The role of basal 18F-FDG PET/CT maximum standard uptake value and maximum standard uptake change in predicting pathological response in breast cancer patients receiving neoadjuvant chemotherapy

Abstract

Objective

The aim of this study was to determine the role of 18F-FDG PET/CT in predicting pathological response among patients diagnosed with local or locally advanced breast cancer and receiving neoadjuvant chemotherapy (NAC).

Methods

Basal SUVmax value were analyzed in 212 patients and 142 of these patients had posttreatment SUVmax value. Overall pathological complete response (pCR(C)) was defined as no evidence of residual invasive cancer in breast (pCR(B)) and axilla (pCR(A)). Basal SUVmax value of the breast (SUVmax(B)I) and axilla (SUVmax(A)I) and change in SUVmax of the breast (Delta SUVmax(B)) and axilla (Delta SUVmax(A)) were measured. The optimal cutoff value of SUVmax and Delta SUVmax were determined by receiver operating characteristic curve analysis.

Results

The number of patients with pCR(B) was 85 (40.1%), pCR(A) was 76 (42.5%) and pCR(C) was 70 (33%). In the artificial neural network-based analysis the Delta SUVmax(B) (100%) was the most important variable for predicting pCR(B). Delta SUVmax(A) (100%) was the most important variable in estimation of pCR(A). When pCR(C) was evaluated, the highest relation was found with Delta SUVmax(B). When the Delta SUVmax(B) cutoff value for pCR(B) and pCR(C) accepted as <=-87.9%, its sensitivity was 82.3 and 82.4%, and specificity was 72.5% and 65.9%, respectively (P < 0.001 and P < 0.001, respectively). When the Delta SUVmax(A) cutoff value for pCR(A) and pCR(C) accepted as <=-86.6%, its sensitivity was 94.3% and 97.6%, and specificity was 31.3% and 28.2%, respectively (P = 0.017 and P = 0.024, respectively).

Conclusion

Albeit varies according to the molecular subtypes of the breast cancer during NAC, Delta SUVmax value seems to be the most strong factor associated with pCR.