Efficiency of fluorodeoxyglucose positron emission tomography/computed tomography to predict prognosis in breast cancer patients received neoadjuvant chemotherapy

Toshiyuki Ishiba; Tsuyoshi Nakagawa; Takanobu Sato; Makoto Nagahara; Goshi Oda; Hitoshi Sugimoto; Mai Kasahara; Tokuko Hosoya; Kazunori Kubota; Tomoyuki Fujioka; Peter Danenberg; Kathleen Danenberg; Hiroyuki Uetake

doi:10.1186/s40064-015-1634-y

Efficiency of fluorodeoxyglucose positron emission tomography/computed tomography to predict prognosis in breast cancer patients received neoadjuvant chemotherapy

Springerplus. 2015 Dec 24:4:817. doi: 10.1186/s40064-015-1634-y. eCollection 2015.

Affiliations

¹ Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan ; Liquid Genomics, Inc., 1725 Del Amo Blvd. Torrance, Torrance, 90501 CA USA ; Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, 1975 Zonal Ave, Los Angeles, 90089-9151 CA USA.
² Department of Breast Surgery, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
³ Department of Radiology, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.
⁴ Department of Biochemistry and Molecular Biology, University of Southern California/Norris Comprehensive Cancer Center, 1975 Zonal Ave, Los Angeles, 90089-9151 CA USA.
⁵ Liquid Genomics, Inc., 1725 Del Amo Blvd. Torrance, Torrance, 90501 CA USA.
⁶ Department of Surgical Specialities, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan.

Abstract

Neoadjuvant chemotherapy (NAC) has become a standard therapy for patients with advanced breast cancer. Pathological complete response (pCR) after NAC is an important prognostic indicator, but some patients with pCR continue to experience recurrence. So new predictive and prognostic markers in addition to pCR are needed following NAC for breast cancer. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can evaluate metastases in the entire body simultaneously, and has several potential advantages over conventional imaging modalities. The purpose of this study was to evaluate whether FDG-PET/CT can determine NAC response and whether FDG-PET/CT can be a new prognostic marker. We imaged 83 breast cancer tumors with FDG-PET/CT, ultrasound (US), and magnetic resonance imaging (MRI) to evaluate NAC efficacy. As we previously analyzed 110 breast cancers with FDG PET/CT, we defined a threshold of >1.7 maximum standardized uptake value (SUVmax) as abnormal fluorodeoxyglucose (FDG) uptake. After NAC, 16 (19.3 %) tumors had a complete response, 54 (65.1 %) had a partial response, 11 (13.3 %) showed stable disease, and 2 (2.4 %) showed progressive disease. One of the two patients with progressive disease had bone metastasis detected by FDG-PET/CT and was not operated on. Remote metastases were evident in 2.4 % of patients after NAC as determined by FDG-PET/CT. Overall, 17 patients had pathological complete response (pCR). The sensitivity of abnormal FDG uptake after NAC for non-pCR was 20.3 % and the specificity was 94.7 %. Patients with abnormal FDG uptake after NAC experienced significantly more recurrences (P = 0.004) and more of them died (P = 0.010). Moreover, the difference in disease-free survival was more significant in the estrogen receptor (ER)-negative group. FDG-PET after NAC may be more effective for predicting prognosis than for evaluating treatment response. This tendency was particularly remarkable in ER-negative breast cancer tumors. FDG-PET/CT is useful for reevaluating surgical applicability after NAC.

Keywords: Breast cancer; FDG-PET/CT; Metastases; Neoadjuvant chemotherapy; Prognostic marker.