PET/CT radiomics in breast cancer: promising tool for prediction of pathological response to neoadjuvant chemotherapy

  • Lidija AntunovicEmail author
  • Rita De Sanctis
  • Luca Cozzi
  • Margarita Kirienko
  • Andrea Sagona
  • Rosalba Torrisi
  • Corrado Tinterri
  • Armando Santoro
  • Arturo Chiti
  • Renata Zelic
  • Martina Sollini
Original Article



To assess the role of radiomics parameters in predicting pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer.


Seventy-nine patients who had undergone pretreatment staging 18F-FDG PET/CT and treatment with NAC between January 2010 and January 2018 were included in the study. Primary lesions on PET images were delineated, and extraction of first-, second-, and higher-order imaging features was performed using LIFEx software. The relationship between these parameters and pCR to NAC was analyzed by multiple logistic regression models.


Nineteen patients (24%) had pCR to NAC. Different models were generated on complete information and imputed datasets, using univariable and multivariable logistic regression and least absolute shrinkage and selection operator (lasso) regression. All models could predict pCR to NAC, with area under the curve values ranging from 0.70 to 0.73. All models agreed that tumor molecular subtype is the primary predictor of the primary endpoint.


Our models predicted that patients with subtype 2 and subtype 3 (HER2+ and triple negative, respectively) are more likely to have a pCR to NAC than those with subtype 1 (luminal). The association between PET imaging features and pCR suggested that PET imaging features could be considered as potential predictors of pCR in locally advanced breast cancer patients.


Breast cancer Neoadjuvant chemotherapy Radiomics Advanced features 18F-FDG PET/CT Treatment response prediction 



We would like to acknowledge Dr. Katia Marzo and Mrs. Elena Bissolotti for database preparation. The contribution of Drs. Elisa Agostinetto, Jelena Jandric, and Giulia Vatteroni to data collection is greatly acknowledged. We thank also Dr. Bethania Fernandes for histological analyses. We also acknowledge Drs. Alberto Testori and Valentina Errico for patients enrollment. We thank Mr. Lorenzo Leonardi for technical support and image acquisition.

Authors’ contributions

The manuscript has been seen and approved by all authors, whose individual contributions were as follows:

Conception and design: LA, RDS, MS

Patient management and referral: RDS, ASagona, CT, RT, ASantoro

Acquisition of data: LA, MK, RDS

Image analysis: LA, MS, MK, LC

Statistical analysis: LA, RZ, RDS

Interpretation of data: LA, RDS, ASagona, MK, RZ

Drafting the article: LA, RDS, MS

Final approval of the revised manuscript: LA, RDS, LC, ASagona, CT, RT, ASantoro, MK, AC, RZ, MS.

Raw data are available on specific request to the corresponding author.

Compliance with ethical standards

Conflict of interest

A. Chiti received speaker honoraria from General Electric, Blue Earth Diagnostics, and Sirtex Medical, acted as scientific advisor for Blue Earth Diagnostics and Advanced Accelerator Applications, and benefited from an unconditional grant from Sanofi to Humanitas University. A. Santoro received speaker honoraria from Mundipharma, Takeda, Glaxo, Celgene, Roche, Teva, Arqule, Amgen, Eisai, BMS, Bayer, MSD, Astra Zeneca, Gilead, Sandoz, Servier, and Novartis, acted as scientific advisor for Gilead, Pfizer, Eisai, Servier, MSD, Bayer, Eli Lilly, Amgen, Marck Serono, Takeda, Ariad, Italfarmaco, and Celgene. L. Cozzi acts as Scientific Advisor to Varian Medical Systems and is Clinical Research Scientist at Humanitas Cancer Center.

All honoraria and grants are outside the scope of the submitted work.

All other authors have no conflict of interest.

Ethics approval

The study was approved by the Local Ethics Committee (authorization number 1591). Specific informed consent was not required according to Local Ethics Committee rules for retrospective study design.

Supplementary material

259_2019_4313_MOESM1_ESM.doc (132 kb)
ESM 1 (DOC 131 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Lidija Antunovic
    • 1
    Email author
  • Rita De Sanctis
    • 2
  • Luca Cozzi
    • 3
  • Margarita Kirienko
    • 3
  • Andrea Sagona
    • 4
  • Rosalba Torrisi
    • 2
  • Corrado Tinterri
    • 4
  • Armando Santoro
    • 2
  • Arturo Chiti
    • 1
    • 3
  • Renata Zelic
    • 5
  • Martina Sollini
    • 3
  1. 1.Department of Nuclear MedicineHumanitas Clinical and Research Center- IRCCSRozzanoItaly
  2. 2.Department of Medical Oncology and HematologyHumanitas Clinical and Research Center- IRCCSRozzanoItaly
  3. 3.Department of Biomedical SciencesHumanitas UniversityPieve EmanueleItaly
  4. 4.Breast Surgery DepartmentHumanitas Clinical and Research Center- IRCCSRozzanoItaly
  5. 5.Clinical Epidemiology Unit, Department of Medicine SolnaKarolinska InstitutetStockholmSweden

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