Abstract
Positron emission tomography (PET) is typically performed in the supine position. However, breast magnetic resonance imaging (MRI) is performed in prone, as this improves visibility of deep breast tissues. With the emergence of hybrid scanners that integrate molecular information from PET and functional information from MRI, it is of great interest to determine if the prognostic utility of prone PET is equivalent to supine. We compared PERCIST (PET Response Criteria in Solid Tumors) measurements between prone and supine FDG-PET in patients with breast cancer and the effect of orientation on predicting pathologic complete response (pCR). In total, 47 patients were enrolled and received up to 6 cycles of neoadjuvant therapy. Prone and supine FDG-PET were performed at baseline (t0; n = 46), after cycle 1 (t1; n = 1) or 2 (t2; n = 10), or after all neoadjuvant therapy (t3; n = 19). FDG uptake was quantified by maximum and peak standardized uptake value (SUV) with and without normalization to lean body mass; that is, SUVmax, SUVpeak, SULmax, and SULpeak. PERCIST measurements were performed for each paired baseline and post-treatment scan. Receiver operating characteristic analysis for the prediction of pCR was performed using logistic regression that included age and tumor size as covariates. SUV and SUL metrics were significantly different between orientation (P < .001), but were highly correlated (P > .98). Importantly, no differences were observed with the PERCIST measurements (P > .6). Overlapping 95% confidence intervals for the receiver operating characteristic analysis suggested no difference at predicting pCR. Therefore, prone and supine PERCIST in this data set were not statistically different.
Highlights
Patients with locally advanced breast cancer were treated with radical surgery followed by adjuvant chemotherapy
Breast magnetic resonance imaging (MRI) is recommended for evaluation of disease extent in patients with biopsy-proven breast cancer just before surgery, and the utility of this modality to predict response to neoadjuvant therapy (NAT) is an active area of investigation [21,22,23,24,25,26]
By combining the molecular information of Positron emission tomography (PET) with the morphological and functional information provided by MRI, it is possible to provide a more comprehensive biological assessment of a lesion
Summary
Patients with locally advanced breast cancer were treated with radical surgery followed by adjuvant chemotherapy. Neoadjuvant therapy (NAT) is used to downstage tumors in order to allow for breast conservation, convert patients from inoperable to operable, and provide an in vivo marker of tumor response for the individual patient [1,2,3,4,5]. Histopathology obtained from surgical specimens serves as the reference standard for evaluating response to NAT, and the documentation of a pathological complete response (pCR) in the breast and axillary tissue at the time of definitive surgery is associated with longterm survival [6,7,8]. Positron emission tomography (PET) is recognized as an imaging technique that can provide a molecular and physiological assessment of a specific tissue.
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