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The relationship between ring-type dedicated breast PET and immune microenvironment in early breast cancer

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Abstract

Purpose

18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) is related to the biological parameters and prognosis of breast cancer. However, whether whole-body PET (WBPET) and dedicated breast PET (DbPET) can reflect the tumor microenvironment is unclear. This study investigated the relationship between stromal tumor-infiltrating lymphocytes (TILs) and maximum standardized uptake value (SUVmax) in WBPET and DbPET.

Methods

A total of 125 invasive breast cancers underwent WBPET and ring-type DbPET and resected specimens were pathologically assessed. The impact of SUVmax on the tumor biological parameters and TILs was retrospectively evaluated. SUVmax was classified as high and low relative to the median values (WBPET-SUVmax: 2.2 and DbPET-SUVmax: 6.0).

Results

SUVmax correlated with tumor size, nuclear grade, Ki-67 labeling index, and TILs in both WBPET and DbPET (all p < 0.001). In multiple linear regression analysis, tumor size, Ki-67 labeling index, and TILs predicted SUVmax in WBPET and DbPET. The cutoff values of tumor size, Ki-67 labeling index, and TILs predicting high SUVmax were 20 mm, 20%, and 20%, respectively. In multivariate analysis, the predictive factors for high SUVmax were tumor size and Ki-67 labeling index for WBPET and tumor size and TILs for DbPET. High SUVmax in DbPET was related to high numbers of TILs after propensity score matching analysis; however, WBPET was not (p = 0.007 and p = 0.624, respectively).

Conclusions

Both SUVmax values in WBPET and DbPET predicted TIL concentration of the primary breast cancer. In DbPET, SUVmax represented the immune microenvironment after adjusting for tumor biological factors.

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Abbreviations

CTLA-4:

Cytotoxic T-lymphocyte-associated protein 4

DbPET:

Dedicated breast positron emission tomography

ER:

Estrogen receptor

FDG:

18F-fluorodeoxyglucose

FOV:

Field of view

FOXP3:

Forkhead box P3

HER2:

Human epidermal growth factor receptor 2

IC-NST:

Invasive carcinoma of no special type

OR:

Odds ratio

PD-1:

Programmed cell death-1

PET:

Positron emission tomography

SUVmax:

Maximum standardized uptake value

TIL:

Tumor-infiltrating lymphocytes

TNBC:

Triple-negative breast cancer

WBPET:

Whole-body positron emission tomography

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Acknowledgements

We thank Kazushi Marukawa and Masatsugu Tsujimura of Chuden Hospital for providing PET examination data.

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Authors and Affiliations

  1. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan

    Shinsuke Sasada, Noriko Goda, Keiko Kajitani, Akiko Emi, Norio Masumoto, Takayuki Kadoya & Morihito Okada

  2. Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan

    Noriyuki Shiroma & Koji Arihiro

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  1. Shinsuke Sasada
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  2. Noriyuki Shiroma
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Correspondence to Shinsuke Sasada.

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Sasada, S., Shiroma, N., Goda, N. et al. The relationship between ring-type dedicated breast PET and immune microenvironment in early breast cancer. Breast Cancer Res Treat 177, 651–657 (2019). https://doi.org/10.1007/s10549-019-05339-0

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