Annals of Nuclear Medicine

, Volume 31, Issue 7, pp 544–552 | Cite as

Textural features of 18F-FDG PET after two cycles of neoadjuvant chemotherapy can predict pCR in patients with locally advanced breast cancer

  • Lin ChengEmail author
  • Jianping Zhang
  • Yujie Wang
  • Xiaoli Xu
  • Yongping Zhang
  • Yingjian Zhang
  • Guangyu Liu
  • Jingyi ChengEmail author
Original Article



This study was designed to evaluate the utility of textural features for predicting pathological complete response (pCR) to neoadjuvant chemotherapy (NAC).


Sixty-one consecutive patients with locally advanced breast cancer underwent 18F-FDG PET/CT scanning at baseline and after the second course of NAC. Changes to imaging parameters [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG)] and textural features (entropy, coarseness, skewness) between the 2 scans were measured by two independent radiologists. Pathological responses were reviewed by one pathologist, and the significance of the predictive value of each parameter was analyzed using a Chi-squared test. Receiver operating characteristic curve analysis was used to compare the area under the curve (AUC) for each parameter.


pCR was observed more often in patients with HER2-positive tumors (22 patients) than in patients with HER2-negative tumors (5 patients) (71.0 vs. 16.7%, p < 0.001). ∆ %SUVmax, ∆ %entropy and ∆ %coarseness were significantly useful for differentiating pCR from non-pCR in the HER2-negative group, and the AUCs for these parameters were 0.928, 0.808 and 0.800, respectively (p = 0.003, 0.032 and 0.037). In the HER2-positive group, ∆ %SUVmax and ∆ %skewness were moderately useful for predicting pCR, and the respective AUCs were 0.747 and 0.758 (p = 0.033 and 0.026). Although there was no significant difference in the AUCs between groups for these parameters, an additional 3/22 patients in the HER2-positive group with pCR were identified when ∆ %skewness and ∆ %SUVmax were considered together (p = 0.031). The absolute values for each parameter before NAC and after 2 cycles cannot predict pCR in our patients. Neither ∆ %MTV nor ∆ %TLG was efficiently predictive of pCR in any group.


The early changes in the textural features of 18F-FDG PET images after two cycles of NAC are predictive of pCR in both HER2-negative and HER2-positive patients; this evidence warrants confirmation by further research.


Breast cancer 18F-FDG PET Neoadjuvant chemotherapy Textural feature 


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Copyright information

© The Japanese Society of Nuclear Medicine 2017

Authors and Affiliations

  • Lin Cheng
    • 1
    Email author
  • Jianping Zhang
    • 2
    • 4
    • 5
  • Yujie Wang
    • 6
    • 7
  • Xiaoli Xu
    • 8
  • Yongping Zhang
    • 2
    • 4
    • 5
  • Yingjian Zhang
    • 3
    • 4
    • 5
  • Guangyu Liu
    • 6
    • 7
  • Jingyi Cheng
    • 3
    • 4
    • 5
    Email author
  1. 1.Department of Nuclear MedicineShanghai Proton and Heavy Ion CenterShanghaiChina
  2. 2.Department of Nuclear MedicineFudan University Shanghai Cancer CenterShanghaiChina
  3. 3.Department of Nuclear Medicine, Shanghai Proton and Heavy Ion CenterFudan University Cancer HospitalShanghaiChina
  4. 4.Center for Biomedical ImagingFudan UniversityShanghaiChina
  5. 5.Shanghai Engineering Research Center for Molecular Imaging ProbesShanghaiChina
  6. 6.Department of Breast SurgeryFudan University Shanghai Cancer CenterShanghaiChina
  7. 7.Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
  8. 8.Department of PathologyFudan University Shanghai Cancer CenterShanghaiChina

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