Volume-based metabolic parameter of breast cancer on preoperative 18F-FDG PET/CT could predict axillary lymph node metastasis

Abstract

The purpose of our study was to evaluate the association between metabolic parameters on FDG PET/CT and axillary lymph node metastasis (ALNM) in patients with invasive breast cancer.From January 2012 to December 2012, we analyzed 173 patients with invasive ductal carcinoma (IDC) who underwent both initial breast magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) examinations. All metabolic parameters were measured from the tumor volume segmented by a gradient-based method. Once the primary target lesion was segmented, maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated automatically by the MIMvista software.Mean age of 173 patients was 49 years. Of 173 patients, 45 (26%) showed ALNM. On univariate analysis, larger tumor size (>2.2 cm; P = .002), presence of lymphovascular invasion (P < .001), higher SUVmax (>2.82; P = .038), higher SUVmean (>1.2; P = .027), higher MTV (>2.38; P < .001), and higher TLG (>3.98; P = .007) were associated with a higher probability of ALNM. On multivariate analysis, presence of lymphovascular invasion (adjusted odds ratio [OR], 11.053; 95% CI, 4.403–27.751; P < .001) and higher MTV (>2.38) (adjusted OR, 2.696; 95% CI, 1.079–6.739; P = .034) maintained independent significance in predicting ALNM. In subgroup analysis of T2/T3 breast cancer, lymphovascular invasion (adjusted OR, 20.976; 95% CI, 5.431–81.010; P < .001) and higher MTV (>2.38) (adjusted OR, 4.906; 95% CI, 1.616–14.896; P = .005) were independent predictors of ALNM. However in T1 breast cancer, lymphovascular invasion (adjusted OR, 16.096; 95% CI, 2.517–102.939; P = .003) and larger SUV mean (>1.2) (adjusted OR, 13.275; 95% CI, 1.233–142.908; P = .033) were independent predictors while MTV was not.MTV may be associated with ALNM in patients with invasive breast cancer, particularly T2 and T3 stages. In T1 breast cancer, SUVmean was associated with ALNM.

Correlation of primary tumor metabolic parameters with clinical, histopathological and molecular characteristics in breast cancer patients at pre-operative staging FDG-PET/CT study

“…Several studies proved that the SUVmax of primary tumor was significantly higher in cases with high nuclear grade tumors similar to ours [32,33].ALNs metastasis is considered the most important prognostic factor in the BC . Patients with positive ALNs had significantly higher median SUVmax values similar to several studies [35,41]. Larger tumors contain more tumor cells than the smaller ones , thus requiring a greater glucose supply to maintain the metabolism and proliferation of tumor cells, which would result in an increase in SUVmax.…”

Prognostic Significance of Metabolic Parameters and Textural Features on 18F-FDG PET/CT in Invasive Ductal Carcinoma of Breast

“…Their analysis showed that SUVmax and TLG were not significantly predictive of survival, yet MTV was significant. A similar study concluded that MTV may be associated with axillary lymph node status in breast cancer patients, particularly in T2 and T3 stages 6 . Another study by Hyun et al .…”

Clustering subtypes of breast cancer by combining immunohistochemistry profiles and metabolism characteristics measured using FDG PET/CT

“…Volumetric PET parameters including the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) have also taken on greater importance in prognostic prediction over SUV parameters [ 48 , 49 ]. In breast cancer, the MTV may be associated with axillary lymph node metastasis and overall survival [ 50 – 52 ]. In addition, TLG can be used to predict event-free survival [ 53 ].…”