18F-FDG/PET May Help to Identify a Subgroup of Patients with T1-T2 Breast Cancer and 1-3 Positive Lymph Nodes Who Are at a High Risk of Recurrence after Mastectomy.
- Author:
Jee Suk CHANG
1
;
Jeongshim LEE
;
Hyun Jung KIM
;
Kyung Hwan KIM
;
Mijin YUN
;
Seung Il KIM
;
Ki Chang KEUM
;
Chang Ok SUH
;
Yong Bae KIM
Author Information
- Publication Type:Original Article
- Keywords: Breast neoplasms; Positron-emission tomography; Recurrence; Prognosis; Mastectomy
- MeSH: Breast Neoplasms*; Breast*; Carcinoma, Ductal; Cohort Studies; Follow-Up Studies; Glycolysis; Humans; Lymph Nodes*; Mastectomy*; Multivariate Analysis; Positron-Emission Tomography; Prognosis; Radiotherapy; Recurrence*; Risk Factors; Tumor Burden
- From:Cancer Research and Treatment 2016;48(2):508-517
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: The purpose of this study is to assess the utility of positron emission tomography (PET) for predicting recurrence among patients with T1-T2/N1 breast cancer who were treated with mastectomy. MATERIALS AND METHODS: Of 712 consecutive patients with T1-T2/N1 breast cancer treated during 2003-2012, 109 had undergone preoperative 18F-fluorodeoxyglucose/PET and were included. Metabolic (maximum standardized uptake value [SUVmax]), volumetric (metabolic tumor volume [MTV]), and combined (total lesion glycolysis [TLG]) indices were measured. The resulting values were analyzed and compared with clinical outcome. RESULTS: At the median follow-up of 46.7 months, the 3-year relapse-free survival (RFS) rate was 95.2%. SUVmax (area under curve, 0.824) was more useful than MTV or TLG as a means of identifying patients at high risk for any recurrence. In multivariate analysis, SUVmax remained an independent risk factor for RFS (p=0.006). Using the method of Contal and O'Quigley, a SUVmax threshold of 5.36 showed the best predictive performance. The PET-based high-risk group (≥ 5.36 in either breast or nodes) had more T1c-T2, high-grade, hormone-receptor negative, and invasive ductal carcinoma tumors than the low-risk group (< 5.36 in both breast and nodes). The prognosis was much worse when high SUVmax (≥ 5.36) was detected in nodes (p < 0.001). In the no-radiotherapy cohort, the PET-based high-risk group had increased risk of locoregional recurrence when compared to the low-risk group (p=0.037). CONCLUSION: High SUVmax on preoperative PET showed association with elevated risk of locoregional recurrence and any recurrence. Pre-treatment PET may improve assessments of recurrence risk and clarify indications for post-mastectomy radiotherapy in this subset of patients.
