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(18)F-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.

 Jee Suk Chang  ;  Jeongshim Lee  ;  Hyun Jung Kim  ;  Kyung Hwan Kim  ;  Mijin Yun  ;  Seung Il Kim  ;  Ki Chang Keum  ;  Chang-Ok Suh  ;  Yong Bae Kim 
 CANCER RESEARCH AND TREATMENT, Vol.48(2) : 508-517, 2016 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/diagnostic imaging* ; Breast Neoplasms/pathology* ; Breast Neoplasms/radiotherapy ; Female ; Fluorodeoxyglucose F18* ; Humans ; Lymph Nodes/pathology ; Lymphatic Metastasis/diagnostic imaging* ; Lymphatic Metastasis/pathology* ; Lymphatic Metastasis/radiotherapy ; Mastectomy* ; Middle Aged ; Neoplasm Recurrence, Local/prevention & control ; Positron-Emission Tomography* ; Risk Assessment ; Risk Factors ; Tumor Burden
Breast neoplasms ; Mastectomy ; Positron-emission tomography ; Prognosis ; Recurrence
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 (18)F-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.
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1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Keum, Ki Chang(금기창) ORCID logo https://orcid.org/0000-0003-4123-7998
Kim, Seung Il(김승일)
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Suh, Chang Ok(서창옥)
Yun, Mi Jin(윤미진) ORCID logo https://orcid.org/0000-0002-1712-163X
Lee, Jeong Shim(이정심)
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
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