Rationale and Objectives
To investigate the diagnostic value of Fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose
positron emission tomography and computed tomography (18F-FDG PET/CT) dual-phase imaging for the different molecular subtypes of invasive
ductal carcinoma of the breast.
Materials and Methods
Clinical imaging data of 164 women with invasive ductal carcinoma of the breast confirmed
by pathology who underwent 18F-FDG PET/CT dual-phase imaging were retrospectively analyzed. The maximum standard
uptake values (SUVmax) of the early and delayed phases of the lesion were measured
and recorded as SUVmax1 and SUVmax2, respectively, and the retention index (RI) was
calculated. We analyzed the change rule of SUVmax1, SUVmax2, and RI for the different
molecular subtypes and molecular marker expression groups. The diagnostic threshold
of different molecular marker expression status was determined using receiver operating
characteristic curve analysis.
Results
SUVmax1 and SUVmax2 were highest in the TNBC group and lowest in the luminal A group
(p<0.001). TNBC and HER2 overexpression groups had higher RI than the luminal A and
B groups (p<0.001), with no significant difference between the TNBC and HER2 overexpression groups
or between the luminal A and B groups (p=0.640 and 0.345, respectively). The ER- and PR-negative groups had significantly
higher SUVmax1, SUVmax2, and RI than the PR-positive group (p<0.001). The HER2-positive group had higher SUVmax1 and SUVmax2 than the negative
group (p<0.001). The Ki67 overexpression group had higher SUVmax1 and SUVmax2 levels than
the low expression group (p<0.001). There was no significant difference in RI between HER2-positive and negative
groups or between Ki67 high and low expression groups (p=0.904 and 0.216, respectively). For ER-negative and positive expression status, the
maximum area under the curve (AUC) of SUVmax2 was 0.852, diagnostic threshold was
10.87, sensitivity was 79.6%, and specificity was 74.5%. For PR-negative and positive
expression status, the AUC of SUVmax2 was 0.858, diagnostic threshold was 10.45, sensitivity
was 83.1%, and specificity was 75.3%. For HER2-negative and positive expression status,
the AUC of SUVmax1 was 0.714, diagnostic threshold was 9.28, sensitivity was 79.6%,
and specificity was 60.9%. For Ki67 high- and low expression status, the AUC of SUVmax2
was 0.915 at maximum, diagnostic threshold was 10.21, sensitivity was 83.4%, and specificity
was 93.9%.
Conclusion
18F-FDG PET/CT dual-phase imaging facilitates the prediction of the expression of molecular
markers and subtypes of invasive ductal carcinoma of the breast and the development
of more tailored treatment plans for patients with this disease.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Discordance in ER, PR, HER2, and Ki-67 expression between primary and recurrent/metastatic lesions in patients with primary early stage breast cancer and the clinical significance: retrospective analysis of 75 cases.Pathol Oncol Res. 2021; 27599894
- Relation between Ki-67, ER, PR, Her2/neu, p21, EGFR, and TOP II-α expression in invasive ductal breast cancer patients and correlations with prognosis.Asian Pac J Cancer Prev. 2015; 16: 823-829
- Different prognosis of young breast cancer patients in their 20s and 30s depending on subtype: a nationwide study from the Korean Breast Cancer Society.Breast Cancer Res Treat. 2017; 166: 833-842
- Combined quantitative measures of ER, PR, HER2, and KI67 provide more prognostic information than categorical combinations in luminal breast cancer.Mod Pathol. 2019; 32: 1244-1256
- Usefulness of staging chest CT in breast cancer: evaluating diagnostic yield of chest CT according to the molecular subtype and clinical stage.J Clin Med. 2021; 10: 906
- Molecular subtypes of invasive breast cancer: correlation between PET/computed tomography and MRI findings.Nucl Med Commun. 2020; 41: 810-816
- Prediction of breast cancer molecular subtypes using DCE-MRI based on CNNs combined with ensemble learning.Phys Med Biol. 2021; 66
- Ultrasonic and pathological comparative analysis of different subtypes of breast encapsulated papillary carcinoma.Zhonghua Yi Xue Za Zhi. 2021; 101: 57-61
- Ultrasonic features and molecular subtype predict somatic mutations in TP53 and PIK3CA genes in breast cancer.Acad Radiol. 2022; S1076-6332: 00131-00133
- Mammography-based radiomics in breast cancer: a scoping review of current knowledge and future needs.Acad Radiol. 2022; 29: 1228-1247
- Biological characterisation of breast cancer by means of PET.Eur J Nucl Med Mol Imaging. 2004; 31: S80-S87
- Advances on correlation of PET-CT findings with breast cancer molecular subtypes, treatment response and prognosis.Zhejiang Da XueXue Bao Yi Xue Ban. 2017; 46: 473-480
- Assessment of biological and clinical aggressiveness of invasive ductal breast cancer using baseline 18F-FDG PET/CT-derived volumetric parameters.Nucl Med Commun. 2018; 39: 83-93
- Clustering subtypes of breast cancer by combining immunohistochemistry profiles and metabolism characteristics measured using FDG PET/CT.Cancer Imaging. 2021; 21: 55
- Quantitative assessment of metabolic tumor burden in molecular subtypes of primary breast cancer with FDG PET/CT.Diagn Interv Radiol. 2018; 24: 336-341
- American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer.J Clin Oncol. 2010; 28: 2784-2795
- Human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline focused update.J Clin Oncol. 2018; 36: 2105-2122
- Optimal Ki67 cut-off for luminal breast cancer prognostic evaluation: a large case series study with a long-term follow-up.Breast Cancer Res Treat. 2016; 157: 363-371
- Expression profiling predicts outcome in breast cancer.Breast Cancer Res. 2003; 5: 57-58
- Breast cancer - one term, many entities?.J Clin Invest. 2011; 121: 3789-3796
- Triple-negative breast cancer molecular subtyping and treatment progress.Breast Cancer Res. 2020; 22: 61
- Ki-67 index value and progesterone receptor status can predict prognosis and suitable treatment in node-negative breast cancer patients with estrogen receptor-positive and HER2-negative tumors.Oncol Lett. 2019; 17: 616-622
- The screening, diagnosis, treatment, and follow-up of breast cancer.Dtsch Arztebl Int. 2018; 115: 316-323
- 18F-FDG uptake in breast cancer correlates with immunohistochemically defined subtypes.EurRadiol. 2014; 24: 610-618
- Diagnostic value of (18)F-FDG PET/CT and MRI in predicting the clinicopathologic subtypes of invasive breast cancer.AJR Am J Roentgenol. 2014; 203: 272-279
- Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0.J Nucl Med. 2006; 47: 885-895
- PET-CT upstaging of unilateral operable breast cancer and its correlation with molecular subtypes.Indian J Radiol Imaging. 2020; 30: 319-326
- Role of 18F-FDG PET/CT in evaluating molecular subtypes and clinicopathological features of primary breast cancer.Nucl Med Commun. 2018; 39: 680-690
- Molecular subtype classification of breast cancer using established radiomic signature models based on 18F-FDG PET/CT images[J].Front Biosci . 2021; 26: 475-484
- Early SUVmax is the best predictor of axillary lymph node metastasis in stage III breast cancers.Quant Imaging Med Surg. 2021; 11: 1680-1691
- Correlation of high 18F-FDG uptake to clinical, pathological, and biological prognostic factors in breast cancer.Eur J NuclMed Mol Imaging. 2011; 38: 426-435
- Correlation of molecular subtypes of invasive ductal carcinoma of breast with glucose metabolism in FDG PET/CT: based on the recommendations of the St. Gallen Consensus Meeting 2013.Nucl Med Mol Imaging. 2017; 51: 79-85
- A novel small molecular antibody, HER2-nanobody, inhibits tumor proliferation in HER2-positive breast cancer cells in vitro and in vivo.Front Oncol. 2021; 11669393
- Associations between PET parameters and expression of Ki-67 in breast cancer.Transl Oncol. 2019; 12: 375-380
- Standardized uptake value of 18F-fluorodeoxyglucose positron emission tomography for prediction of tumor recurrence in breast cancer beyond tumor burden.Breast Cancer Res. 2014; 16: 502
- Concomitant use of 18F-FDG PET-CT SUVmax is useful in the assessment of Ki67 labeling index in core-needle biopsy specimens of breast cancer.Gland Surg. 2021; 10: 1-9
- Correlation between 18F-fluorodeoxyglucose positron emission tomography/computed tomography and clinicopathological features in invasive ductal carcinoma of the breast.Acta Med Okayama. 2015; 69: 333-338
- HER kinase inhibition in patients with HER2- and HER3-mutant cancers.Nature. 2018; 554: 189-194
Article info
Publication history
Published online: January 07, 2023
Accepted:
December 21,
2022
Received in revised form:
November 18,
2022
Received:
October 18,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of The Association of University Radiologists.
