Abstract
To analyze the 18F-FDG PET/CT imaging features of the metastases from nonspecific invasive breast cancer (NSIBC) according to intrinsic molecular subtypes, and its prognostic value in metastatic NSIBC. Female breast cancer patients has 18F-FDG PET/CT at our hospital 12/2013-10/2018 were collected retrospectively, including image features, clinicopathological, and disease status after PET/CT. All patients were divided as five groups: Luminal A (LA), Luminal B (LB), HER2 positive luminal (LHER), HER2 enriched (HER) and Basal like (TN). Nonparametric tests were used to analyze the difference of maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), heterogeneity index (HI) and coefficient of variation (COV) among metastases. And, ROC curve was used to evaluate the diagnostic performance of SUVmax for bone and lymph node metastases. Cox regression was used to test for relationship among PET/CT parameters, clinicopathological and progression-free survival (PFS). 54 metastatic NSIBC with 747 metastases were enrolled. There was significant in SUVmax and HI of the metastases among five groups (P=0.00). The metastases in lung had the highest HI (P=0.00). LA had the smallest SUVmax and HI (P=0.00); LHER had the highest SUVmax (P=0.00). Among different molecular subtypes, SUVmax for bone were: LA＜HER＜LB＜LHER. ROC curve analysis showed that among LHER and TN, the SUVmax cutoff values of 4.55 and 2.65 identified bone and lymph node metastases with high sensitivity (92.90% and 95.30%) and specificity (100.00% and 86.20%). More than 12 months follow-up after PET/CT, 34 metastatic NSIBC cases had progressive disease (PD), 17 cases had non PD. The whole body MTV (HR=1.01, P=0.00), molecular subtypes (LA (HR=0.309, P=0.028) and LHER (HR=0.312, P=0.031))and presence of recurrent (HR=2.15, P=0.035) were identified as independent prognostic factors of PFS. The metastases of NSIBC from different molecular subtypes presented with diverse 18F-FDG PET/CT imaging features. Based on individualized analysis of molecular subtypes and metastatic sites, can yield a better diagnostic performance. Moreover, wMTV is one of independent prognostic factors in metastatic NSIBC.
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