The ability of pre-treatment F-18 FDG PET/CT metabolic parameters for predicting axillary lymph node and distant metastasis and overall survival

Abstract

The current study aimed to investigate the diagnostic performance of metabolic parameters of pre-treatment F-18 fluorodeoxyglucose PET/computed tomography for predicting axillary lymph node metastases, distant metastases, and overall survival rates in breast cancer patients. One hundred thirteen breast cancer patients who underwent pre-treatment F18 [FDG] PET-computed tomography with biopsy-proven axillary lymph node status were included in the current study. In pre-treatment F18 [FDG] PET-computed tomography for primary tumour area maximum standard uptake value, metabolic tumour volume, tumour lesion glycolysis, tumour diameter and for axillary lymph nodes maximum standard uptake value-LN were recorded. Also if distant metastatic sites were observed they were verified. The median follow-up period was 43.8 months. Five-year overall survival was 98% vs. 56% in patients with tumour diameter < vs. ≥22 mm, 93% vs. 50% in patients with maximum standard uptake value-T < vs. ≥6.7, 71% vs. 70% in patients with metabolic tumour volume < vs. ≥8.31cm, 94% vs. 49% in patients with maximum standard uptake value-LN < vs. ≥1.6, 98% vs. 48% in patients with tumour lesion glycolysis < vs. ≥19 084 g/ml × cm, 90% vs. 30% in patients with negative or positive distant metastases in initial PET/computed tomography, respectively. Maximum standard uptake value-LN with a cut-off level of <1.6 and <5.7 had high sensitivity and specificity for predicting axillary lymph node and systemic metastasis, respectively. Additionally, tumour lesion glycolysis was the strongest independent prognostic factor for overall survival. Our data shows that the combination of pre-treatment tumour lesion glycolysis and maximum standard uptake value-LN could improve risk stratification among breast cancer patients.