Preoperative F-18 FDG PET/CT Parameters to Evaluate Disease-Free Survival in Operable Breast Cancer

Objectives We performed this study to evaluate the predictive value of preoperative F-18 FDG PET/CT parameters for disease-free survival (DFS) in operable breast cancer.

Methods We retrospectively reviewed 92 female patients (age: 50.5 ± 10.6 yrs) with pathologically proven invasive ductal carcinoma who had measurable metabolic tumor volume (MTV, defined as the volume of tumor with SUV>2.5) of primary lesion in preoperative F-18 FDG PET/CT. PET parameters, SUVmax and MTV were measured from primary breast tumor lesion. ROC curves were used to find out optimal cutoff values of SUVmax and MTV for recurrence. Cox proportional hazard model was used with age, tumor size, presence of lymph node metastasis, tumor grade, pathologic stage, estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 status, and PET parameters (SUVmax and MTV) to predict recurrence.

Results Of 92 patients, 11 (11.6 %) had recurrence. The mean follow-up duration was 47.1 ± 10.4 months (range 11.4-58.3). In univariate analysis, tumor grade (1, 2 vs 3), PR status (positive vs negative), SUVmax (>14.41 vs ≤14.41), MTV (>5.42 vs ≤5.42) were significantly associated with recurrence. In multivariate analysis, high SUVmax (p=0.041, HR 4.22, 95% CI 1.06-16.73) and high MTV (p=0.040, HR 4.61, 95% CI 1.08-19.78) were poor prognostic factors for DFS.Of 92 patients, 11 (11.6 %) had recurrence. The mean follow-up duration was 47.1 ± 10.4 months (range 11.4-58.3). In univariate analysis, tumor grade (1, 2 vs 3), PR status (positive vs negative), SUVmax (>14.41 vs ≤14.41), MTV (>5.42 vs ≤5.42) were significantly associated with recurrence. In multivariate analysis, high SUVmax (p=0.041, HR 4.22, 95% CI 1.06-16.73) and high MTV (p=0.040, HR 4.61, 95% CI 1.08-19.78) were poor prognostic factors for DFS.

Conclusions SUVmax and MTV measured by preoperative F-18 FDG PET/CT are independent prognostic factors for DFS in operable breast cancer.