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Tumour 18 F-FDG Uptake on preoperative PET/CT may predict axillary lymph node metastasis in ER-positive/HER2-negative and HER2-positive breast cancer subtypes

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Abstract

Objectives

To evaluate the association between tumour FDG uptake on preoperative PET/CT and axillary lymph node metastasis (ALNM) according to breast cancer subtype.

Methods

The records of 671 patients with invasive breast cancer who underwent 18 F-FDG PET/CT and surgery were reviewed. Using immunohistochemistry, tumours were divided into three subtypes: oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive, and triple-negative. Tumour FDG uptake, expressed as maximum standardized uptake value (SUVmax), and clinicopathological variables were analysed.

Results

ALNM was present in 187 of 461 ER-positive/HER2-negative, 54 of 97 HER2-positive, and 38 of 113 triple-negative tumours. On multivariate analysis, high tumour SUVmax (≥4.25) (P < 0.001), large tumour size (>2 cm) (P = 0.003) and presence of lymphovascular invasion (P < 0.001) were independent variables associated with ALNM. On subset analyses, tumour SUVmax maintained independent significance for predicting ALNM in ER-positive/HER2-negative (adjusted odds ratio: 3.277, P < 0.001) and HER2-positive tumours (adjusted odds ratio: 14.637, P = 0.004). No association was found for triple-negative tumours (P = 0.161).

Conclusions

Tumour SUVmax may be an independent prognostic factor for ALNM in patients with invasive breast cancer, especially in ER-positive/HER2-negative and HER2-positive subtypes, but not in those with triple-negative subtype.

Key points

• Tumour SUVmax could be an imaging biomarker for predicting ALNM

• Tumour SUVmax predicting ALNM is effective in ER-positive/HER2-negative and HER2-positive subtypes

• Tumour SUVmax predicting ALNM is inaccurate in triple-negative subtypes

• Accurate prognostic prediction based on molecular subtype may facilitate individualized management

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Acknowledgments

The scientific guarantor of this publication is Jin You Kim. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Korea

    Jin You Kim, Suck Hong Lee & Suk Kim

  2. Busan Cancer Center, Pusan National University Hospital, Busan, Republic of Korea

    Taewoo Kang

  3. Department of Surgery, Pusan National University Hospital, Busan, Republic of Korea

    Young Tae Bae

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  1. Jin You Kim
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Correspondence to Jin You Kim.

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Kim, J.Y., Lee, S.H., Kim, S. et al. Tumour 18 F-FDG Uptake on preoperative PET/CT may predict axillary lymph node metastasis in ER-positive/HER2-negative and HER2-positive breast cancer subtypes. Eur Radiol 25, 1172–1181 (2015). https://doi.org/10.1007/s00330-014-3452-y

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  • DOI: https://doi.org/10.1007/s00330-014-3452-y

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