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Combined use of 18F-FDG PET/CT and MRI for response monitoring of breast cancer during neoadjuvant chemotherapy

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

Abstract

Purpose

To explore the potential complementary value of PET/CT and dynamic contrast-enhanced MRI in predicting pathological response to neoadjuvant chemotherapy (NAC) of breast cancer and the dependency on breast cancer subtype.

Methods

We performed 18F-FDG PET/CT and MRI examinations before and during NAC. The imaging features evaluated on both examinations included baseline and changes in 18F-FDG maximum standardized uptake value (SUVmax) on PET/CT, and tumour morphology and contrast uptake kinetics on MRI. The outcome measure was a (near) pathological complete response ((near-)pCR) after surgery. Receiver operating characteristic curves with area under the curve (AUC) were used to evaluate the relationships between patient, tumour and imaging characteristics and tumour responses.

Results

Of 93 patients, 43 achieved a (near-)pCR. The responses varied among the different breast cancer subtypes. On univariate analysis the following variables were significantly associated with (near-)pCR: age (p = 0.033), breast cancer subtype (p < 0.001), relative change in SUVmax on PET/CT (p < 0.001) and relative change in largest tumour diameter on MRI (p < 0.001). The AUC for the relative reduction in SUVmax on PET/CT was 0.78 (95 % CI 0.68–0.88), and for the relative reduction in tumour diameter at late enhancement on MRI was 0.79 (95 % CI 0.70–0.89). The AUC increased to 0.90 (95 % CI 0.83–0.96) in the final multivariate model with PET/CT, MRI and breast cancer subtype combined (p = 0.012).

Conclusion

PET/CT and MRI showed comparable value for monitoring response during NAC. Combined use of PET/CT and MRI had complementary potential. Research with more patients is required to further elucidate the dependency on breast cancer subtype.

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Acknowledgments

The authors thank Anita Paape, Inge Kemper, Marjo Holtkamp, Margaret Schot, and Jacqueline van Zyll de Jong for their contribution to this study.

Conflicts of interest

None.

Disclosure

This study was performed within the framework of CTMM, the Center for Translational Molecular Medicine (www.ctmm.nl), project Breast CARE (grant 03O-104).

Author information

Authors and Affiliations

  1. Department of Radiology, The Netherlands Cancer Institute, PO Box 90203, 1006 BE, Amsterdam, The Netherlands

    Kenneth E. Pengel, Claudette E. Loo & Kenneth G. A. Gilhuijs

  2. Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Bas B. Koolen, Wouter V. Vogel & Renato A. Valdés Olmos

  3. Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Jelle Wesseling & Esther H. Lips

  4. Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Emiel J. Th. Rutgers & Marie Jeanne T. F. D. Vrancken Peeters

  5. Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    Sjoerd Rodenhuis

  6. Department of Radiology/Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Kenneth G. A. Gilhuijs

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  1. Kenneth E. Pengel
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Correspondence to Kenneth G. A. Gilhuijs.

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Pengel, K.E., Koolen, B.B., Loo, C.E. et al. Combined use of 18F-FDG PET/CT and MRI for response monitoring of breast cancer during neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging 41, 1515–1524 (2014). https://doi.org/10.1007/s00259-014-2770-2

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  • DOI: https://doi.org/10.1007/s00259-014-2770-2

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