Abstract
BackgroundThe aim of this prospective study was to evaluate the correlation of primary tumor metabolic activity parameters; maximum standardized uptake value (SUVmax) and tumor SUVmax/liver average SUV ratio (TLR) with clinical, histopathological and molecular characteristics of initial staging breast cancer (BC) patients using 18F-fluorodeoxyglucose (FDG) positron emission tomography / computerized tomography (PET/CT) scan.ResultsForty female patients with newly diagnosed BC were enrolled in our study, age ranging from 31-78 years (mean 50.5 +/- SD11.7).All the primary tumors were detected with mean SUVmax 10.8(+/-SD 7.9). The mean /median SUVmax values of primary tumor was higher in premenopausal , stage III and IV, Estrogen Receptors negative( ER-), Progesterone Receptors negative(PR-), Human epidermal growth factor receptor 2 positive ( Her2neu+) patients, high nuclear grade (GIII), triple negative molecular subgroup (TN) and positive axillary lymph node (ALNs) metastasis,(P= 0.003, 0.017, 0.113, 0.089 0.01 ,0.002 , 0.007 and 0.016 respectively).The mean/median TLR values was higher in premenopausal ,Her2neu+, GIII, TN molecular subtype patients, stage III and IV and in patients with positive ALNs , ER- and PR - patients (P= 0.002, 0.0476 , 0.005 , 0.018 , 0.039 and 0.022, 0.095 and 0.129 respectively).SUVmax of the primary lesion and TLR were moderately negatively correlated with the age of the patients (P= 0.005 and 0.008 respectively), also they were moderately positively correlated with the size of the primary tumor (P= 0.019 and 0.036 respectively). TLR was predictive of nodal involvement AUC= 0.612 (95% CI: 0.431-792). The overall sensitivity and specificity of PET/CT for axillary staging was 100 % and 60 %, respectively (P= 0.006).ConclusionThe SUVmax of the primary tumor and TLR values had similar significant associations with different prognostic factors in BC but only TLR can predict nodal involvement.
Highlights
The aim of this prospective study was to evaluate the correlation of primary tumor metabolic activity parameters; maximum standardized uptake value (SUVmax) and tumor SUVmax/liver average SUV ratio (TLR) with clinical, histopathological and molecular characteristics of initial staging breast cancer (BC) patients using 18Ffluorodeoxyglucose (FDG) positron emission tomography / computerized tomography (PET/CT) scan
BC is the commonest cancer and the leading cause of cancer mortality among women worldwide [1].Classification can be done according to TNM stage, immunohistochemical features, grade, proliferation index and gene expression profiles, with histopathology remaining the cornerstone of characterization [2]
Nodal staging was evaluated after axillary clearance or sentinel lymph node biopsies (SLNBs)
Summary
The aim of this prospective study was to evaluate the correlation of primary tumor metabolic activity parameters; maximum standardized uptake value (SUVmax) and tumor SUVmax/liver average SUV ratio (TLR) with clinical, histopathological and molecular characteristics of initial staging breast cancer (BC) patients using 18Ffluorodeoxyglucose (FDG) positron emission tomography / computerized tomography (PET/CT) scan. F18-FDG PET/CT is a noninvasive method, based on the principle of elevated glucose metabolism in malignant tumors; it detects distant metastasis as well as providing additional information about tumor histology [7, 8]. In patients with locally advanced BC, 18F-FDG PET/CT can be useful prior to surgery or neoadjuvant chemotherapy as it detects distant metastasis with a high rate (6% to 26%). 18F-FDG PET/CT can change the treatment plane in 1%–8% of patients with early-stage BC , in 7%–13% of those with locally advanced disease and in up to 52% of those with aggressive tumors [9] In patients with locally advanced BC, 18F-FDG PET/CT can be useful prior to surgery or neoadjuvant chemotherapy as it detects distant metastasis with a high rate (6% to 26%). 18F-FDG PET/CT can change the treatment plane in 1%–8% of patients with early-stage BC , in 7%–13% of those with locally advanced disease and in up to 52% of those with aggressive tumors [9]
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