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The Effects of Estrogen, Progesterone, and C-erbB-2 Receptor States on ¹⁸F-FDG Uptake of Primary Breast Cancer Lesions

¹ Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; ² Department of Computer Engineering, Izmir Institute of Technology, Izmir, Turkey; and ³ Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

Correspondence: For correspondence or reprints contact: Abass Alavi, MD, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St., 110 Donner Bldg., Philadelphia, PA 19104. E-mail: alavi{at}rad.upenn.edu

The purpose of this prospective study was to investigate whether correlations exist between ¹⁸F-FDG uptake of primary breast cancer lesions and predictive and prognostic factors such as estrogen receptor (ER), progesterone receptor (PR), and C-erbB-2 receptor (C-erbB-2R) states. Methods: Before undergoing partial or total mastectomy, 213 patients with newly diagnosed breast cancer underwent ¹⁸F-FDG PET (5.2 MBq/kg of body weight). The maximum standardized uptake value (SUV) of the primary lesion was measured in each patient. Standard immunohistochemistry was performed on a surgical specimen of the cancer lesion to characterize the receptor state of the tumor cells. Pearson ² tests were performed on the cross-tables of different receptor states to test any association that may exist among ER, PR, and C-erbB-2R. Maximum SUV measurements for different receptor states were compared using factorial ANOVA in a completely random design. Results: After exclusion of certain lesions, 118 lesions were analyzed for this study. The mean maximum SUVs of ER-positive and ER-negative lesions were 3.03 ± 0.26 and 5.64 ± 0.75, whereas those of PR were 3.24 ± 0.29 and 4.89 ± 0.67, respectively, and those of C-erbB-2R were 4.64 ± 0.70 and 3.70 ± 0.35, respectively. ² tests for ER and PR showed that if one is positive then the other tends to be positive as well (² = 71.054, P < 0.01). For ER and C-erbB-2R states, if ER is positive, C-erbB-2R will more likely be negative (² = 13.026, P < 0.01). No relationship was detected between PR and C-erbB-2R states (² = 3.695, P > 0.05). ANOVAs showed that PR state alone (F = 0.095, P > 0.05) and C-erbB-2R state alone (F = 0.097, P > 0.05) had no effect on ¹⁸F-FDG uptake but ER state alone had an effect (F = 9.126, P < 0.01). ER and PR being together had no additional effect on ¹⁸F-FDG uptake. Our study also demonstrated that interactions exist between ER and C-erbB-2R state and between PR and C-erbB-2R state. Conclusion: SUV measurements may provide valuable information about the state of ER, PR, and C-erbB-2R and the associated glucose metabolism as measured by ¹⁸F-FDG uptake of the primary breast cancer lesions. Such an association may be of importance to treatment planning and outcome in these patients.

Key Words: ¹⁸F-FDG PET • breast cancer • estrogen • progesterone • C-erbB-2 • interactions between receptors

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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