Abstract
Purpose
Inflammatory breast cancer (IBC) is the most aggressive type of breast cancer with a poor prognosis. Locoregional staging is based on dynamic contrast-enhanced (DCE) CT or MRI. The aim of this study was to compare the performances of FDG PET/CT and DCE CT in locoregional staging of IBC and to assess their respective prognostic values.
Methods
The study group comprised 50 women (median age: 51 ± 11 years) followed in our institution for IBC who underwent FDG PET/CT and DCE CT scans (median interval 5 ± 9 days). CT enhancement parameters were net maximal enhancement, net early enhancement and perfusion.
Results
The PET/CT scans showed intense FDG uptake in all primary tumours. Concordance rate between PET/CT and DCE CT for breast tumour localization was 92 %. No significant correlation was found between SUVmax and CT enhancement parameters in primary tumours (p > 0.6). PET/CT and DCE CT results were poorly correlated for skin infiltration (kappa = 0.19). Ipsilateral foci of increased axillary FDG uptake were found in 47 patients (median SUV: 7.9 ± 5.4), whereas enlarged axillary lymph nodes were observed on DCE CT in 43 patients. Results for axillary node involvement were fairly well correlated (kappa = 0.55). Nineteen patients (38 %) were found to be metastatic on PET/CT scan with a significant shorter progression-free survival than patients without distant lesions (p = 0.01). In the primary tumour, no statistically significant difference was observed between high and moderate tumour FDG uptake on survival, using an SUVmax cut-off of 5 (p = 0.7 and 0.9), or between high and low tumour enhancement on DCE CT (p > 0.8).
Conclusion
FDG PET/CT imaging provided additional information concerning locoregional involvement to that provided by DCE CT on and allowed detection of distant metastases in the same whole-body procedure. Tumour FDG uptake or CT enhancement parameters were not correlated and were not found to have any prognostic value.
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References
Van der Auwera I, Van Laere SJ, Van den Eynden GG, Benoy I, van Dam P, Colpaert CG, et al. Increased angiogenesis and lymphangiogenesis in inflammatory versus noninflammatory breast cancer by real-time reverse transcriptase-PCR gene expression quantification. Clin Cancer Res. 2004;10:7965–71.
Shirakawa K, Kobayashi H, Sobajima J, Hashimoto D, Shimizu A, Wakasugi H. Inflammatory breast cancer: vasculogenic mimicry and its hemodynamics of an inflammatory breast cancer xenograft model. Breast Cancer Res. 2003;5:136–9.
McCarthy NJ, Yang X, Linnoila IR, Merino MJ, Hewitt SM, Parr AL, et al. Microvessel density, expression of estrogen receptor alpha, MIB-1, p53, and c-erbB-2 in inflammatory breast cancer. Clin Cancer Res. 2002;8:3857–62.
Kleer CG, van Golen KL, Merajver SD. Molecular biology of breast cancer metastasis. Inflammatory breast cancer: clinical syndrome and molecular determinants. Breast Cancer Res. 2000;2:423–9.
Vermeulen PB, van Golen KL, Dirix LY. Angiogenesis, lymphangiogenesis, growth pattern, and tumor emboli in inflammatory breast cancer: a review of the current knowledge. Cancer. 2010;116(Suppl):2748–54.
Alberini JL, Lerebours F, Wartski M, Fourme E, Le Stanc E, Gontier E, et al. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging in the staging and prognosis of inflammatory breast cancer. Cancer. 2009;115:5038–47.
Yang WT, Le-Petross HT, Macapinlac H, Carkaci S, Gonzalez-Angulo AM, Dawood S, et al. Inflammatory breast cancer: PET/CT, MRI, mammography, and sonography findings. Breast Cancer Res Treat. 2008;109:417–26.
Bos R, van Der Hoeven JJ, van Der Wall E, van Der Groep P, van Diest PJ, Comans EF, et al. Biologic correlates of (18)fluorodeoxyglucose uptake in human breast cancer measured by positron emission tomography. Clin Oncol. 2002;20:379–87.
Brix G, Henze M, Knopp MV, Lucht R, Doll J, Junkermann H, et al. Comparison of pharmacokinetic MRI and [18F]fluorodeoxyglucose PET in the diagnosis of breast cancer: initial experience. Eur Radiol. 2001;11:2058–70.
Groves AM, Wishart GC, Shastry M, Moyle P, Iddles S, Britton P, et al. Metabolic-flow relationships in primary breast cancer: feasibility of combined PET/dynamic contrast-enhanced CT. Eur J Nucl Med Mol Imaging. 2009;36:416–21.
Carbognin G, Calciolari C, Girardi V, Camera L, Pollini G, Pozzi MR. Inflammatory breast cancer: MR imaging findings. Radiol Med. 2010;115:70–82.
Green FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, et al. AJCC cancer staging manual. 6th ed. New York: Springer; 2002. p. 225–81.
Dawood S, Merajver SD, Viens P, Vermeulen PB, Swain SM, Buchholz TA, et al. International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol. 2011;22:515–23.
Pierga JY, Petit T, Delozier T, Ferrero JM, Campone M, Gligorov J, et al. Neoadjuvant bevacizumab, trastuzumab, and chemotherapy for primary inflammatory HER2-positive breast cancer (BEVERLY-2): an open-label, single-arm phase 2 study. Lancet Oncol. 2012;13:375–84.
Le-Petross CH, Bidaut L, Yang WT. Evolving role of imaging modalities in inflammatory breast cancer. Semin Oncol. 2008;35:51–63.
Mogavero GT, Fishman EK, Kuhlman JE. Inflammatory breast cancer: CT evaluation. Clin Imaging. 1992;16:183–6.
Moyses B, Haegele P, Rodier JF, Lehmann S, Petit T, Velten M, et al. Assessment of response by breast helical computed tomography to neoadjuvant chemotherapy in large inflammatory breast cancer. Clin Breast Cancer. 2002;2:304–10.
Crippa F, Seregni E, Agresti R, Chiesa C, Pascali C, Bogni A, et al. Association between [18F]fluorodeoxyglucose uptake and postoperative histopathology, hormone receptor status, thymidine labelling index and p53 in primary breast cancer: a preliminary observation. Eur J Nucl Med. 1998;25:1429–34.
Gil-Rendo A, Martínez-Regueira F, Zornoza G, García-Velloso MJ, Beorlegui C, Rodriguez-Spiteri N. Association between [18F]fluorodeoxyglucose uptake and prognostic parameters in breast cancer. Br J Surg. 2009;96:166–70.
Avril N, Menzel M, Dose J, Schelling M, Weber W, Jänicke F, et al. Glucose metabolism of breast cancer assessed by 18F-FDG PET: histologic and immunohistochemical tissue analysis. J Nucl Med. 2001;42:9–16.
Groheux D, Giacchetti S, Espié M, Vercellino L, Hamy AS, Delord M, et al. The yield of 18FDG-PET/CT in patients with clinical stage IIA, IIB, or IIIA breast cancer: a prospective study. J Nucl Med. 2011;52:1526–34.
Buck A, Schirrmeister H, Kühn T, Shen C, Kalker T, Kotzerke J, et al. FDG uptake in breast cancer: correlation with biological and clinical prognostic parameters. Eur J Nucl Med Mol Imaging. 2002;29:1317–23.
Osborne JR, Port E, Gonen M, Doane A, Yeung H, Gerald W, et al. 18F-FDG PET of locally invasive breast cancer and association of estrogen receptor status with standardized uptake value: microarray and immunohistochemical analysis. J Nucl Med. 2010;51:543–50.
Semple SI, Gilbert FJ, Redpath TW, Staff RT, Ahearn TS, Welch AE, et al. The relationship between vascular and metabolic characteristics of primary breast tumours. Eur Radiol. 2004;14:2038–45.
Carkaci S, Macapinlac HA, Cristofanilli M, Mawlawi O, Rohren E, Gonzalez Angulo AM, et al. Retrospective study of 18F-FDG PET/CT in the diagnosis of inflammatory breast cancer: preliminary data. J Nucl Med. 2009;50:231–8.
Le-Petross HT, Cristofanilli M, Carkaci S, Krishnamurthy S, Jackson EF, Harrell RK, et al. MRI features of inflammatory breast cancer. AJR Am J Roentgenol. 2011;197:W769–76.
Nasu Y, Shikishima H, Miyasaka Y, Nakakubo Y, Ichinokawa K, Kaneko T. A study of the assessment of axillary lymph nodes before surgery for breast cancer using multi-detector-row computed tomography. Surg Today. 2010;40:1023–6.
Cheung YC, Chen SC, Ueng SH, Ko SF, Wan YL. Dynamic enhanced computed tomography values of locally advanced breast cancers predicting axilla nodal metastasis after neoadjuvant chemotherapy. J Comput Assist Tomogr. 2009;33:422–5.
Chow CK. Imaging in inflammatory breast carcinoma. Breast Dis. 2005-2006; 22:45–54.
Shin HJ, Kim HH, Ahn JH, Kim SB, Jung KH, Gong G, et al. Comparison of mammography, sonography, MRI and clinical examination in patients with locally advanced or inflammatory breast cancer who underwent neoadjuvant chemotherapy. Br J Radiol. 2011;84:612–20.
Thukral A, Thomasson DM, Chow CK, Eulate R, Wedam SB, Gupta SN, et al. Inflammatory breast cancer: dynamic contrast-enhanced MR in patients receiving bevacizumab: initial experience. Radiology. 2007;244:727–35.
Wedam SB, Low JA, Yang SX, Chow CK, Choyke P, Danforth D, et al. Antiangiogenic and antitumor effects of bevacizumab in patients with inflammatory and locally advanced breast cancer. J Clin Oncol. 2006;24:769–77.
Forero-Torres A, Saleh MN, Galleshaw JA, Jones CF, Shah JJ, Percent IJ, et al. Pilot trial of preoperative (neoadjuvant) letrozole in combination with bevacizumab in postmenopausal women with newly diagnosed estrogen receptor- or progesterone receptor-positive breast cancer. Clin Breast Cancer. 2010;10:275–80.
Cochet A, Pigeonnat S, Khoury B, Vrigneaud JM, Touzery C, Berriolo-Riedinger A, et al. Evaluation of breast tumor blood flow with dynamic first-pass 18F-FDG PET/CT: comparison with angiogenesis markers and prognostic factors. J Nucl Med. 2012;53:512–20.
de Langen AG, van den Boogaart V, Lubberink M, Backes WH, Marcus JT, et al. Monitoring response to antiangiogenic therapy in non-small cell lung cancer using imaging markers derived from PET and dynamic contrast-enhanced MRI. J Nucl Med. 2011;52:48–55.
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Champion, L., Lerebours, F., Cherel, P. et al. 18F-FDG PET/CT imaging versus dynamic contrast-enhanced CT for staging and prognosis of inflammatory breast cancer. Eur J Nucl Med Mol Imaging 40, 1206–1213 (2013). https://doi.org/10.1007/s00259-013-2405-z
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DOI: https://doi.org/10.1007/s00259-013-2405-z