

“…As most studies that have previously assessed PET-based tumor response in breast cancer (24,34), and in accordance with the recommendations of the European Organization of Research and Treatment of cancer (EORTC; ref. 35), the relative change in tumor SUV max was measured to assess tumor response.…”

Section: Biologic Biomarkers Of Tumor Responsementioning

confidence: 99%

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Humbert

Riedinger

Charon-Barra

et al. 2015

Clinical Cancer Research

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“…The main objective of our study was to determine whether PET is useful in predicting pCR and patient outcome early in TNBC patients and to evaluate whether the type of chemotherapy regimen influences metabolic response. The secondary objectives were to optimize the PET criteria for predicting pathologic response and to determine whether assessing 18 F-FDG changes in axillary nodes, in addition to the primary tumor, improves PET prediction as recently suggested (19).…”

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confidence: 99%

¹⁸F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen

et al. 2015

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Patients with triple-negative breast cancer (TNBC) have poor outcome when pathologic complete response (pCR) is not reached after neoadjuvant chemotherapy. Early prediction would be helpful. We evaluated the association between metabolic response after 2 cycles of neoadjuvant chemotherapy, pCR, and outcome in patients receiving 2 different anthracycline-based regimens (conventional and intensified). Methods: Of 77 consecutive TNBC patients, 23 received EC-D (4 cycles of epirubicin 1 cyclophosphamide followed by 4 cycles of docetaxel at conventional doses) and 55 received a dose-intensified, dose-dense concomitant regimen of epirubicin 1 cyclophosphamide (historically called SIM) for 6 cycles. PET/CT with 18 F-FDG was performed at baseline and after 2 cycles of neoadjuvant chemotherapy. The associations between clinical factors, biologic factors, early metabolic change, pCR, and event-free survival (EFS) were examined (log-rank test). Results: Of the 78 patients, 29 (37%) achieved pCR. The change in SUV max (ΔSUV max ) after 2 cycles was more pronounced in patients who achieved pCR (−72% vs. −42%; P , 0.0001). ΔSUV max was more pronounced under SIM than under EC-D (−68% vs. −35%, P 5 0.009), and there was a trend for a higher pCR rate (44% vs. 22%, P 5 0.078). Twenty-two patients relapsed and 10 of them died (median follow-up, 34 mo). pCR was associated with EFS (log-rank, P 5 0.001). ΔSUV max was also significantly associated with EFS both in patients receiving SIM (P 5 0.028) and in those receiving EC-D (P 5 0.021). The optimal ΔSUV max for predicting pCR and EFS was, however, specific to the treatment regimen. EFS was not associated with tumor grade (P 5 0.98), histologic subtype (P 5 0.17), or clinical stage (P 5 0.097). Conclusion: Early metabolic change during neoadjuvant chemotherapy can predict pathologic response and EFS in TNBC patients under different chemotherapy regimens. However, the metabolic response varies with the type of chemotherapy.

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“…Several reports have described early treatment response assessment using FDG-PET in specific subtypes of breast cancer, including ER-positive tumors [79,83,85,86], HER2-positive tumors [82,84,85,87], and triple-negative tumors [85,88]. However, there are several problems in such studies.…”

Section: Early Treatment Response Assessmentmentioning

confidence: 99%

“…In many studies [71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] that have evaluated a possible role for metabolic evaluation with FDG-PET and PET/ CT, investigators demonstrated a correlation between early changes in FDG uptake, mostly in terms of the SUV max value, after one or two courses of chemotherapy and the final pathologic response upon completion of chemotherapy, or patient outcome (Table 4). A review article including 745 patients in 15 studies indicated that the pooled sensitivity and specificity of FDG-PET for early separation of responders from non-responders could reach 80.5 % (95 % CI, 75.9-84.5 %) and 78.8 % (95 % CI, 74.1-83.0 %), respectively [91].…”

Section: Early Treatment Response Assessmentmentioning

confidence: 99%

Present and future role of FDG-PET/CT imaging in the management of breast cancer

Kitajima

Miyoshi

2016

Jpn J Radiol

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by malignant cells, opened a new field in clinical oncologic imaging. Recently, integrated positron emission tomography/computed tomography (PET/CT), in which a full-ringdetector clinical PET scanner and multidetector-row helical CT scanner are combined, has made it possible to acquire both metabolic and anatomic imaging data using a single device in a single diagnostic session, and provides precise anatomic localization of suspicious areas of increased FDG uptake. When used in a clinical setting, FDG-PET/CT leads to a significant improvement in diagnostic accuracy and has had a considerable impact on patient management, including diagnosis, initial staging, optimization of treatment, restaging, monitoring of the response to therapy, and prognostication of various malignant tumors. We herein review the current and future roles of FDG-PET/CT in the management of breast cancer, discussing its usefulness and limitations for imaging in these patients. DiagnosisFDG-PET imaging has poor sensitivity (<50 %) for subcentimeter breast cancers [9,10]. This is due to the limited spatial resolution of PET and, in some cases, by tumor characteristics (e.g., low FDG avidity in grade 1 cancer, ductal carcinoma in situ, or lobular carcinoma) [1,2]. Specificity can also be altered by variations of FDG uptake in certain benign conditions, such as infection, fibroadenoma, ductal adenoma, inflammatory granulomatous mastitis, and fibrocystic changes [3].In order to improve specificity, some authors would obtain a second series of PET images centered on the breast approximately 2 h after FDG injection (dual-time imaging) [4]. Indeed, FDG uptake seems to increase with time in the case of malignancy, while some inflammatory lesions show stable or decreasing uptake [4]. However, dual-time Abstract Integrated positron emission tomography/computed tomography (PET/CT) with 2-[18F]fluoro-2-deoxyd-glucose (FDG) is a useful tool for acquisition of both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session, and has opened a new field in clinical oncologic imaging. FDG-PET/CT has been used successfully for the diagnosis, initial staging, restaging, early treatment response assessment, evaluation of metastatic disease response, and prognostication of breast cancer as well as various malignant tumors. We herein review the current place and role of FDG-PET/CT in the management of breast cancer, focusing on its usefulness and limitations in the imaging of these patients.

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Sequential 18F-FDG PET/CT for early prediction of complete pathological response in breast and axilla during neoadjuvant chemotherapy

Cited by 54 publications

References 32 publications

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

¹⁸F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen

Present and future role of FDG-PET/CT imaging in the management of breast cancer

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Sequential 18F-FDG PET/CT for early prediction of complete pathological response in breast and axilla during neoadjuvant chemotherapy

Cited by 54 publications

References 32 publications

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer

18F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen

Present and future role of FDG-PET/CT imaging in the management of breast cancer

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¹⁸F-FDG PET/CT for the Early Evaluation of Response to Neoadjuvant Treatment in Triple-Negative Breast Cancer: Influence of the Chemotherapy Regimen