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18F-FLT PET/CT as an imaging tool for early prediction of pathological response in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy: a pilot study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

We evaluated whether 18F-3′-deoxy-3′-fluorothymidine positron emission tomography (FLT PET) can predict the final postoperative histopathological response in primary breast cancer after the first cycle of neoadjuvant chemotherapy (NCT).

Methods

In this prospective cohort study of 15 patients with locally advanced operable breast cancer, FLT PET evaluations were performed before NCT, after the first cycle of NCT, and at the end of NCT. All patients subsequently underwent surgery. Variables from FLT PET examinations were correlated with postoperative histopathological results.

Results

At baseline, median of maximum standardized uptake values (SUVmax) in the groups showing a complete pathological response (pCR) + residual cancer burden (RCB) I, RCB II or RCB III did not differ significantly for the primary tumour (5.0 vs. 2.9 vs. 8.9, p = 0.293) or for axillary nodes (7.9 vs. 1.6 vs. 7.0, p = 0.363), whereas the Spearman correlation between SUVmax and Ki67 proliferation rate index was significant (r = 0.69, p < 0.001). Analysis of the relative percentage change of SUVmaxin the primary tumour (∆SUVTmax(t 1)) and axillary nodes (∆SUVNmax(t 1)) after the first NCT cycle showed that the power of ∆SUVTmax(t 1) to predict pCR + RCB I responses (AUC = 0.91, p < 0.001) was statistically significant, whereas ∆SUVNmax(t 1) had a moderate ability (AUC = 0.77, p = 0.119) to separate subjects with ΔSUVTmax(t 1) > −52.9 % into two groups: RCB III patients and a heterogeneous group that included RCB I and RCB II patients. A predictive score μ based on ΔSUVTmax(t 1) and ΔSUVNmax(t 1) parameters is proposed.

Conclusion

The preliminary findings of the present study suggest the potential utility of FLT PET scans for early monitoring of response to NCT and to formulate a therapeutic strategy consistent with the estimated efficacy of NCT. However, these results in a small patient population need to be validated in a larger independent cohort.

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Conflicts of interest

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Funding

This work was supported by a grant from Associazione Italiana Ricerca sul Cancro (Study INT/35/10).

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    Authors and Affiliations

    1. Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori – Milan (Italy), 20133, Milan, Italy

      Flavio Crippa, Barbara Padovano, Alessandra Alessi, Emilio Bombardieri, Claudio Pascali & Anna Bogni

    2. Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori – Milan (Italy), Via Venezian 1, 20133, Milan, Italy

      Roberto Agresti, Ilaria Maugeri, Mario Rampa & Gabriele Martelli

    3. Molecular Targeting Unit, Fondazione IRCCS Istituto Nazionale dei Tumori – Milan (Italy), 20133, Milan, Italy

      Marco Sandri

    4. Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori – Milan (Italy), 20133, Milan, Italy

      Gabriella Mariani, Giulia Bianchi & Filippo de Braud

    5. Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori – Milan (Italy), 20133, Milan, Italy

      Maria Luisa Carcangiu

    6. Radiology-RMI Unit, Fondazione IRCCS Istituto Nazionale dei Tumori – Milan (Italy), 20133, Milan, Italy

      Giovanna Trecate

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    1. Flavio Crippa
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    Correspondence to Roberto Agresti.

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    Flavio Crippa and Roberto Agresti contributed equally to this work.

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    Crippa, F., Agresti, R., Sandri, M. et al. 18F-FLT PET/CT as an imaging tool for early prediction of pathological response in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy: a pilot study. Eur J Nucl Med Mol Imaging 42, 818–830 (2015). https://doi.org/10.1007/s00259-015-2995-8

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