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Response to neoadjuvant chemotherapy for breast cancer judged by PERCIST – multicenter study in Japan

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate therapeutic response to neoadjuvant chemotherapy (NAC) and predict breast cancer recurrence using Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST).

Materials and methods

Fifty-nine breast cancer patients underwent fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) before and after NAC prior to planned surgical resection. Pathological complete response (pCR) of the primary tumor was evaluated using PERCIST, while effects of clinicopathological factors on progression-free survival (PFS) were examined using log-rank and Cox methods.

Results

Fifty-six patients and 54 primary tumors were evaluated. Complete metabolic response (CMR), partial metabolic response, stable metabolic disease, and progressive metabolic disease were seen in 45, 7, 3, and 1 patients, respectively, and 43, 7, 3, and 1 primary tumors, respectively. Eighteen (33.3%) of the 54 primary tumors showed pCR. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PERCIST to predict pCR were 100% (18/18), 30.6% (11/36), 41.9% (18/43), 100% (11/11), and 53.7% (29/54), respectively. An optimal percent decrease in peak standardized uptake value for a primary tumor corrected for lean body mass (SULpeak) of 84.3% was found to have a sensitivity of 77.8% (14/18), specificity of 77.8% (28/36), PPV of 63.6% (14/22), NPV of 87.5% (28/32), and accuracy of 77.8% (42/54). Seven (12.5%) of the 56 patients developed recurrent disease (median follow-up 28.1 months, range 11.4–96.4 months). CMR (p = 0.031), pCR (p = 0.024), and early TNM stage (p = 0.033) were significantly associated with longer PFS.

Conclusion

PERCIST is useful for predicting pathological response and prognosis following NAC in breast cancer patients. However, FDG-PET/CT showed a tendency toward underestimation of the residual tumor, and relatively low specificity and PPV of PERCIST showed that a combination of other imaging modalities would still be needed to predict pCR.

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Authors and Affiliations

  1. Department of Radiology, Division of Nuclear Medicine and PET Center, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Kazuhiro Kitajima

  2. Department of Diagnostic Radiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan

    Koya Nakatani

  3. Department of General Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan

    Kazushige Yamaguchi

  4. Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan

    Masatoyo Nakajo & Atsushi Tani

  5. Department of Pathophysiological and Therapeutic Sciences, Division of Radiology, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan

    Mana Ishibashi

  6. Division of Breast Cancer and Endocrine Surgery, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Tottori, 683-8504, Japan

    Keiko Hosoya

  7. Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Takahiro Morita

  8. Department of Breast Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Takayuki Kinoshita

  9. Department of Radiology, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan

    Hayato Kaida

  10. Department of Breast and Endocrine Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Yasuo Miyoshi

Authors
  1. Kazuhiro Kitajima
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  2. Koya Nakatani
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  3. Kazushige Yamaguchi
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  4. Masatoyo Nakajo
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  5. Atsushi Tani
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  6. Mana Ishibashi
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  7. Keiko Hosoya
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  8. Takahiro Morita
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  9. Takayuki Kinoshita
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  10. Hayato Kaida
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  11. Yasuo Miyoshi
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Corresponding author

Correspondence to Kazuhiro Kitajima.

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Disclosure of potential conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Because our study is retrospective, formal consent is not required.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

This retrospective study was approved by the institutional review board, and the need for patient informed consent was waived.

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The authors confirm that this manuscript has not been published or presented elsewhere, in part or in its entirety, and is not under consideration by any other journal. All authors have made substantial contributions to this work and have read and approved the final submitted version.

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Kitajima, K., Nakatani, K., Yamaguchi, K. et al. Response to neoadjuvant chemotherapy for breast cancer judged by PERCIST – multicenter study in Japan. Eur J Nucl Med Mol Imaging 45, 1661–1671 (2018). https://doi.org/10.1007/s00259-018-4008-1

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  • DOI: https://doi.org/10.1007/s00259-018-4008-1

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