Abstract
ObjectiveIt is unclear whether the receptor status of breast malignancy or the proportion of receptors expression is useful in the interpretation of 18F-FDG PET/CT. This study’s purpose was to analyze whether 18F-FDG PET/CT was valuable for helping newly diagnosed breast cancer patients find suspected or unsuspected metastasis lesions based on the proportion of receptors expression.Materials and MethodsEighty newly diagnosed breast cancer patients were divided into six groups, containing N0 (no extraaxillary lymph node metastasis), N1 (extraaxillary lymph node metastasis), M0 (no distant metastasis), and M1 (distant metastasis) groups, C0 (no unsuspected metastasis), and C1 (unsuspected metastasis and treatment plan changed) detected by PET/CT. The main data, including the proportion of receptors ER (estrogen receptor), PR (progesterone receptor), and Her-2 (human epidermal growth factor receptor 2) status, were extracted. Simple correlation and logistic regression were preformed to analyze the association between them.ResultsPatients in N1 group had lower proportion of ER (%) and PR (%) than that in N0 group (ER: 2 [0–80] vs. 80 [15–95]; PR: 1 [0–10] vs. 20 [0–45], p<0.001). Moreover, the proportions of ER and PR were negatively correlated with N1 (ER: [r= −0.339, p= 0.002], PR: [r= −0.247, p= 0.011]) by simple correlation. Also, patients in C1 group had lower proportion of ER (%) and PR (%) than those in C0 group (ER: 10 [0–85] vs. 80 [15–90], p=0.026; PR: 1 [0–10] vs. 20 [0–70], p=0.041), while the distribution of ER and PR between M1 and M0 group had no significant difference. After the adjustment of traditional factors, the negative correlation between the proportion of ER (OR=0.986, 95% CI of OR [0.972–0.999], p=0.016) and C1 was found by logistic regression, cutoff value was 25% (ER) calculated by ROC (Receiver Operating Characteristic) curve (AUC [Area Under Curve]= 0.647, p=0.024).ConclusionThe proportion of ER in newly diagnosed breast cancer was negatively correlated with unsuspected metastasis detected by 18F-FDG PET/CT. 18F-FDG PET/CT might be recommended for newly diagnosed breast cancer patients with single lesions when the ER expression proportion is less than 25% to find unsuspected metastasis lesions and to modify treatment plan contrasted with conventional imaging and clinical examination.
Highlights
The International Agency for Research on Cancer (IARC) of the World Health Organization released the latest global cancer burden data for 2020, stating that breast cancer has replaced lung cancer and became the most prevalent cancer in the world (1)
National Comprehensive Cancer Network(NCCN)guidelines 2021 mentioned that 18F-FDG positron emission tomography–computed tomography (PET/CT) may be helpful in identifying unsuspected regional nodal disease and/or distant metastases, and 18F-FDG PET/CT is most helpful in situations where standard staging studies are equivocal or suspicious, especially in the setting of locally advanced or metastatic disease (6)
Among all the 80 patients included in this research, there were three false positives and three false negatives
Summary
The International Agency for Research on Cancer (IARC) of the World Health Organization released the latest global cancer burden data for 2020, stating that breast cancer has replaced lung cancer and became the most prevalent cancer in the world (1). It plays an important role in the systematic staging of breast cancer, detecting the effect of treatment, monitoring regeneration, and so on (2). PET/CT is a radiological and high-cost examination, and the application is subject to certain restrictions (7). It is not suitable for all breast cancer patients, the use of 18F-FDG PET/CT may have important clinical effects for some appropriate patients (8)
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