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Usefulness of Combined Metabolic–Volumetric Indices of 18F-FDG PET/CT for the Early Prediction of Neoadjuvant Chemotherapy Outcomes in Breast Cancer

Nuclear Medicine and Molecular Imaging volume 47, pages 36–43 (2013)Cite this article

Abstract

Purpose

The purpose of this study was to investigate the usefulness of metabolic-volumetric indices of 18F- fluorodeoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for the evaluation of neoadjuvant chemotherapy outcomes in breast cancer.

Methods

Twenty-four patients with locally advanced breast cancer were enrolled in the study. They underwent baseline 18F-FDG PET/CT scan and received four or six cycles of neoadjuvant chemotherapy, interim 18F-FDG PET/CT was done after second cycle of chemotherapy. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary lesions were calculated. Reduction rates of these parameters were obtained between baseline and interim 18F-FDG PET/CT. Chemotherapy outcomes were assessed using tumor size reduction rate and histological grading system (Miller and Payne system). Reduction rates of SUVmax, MTV, and TLG correlated with chemotherapy outcomes.

Results

MTV and TLG reduction rates showed significant correlation with tumor size reduction rate (R = 0.68, P = 0.0004; R = 0.62, P = 0.002, respectively). However, SUVmax reduction rate showed no significant correlation. MTV and TLG reduction rates were significantly higher in responders than nonresponders, as determined by Miller and Payne system (P < 0.0007, P < 0.002). However, SUVmax reduction rate showed no significant difference. On ROC analysis, the area under the MTV and TLG curves was 0.886, and that of SUVmax was 0.743. Sensitivity, specificity, positive predictive value, and negative predictive value to predict histopathologic response were the same for MTV and TLG, and the values were 100 %, 85.7 %, 83.3 %, and 100 %, respectively (at the reduction rate of 93.2 % for MTV, and 95.8 % for TLG).

Conclusion

Changes of metabolic–volumetric indices successfully reflected the neoadjuvant chemotherapy outcomes. MTV and TLG could be robust indices in discriminating pathologic responder as SUVmax, after neoadjuvant chemotherapy.

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Acknowledgements

This work was supported by the National Research Foundation of Korea (NRF) grant, funded by the Korea government (MEST) (No. 2011-0018636).

Conflict of Interest

The authors declare that they have no conflict of interest.

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Affiliations

  1. Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea

    Hyung-Jun Im, Yu Kyeong Kim, Yong-il Kim, Won Woo Lee & Sang Eun Kim

  2. Department of Nuclear Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Borame-gil 41, Dongjak-gu, Seoul, 156-707, Korea

    Yu Kyeong Kim

  3. Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggyi, Korea

    Won Woo Lee & Sang Eun Kim

  4. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Jong Jin Lee

  5. Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea

    Hyung-Jun Im & Yong-il Kim

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  1. Hyung-Jun Im
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Correspondence to Yu Kyeong Kim.

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Im, HJ., Kim, Y.K., Kim, Yi. et al. Usefulness of Combined Metabolic–Volumetric Indices of 18F-FDG PET/CT for the Early Prediction of Neoadjuvant Chemotherapy Outcomes in Breast Cancer. Nucl Med Mol Imaging 47, 36–43 (2013). https://doi.org/10.1007/s13139-012-0181-5

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  • DOI: https://doi.org/10.1007/s13139-012-0181-5

Keywords

  • Breast cancer
  • Neoadjuvant chemotherapy
  • Metabolic tumor volume
  • Total lesion glycolysis
  • 18F-FDG PET/CT