Texture analysis of high-resolution dedicated breast 18 F-FDG PET images correlates with immunohistochemical factors and subtype of breast cancer
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This study aims to determine whether PET textural features measured with a new dedicated breast PET scanner reflect biological characteristics of breast tumors.
One hundred and thirty-nine breast tumors from 127 consecutive patients were included in this analysis. All of them underwent a 18F-FDG PET scan before treatment. Well-known PET quantitative parameters such as SUV m a x , SUV m e a n , metabolically active tumor volume (MATV) and total lesion glycolysis (TLG) were extracted. Together with these parameters, local, regional, and global heterogeneity descriptors, which included five textural features (TF), were computed. Immunohistochemical classification of breast cancer considered five subtypes: luminal A like (LA), luminal B like/HER2 − (LB −), luminal B like/HER2+ (LB+), HER2-positive-non-luminal (HER2pnl), and triple negative (TN). Associations between PET features and tumor characteristics were assessed using non-parametric hypothesis tests.
Along with well-established associations, new correlations were found. HER2-positive tumors had significantly higher uptake (p < 0.001, AUCs > 0.70) and presented different global and regional heterogeneity (p = 0.002, p = 0.016, respectively, AUCs < 0.70). Nine out of ten analyzed features were significantly associated with immunohistochemical subtype. Uptake was lower for LA tumors (p < 0.001) with AUCs ranging from 0.71 to 0.88 for each subgroup comparison. Heterogeneity metrics were significantly associated when comparing LA and LB − (p < 0.01), being regional heterogeneity metrics more discriminative than any other parameter (AUC = 0.80 compared to AUC = 0.71 for SUV). LB+ and HER2pnl tumors also showed more regional heterogeneity than LA tumors (AUCs = 0.79 and 0.84, respectively). After comparison with whole-body PET studies, we observed an overall improvement in the classification ability of both non-heterogeneity metrics and textural features.
PET parameters extracted from high-resolution dedicated breast PET images showed new and stronger correlations with immunohistochemical factors and immunohistochemical subtype of breast cancer compared to whole-body PET.
Keywords18F-FDG Breast cancer PET Texture analysis Dedicated breast Heterogeneity
This work was supported in part by the project PI14/02001 (Instituto de Salud Carlos III) cofunded by FEDER. JP-M is funded by Miguel Servet grant (CP12/03162), PA is funded by Ramón y Cajal grant (RYC-2015-17430) and AM is funded by IDIS predoctoral fellowship.
Compliance with Ethical Standards
Conflict of interest
Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thrlimann B, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol 2013;24(9):2206–23.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Cook GJ, Yip C, Siddique M, Goh V, Chicklore S, et al. Are pretreatment 18F-FDG PET tumor textural features in non-small cell lung cancer associated with response and survival after chemoradiotherapy? J Nucl Med 2013;54:1926.Google Scholar
- 16.Groheux D, Majdoub M, Tixier F, Le Rest CC, Martineau A, Merlet P, et al. Do clinical, histological or immunohistochemical primary tumour characteristics translate into different (18)F-FDG PET/CT volumetric and heterogeneity features in stage II/III breast cancer? Eur J Nucl Med Mol Imaging 2015;42 (11):1682–91.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Lemarignier C, Martineau A, Teixeira L, Vercellino L, Espi M, Merlet P, et al. Correlation between tumour characteristics, SUV measurements, metabolic tumour volume, TLG and textural features assessed with 18F-FDG PET in a large cohort of oestrogen receptor-positive breast cancer patients, Eur J Nucl Med Mol Imaging. 2017. http://dx.doi.org/https://doi.org/10.1007/s00259-017-3641-4.
- 21.Thibault G, Fertil B, Navarro C, Pereira S, Cau P, Levy N, et al. Texture indexes and gray level size zone matrix: application to cell nuclei classification. In: 10th international conference on pattern recognition and information processing, PRIP. Minsk, Belarus; 2009. p. 140–145.Google Scholar
- 25.Hatt M, Majdoub M, Vallières M, Tixier F, Le Rest CC, Groheux D, et al. 18F-FDG PET uptake characterization through texture analysis: investigating the complementary nature of heterogeneity and functional tumor volume in a multicancer site patient cohort. J Nucl Med 2015;56:38–44.CrossRefPubMedGoogle Scholar
- 26.Yan J, Chu-Shern JL, Loi HY, Khor LK, Sinha AK, Quek ST. Impact of image reconstruction settings on texture features in 18F-FDG PET. J Nucl Med. 2015;56:1667–73.Google Scholar
- 27.Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Royal Stat Soc Ser B Methodol 1995;57(1):289–300.Google Scholar
- 31.Osborne JR, Port E, Gonen M, Doane A, Yeung H. Gerald W, others. 18F-FDG PET of locally invasive breast cancer and association of estrogen receptor status with standardized uptake value: microarray and immunohistochemical analysis. J Nucl Med 2010;51(4):543–50.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Koolen BB, Vrancken Peeters MJ, Wesseling J, Lips EH, Vogel WV, Aukema TS. Association of primary tumour FDG uptake with clinical, histopathological and molecular characteristics in breast cancer patients scheduled for neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging. 2012;39(12):1830–8.CrossRefPubMedGoogle Scholar
- 33.Lee SS, Bae SK, Park YS, Park JS, Kim TH, Yoon HK. Correlation of molecular subtypes of invasive ductal carcinoma of breast with glucose metabolism in FDG PET/CT: Based on the Recommendations of the St. Gallen Consensus Meeting 2013. Nucl Med Mol Imaging 2017;51(1):79–85.CrossRefPubMedGoogle Scholar