Open Access Highly Accessed Research article

Early metabolic response using FDG PET/CT and molecular phenotypes of breast cancer treated with neoadjuvant chemotherapy

Bhumsuk Keam12, Seock-Ah Im12*, Youngil Koh1, Sae-Won Han12, Do-Youn Oh12, Nariya Cho4, Jee Hyun Kim12, Wonshik Han5, Keon Wook Kang23, Woo Kyung Moon4, Tae-You Kim12, In Ae Park6, Dong-Young Noh5, June-Key Chung23 and Yung-Jue Bang12

Author Affiliations

1 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

2 Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

3 Department Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea

4 Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

5 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

6 Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

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BMC Cancer 2011, 11:452  doi:10.1186/1471-2407-11-452

Published: 20 October 2011

Abstract

Background

This study was aimed 1) to investigate the predictive value of FDG PET/CT (fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography) for histopathologic response and 2) to explore the results of FDG PET/CT by molecular phenotypes of breast cancer patients who received neoadjuvant chemotherapy.

Methods

Seventy-eight stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this study. FDG PET/CTs were acquired before chemotherapy and after the first cycle of chemotherapy for evaluating early metabolic response.

Results

The mean pre- and post-chemotherapy standard uptake value (SUV) were 7.5 and 3.9, respectively. The early metabolic response provided by FDG PET/CT after one cycle of neoadjuvant chemotherapy was correlated with the histopathologic response after completion of neoadjuvant chemotherapy (P = 0.002). Sensitivity and negative predictive value were 85.7% and 95.1%, respectively. The estrogen receptor negative phenotype had a higher pre-chemotherapy SUV (8.6 vs. 6.4, P = 0.047) and percent change in SUV (48% vs. 30%, P = 0.038). In triple negative breast cancer (TNBC), the pre-chemotherapy SUV was higher than in non-TNBC (9.8 vs. 6.4, P = 0.008).

Conclusions

The early metabolic response using FDG PET/CT could have a predictive value for the assessment of histopathologic non-response of stage II/III breast cancer treated with neoadjuvant chemotherapy. Our findings suggest that the initial SUV and the decline in SUV differed based on the molecular phenotype.

Trial Registration

ClinicalTrials.gov: NCT01396655

Keywords:
FDG PET; breast cancer; neoadjuvant chemotherapy; molecular phenotype