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Patterns of αvβ3 Expression in Primary and Metastatic Human Breast Cancer as Shown by 18F-Galacto-RGD PET

Ambros J. Beer, Markus Niemeyer, Janette Carlsen, Mario Sarbia, Jörg Nährig, Petra Watzlowik, Hans-Jürgen Wester, Nadia Harbeck and Markus Schwaiger
Journal of Nuclear Medicine February 2008, 49 (2) 255-259; DOI: https://doi.org/10.2967/jnumed.107.045526

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    Box plot diagram of mean SUVs of tumors and normal tissue (breast, muscle, blood pool, liver, spleen, lungs, intestine) from static emission scans. Tumor uptake was very heterogeneous but higher than uptake in background tissue, resulting in good image contrast.

  • FIGURE 2. 
    FIGURE 2. 

    A 70-y-old patient with invasive ductal breast cancer of left breast (arrow, open tip), axillary lymph-node metastases on left side (arrow, open tip, dotted line), an osseous metastasis to the sternum (arrow, closed tip), and a pulmonary metastasis on right side (arrow, closed tip, dotted line). Maximum-intensity projection of 18F-galacto-RGD PET (A) and planar images (B, axial plane; C, coronal plane; D, axial plane) show primary tumor, lymph-node metastases, and osseous metastasis with good tumor-to-background contrast. High tracer retention is notable in urogenital tract, predominantly due to renal tracer elimination. Intermediate uptake is notable in liver, spleen, and intestine. One small pulmonary lesion was notable in nonattenuation–corrected images (E) and confirmed by CT (F). In the context of metastasized breast cancer, this was considered to be highly suggestive of a pulmonary metastasis.

  • FIGURE 3. 
    FIGURE 3. 

    Comparison of 18F-galacto-RGD PET (A and D) and immunohistochemistry of αvβ3 expression (B, C, E, and F). (Upper row) Patient with large invasive ductal carcinoma of left breast and low 18F-galacto-RGD uptake (A, arrow). Corresponding immunohistochemistry shows negative staining of most parts of tumor (C, low magnification) and only faint positive staining of single vessels (D, high magnification; arrow). (Lower row) Patient with invasive ductal carcinoma of left breast and intense 18F-galacto-RGD uptake (D, arrow). Corresponding immunohistochemistry (E, low magnification; F, high magnification) shows intense staining of tumor vessels (arrow).

Tables

  • TABLE 1

    Patient Data

    Patient no.Age (y)TNM stageTu size (cm)SUV TuSUV LNSUV MetStaining pattern IHC αvβ3
    173pT2 pN1a pMXR04.03.6Neg.—Tumor cells and vessels positive, moderate
    238ypT0 N0 M0NA*NA*NA*NA*
    364pT3 pN3a pMXR03.04.3Neg.—Tumor cells and vessels positive, intense
    463pT2m pN3a MXR04.52.52.2—Tumor vessels positive, weak
    1.51.5
    573pT2 pN0 MXR04.08.7——Tumor cells and vessels positive, intense
    640NA†————
    773pT2 pN2a pMXR02.03.0Neg.—
    868pT2 pN0 MXR12.13.1——
    970pT4b pN2a(4/5) cM1R16.03.63.53.8
    1.2
    1070cT4c N2c M14.04.14.13.1Tumor vessels positive, weak
    1168pT1c pN1(sn1/1) pMX1.62.8Neg.—
    1244pT4b N3a MXR04.53.2Neg.—
    1354pT3c N0 M12.03.8—2.8
    3.0
    1466pT3c N2c M1———2.2
    3.0
    3.3
    1568pT4c N1 M07.02.3——
    1665pT2m N1 M1bivNANANA2.6

    • ↵* No viable tumor cells found after neoadjuvant chemotherapy.

    • ↵† Tumor suspected according to MR mammography (BIRADS 4), no tumor histopathologically.

    • Tu size = maximum tumor diameter (cm); SUV Tu, SUV LN, and SUV Met = tracer uptake as standardized uptake value (SUV) in tumors, lymph nodes, and distant metastases; IHC αvβ3 = immunohistochemistry with αvβ3-specific antibody LM609; Neg. = negative; NA = not applicable.

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