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Predictive and prognostic value of FDG-PET/CT imaging and different response evaluation criteria after primary systemic therapy of breast cancer

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Abstract

Objectives

(1) To predict pathological complete remission (pCR) and survival after primary systemic therapy (PST) in patients diagnosed with breast cancer by using two different PET/CT based scores: a simplified PERCIST-based PET/CT score (Method 1) and a combined PET/CT score supplemented with the morphological results of the RECIST system (Method 2) and (2) to assess the effect of different breast carcinoma subtypes on tumor response and its evaluation.

Methods

Eighty-eight patients were enrolled in the study who underwent PET/CT imaging before and after PST. PET/CTs were evaluated by changes in maximum Standardized Uptake Value (SUVmax) and tumor size. Method 1 and 2 were applied to predict pathological complete remission (pCR). Kaplan–Meier analyses for survival were performed. Classification into biological subtypes was performed based on the pre-therapeutic tumor characteristics.

Results

A total of 30/88 patients showed pCR (34.1 %). Comparing pCR/non-pCR patient groups, significant differences were detected by changes in SUVmax (p < 0.001) and tumor size (p < 0.001) regarding the primary breast lesions. To predict pCR, Method 2 had higher sensitivity (72.4 % vs. 44.8 %) and negative predictive value (57.9 % vs. 45.8 %) with lower false negativity rate (16 vs. 32) than Method 1. pCR rate was higher in Her2-positive and triple negative tumors. Despite the significant differences detected between the biological subtypes regarding changes in primary tumor SUVmax (p = 0.007) and size (p = 0.015), the subtypes only had significant impact on response evaluation with Method 2 and not with Method 1. In our study, neither clinical nor pathological CR were predictors of longer progression-free survival.

Conclusions

Our results suggest that combined PET/CT criteria are more predictive of pCR. The effect of biological subtypes is significant on pCR rate as well as on the changes in FDG-uptake and morphological tumor response. Response evaluation with combined criteria was also able to reflect the differences between the biological behavior of breast tumor subtypes.

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Acknowledgments

The entire research group would like to expresses their gratitude to Mrs. Elvira Rigóné Kálé (Semmelweis University, 2nd Department of Pathology) for her linguistic corrections.

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Authors and Affiliations

  1. Oncological Division, 1st Department of Internal Medicine, Semmelweis University, Tömő utca 25-29, 4th floor, Budapest, 1083, Hungary

    Tímea Tőkés, Gyöngyvér Szentmártoni, László Torgyík & Magdolna Dank

  2. Pozitron PET/CT Center, Hunyadi J. út 9, Budapest, 1117, Hungary

    Kornélia Kajáry & Zsolt Lengyel

  3. Department of Nuclear Medicine, Semmelweis University, Üllői út 78/A, Budapest, 1082, Hungary

    Tamás Györke

  4. Scanomed Ltd, Laky Adolf utca 44, Budapest, 1145, Hungary

    Tamás Györke

  5. Surgical Division of the St Margaret Hospital, Bécsi út 132, Budapest, 1032, Hungary

    Krisztián Somlai

  6. MTA-SE Tumor Progression Research Group, 2nd Department of Pathology, Üllői út 93, Budapest, 1091, Hungary

    Anna-Mária Tőkés & Janina Kulka

  7. 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, 1091, Hungary

    Anna-Mária Tőkés & Janina Kulka

Authors
  1. Tímea Tőkés
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  2. Kornélia Kajáry
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  3. Gyöngyvér Szentmártoni
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  4. Zsolt Lengyel
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  5. Tamás Györke
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  6. László Torgyík
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  7. Krisztián Somlai
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  8. Anna-Mária Tőkés
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  9. Janina Kulka
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  10. Magdolna Dank
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Corresponding author

Correspondence to Magdolna Dank.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Source of funding

None was involved.

Ethical standards

Ethical approval for the study was given by the Semmelweis University Institutional Review Board. Date and number of the ethical approval: 12 June 2013; TUKEB No. 120/2013. Written informed consent was waived.

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Tőkés, T., Kajáry, K., Szentmártoni, G. et al. Predictive and prognostic value of FDG-PET/CT imaging and different response evaluation criteria after primary systemic therapy of breast cancer. Breast Cancer 24, 137–146 (2017). https://doi.org/10.1007/s12282-016-0685-4

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  • DOI: https://doi.org/10.1007/s12282-016-0685-4

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