Original Article

European Journal of Nuclear Medicine and Molecular Imaging

, Volume 34, Issue 12, pp 1915-1924

[18F]FDG-PET predicts complete pathological response of breast cancer to neoadjuvant chemotherapy

  • Alina Berriolo-RiedingerAffiliated withDepartment of Nuclear Medicine, Centre Georges Francois Leclerc1rue du Professeur Marion Email author 
  • , Claude TouzeryAffiliated withDepartment of Nuclear Medicine, Centre Georges Francois Leclerc
  • , Jean-Marc RiedingerAffiliated withDepartment of Nuclear Medicine, Centre Georges Francois Leclerc
  • , Michel ToubeauAffiliated withDepartment of Nuclear Medicine, Centre Georges Francois Leclerc
  • , Bruno CoudertAffiliated withDepartment of Medical Oncology, Centre Georges Francois Leclerc
  • , Laurent ArnouldAffiliated withDepartment of Pathology, Centre Georges Francois Leclerc
  • , Christophe BoichotAffiliated withDepartment of Nuclear Medicine, Centre Georges Francois Leclerc
  • , Alexandre CochetAffiliated withDepartment of Nuclear Medicine, Centre Georges Francois Leclerc
  • , Pierre FumoleauAffiliated withDepartment of Medical Oncology, Centre Georges Francois Leclerc
    • , François BrunotteAffiliated withDepartment of Nuclear Medicine, Centre Georges Francois LeclercCNRS UMR 5158

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Abstract

Purpose

To evaluate, in breast cancer patients treated by neoadjuvant chemotherapy, the predictive value of reduction in FDG uptake with regard to complete pathological response (pCR).

Methods

Forty-seven women with non-metastatic, non-inflammatory, large or locally advanced breast cancer were included. Tumour uptake of FDG was evaluated before and after the first course of neoadjuvant chemotherapy. Four indices were used: maximal and average SUV without or with correction by body surface area and glycaemia (SUVmax, SUVavg, SUVmax-BSA-G and SUVavg-BSA-G, respectively). The predictive value of reduction in FDG uptake with respect to pCR was studied by logistic regression analysis. Relationships between baseline [18F]FDG uptake and prognostic parameters were assessed.

Results

The relative decrease in FDG uptake (ΔSUV) after the first course of neoadjuvant chemotherapy was significantly greater in the pCR group than in the non-pCR group (p < 0.000066). The four FDG uptake indices were all strongly correlated with each other. A decrease in SUVmax-BSA-G of 85.4% ± 21.9% was found in pCR patients, versus 22.6% ± 36.6% in non-pCR patients. ΔSUVmax-BSA-G <−60% predicted the pCR with an accuracy of 87% and ΔSUVs were found to be only factors predictive of the pCR at multivariate analysis. An elevated baseline SUV was associated with high mitotic activity (p < 0.0016), tumour grading (p < 0.004), high nuclear pleomorphism score (p < 0.03) and negative hormonal receptor status (p < 0.005).

Conclusion

In breast cancer patients, after only one course of neoadjuvant chemotherapy the reduction in FDG uptake is an early and powerful predictor of pCR.

Keywords

18F-fluorodeoxyglucose Breast cancer PET scan Monitoring therapy SUV