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Integrated 18F-FDG PET/MRI in breast cancer: early prediction of response to neoadjuvant chemotherapy

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

Abstract

Purpose

To explore whether integrated 18F-FDG PET/MRI can be used to predict pathological response to neoadjuvant chemotherapy (NAC) in patients with breast cancer.

Methods

Between November 2014 and April 2016, 26 patients with breast cancer who had received NAC and subsequent surgery were prospectively enrolled. Each patient underwent 18F-FDG PET/MRI examination before and after the first cycle of NAC. Qualitative MRI parameters, including morphological descriptors and the presence of peritumoral oedema were assessed. Quantitatively, PET parameters, including maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis (TLG), and MRI parameters, including washout proportion and signal enhancement ratio (SER), were measured. The performance of the imaging parameters singly and in combination in predicting a pathological incomplete response (non-pCR) was assessed.

Results

Of the 26 patients, 7 (26.9%) exhibited a pathological complete response (pCR), and 19 (73.1%) exhibited a non-pCR. No significant differences were found between the pCR and non-pCR groups in the qualitative MRI parameters. The mean percentage reductions in TLG30% on PET and SER on MRI were significantly greater in the pCR group than in the non-pCR group (TLG30% −64.8 ± 15.5% vs. −25.4 ± 48.7%, P = 0.005; SER −34.6 ± 19.7% vs. −8.7 ± 29.0%, P = 0.040). The area under the receiver operating characteristic curve for the percentage change in TLG30% (0.789, 95% CI 0.614 to 0.965) was similar to that for the percentage change in SER (0.789, 95% CI 0.552 to 1.000; P = 1.000).The specificity of TLG30% in predicting pCR) was 100% (7/7) and that of SER was 71.4% (5/7). The sensitivity of TLG30% in predicting non-pCR was 63.2% (12/19) and that of SER was 84.2% (16/19). When the combined TLG30% and SER criterion was applied, sensitivity was 100% (19/19), and specificity was 71.4% (5/7).

Conclusion

18F-FDG PET/MRI can be used to predict non-pCR after the first cycle of NAC in patients with breast cancer and has the potential to improve sensitivity by the addition of MRI parameters to the PET parameters.

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Abbreviations

NAC:

neoadjuvant chemotherapy

FDG PET:

18F-fluoro-deoxy-glucose positron emission tomography

pCR:

pathological complete response

non-pCR:

pathological incomplete response

MRI:

magnetic resonance imaging

SUV:

standardized uptake value

MTV:

metabolic tumour volume

TLG:

total lesion glycolysis

LN:

lymph node

SER:

signal enhancement ratio

ER:

oestrogen receptor

PR:

progesterone receptor

HER:

human epidermal growth factor receptor

RCB:

residual cancer burden

ICC:

intraclass correlation coefficient

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Funding

This study was funded by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (NRF-2014R1A1A2053682), and by a grant (no. 30–2016-0110 and 30-2015-0130) from the Seoul National University Hospital. We also sincerely appreciate Mrs. Myung-Hwa Lee and Mr. Hyuk Jin Chung for their dedication to breast cancer research funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Nariya Cho, Young Seon Kim & Bo Ra Kwon

  2. Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea

    Nariya Cho

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea

    Nariya Cho

  4. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Seock-Ah Im, Kyung-Hun Lee, Tae-Yong Kim & Koung Jin Suh

  5. Cancer Research Institute, Seoul National University, Seoul, Republic of Korea

    Seock-Ah Im, Gi Jeong Cheon, Kyung-Hun Lee & Tae-Yong Kim

  6. Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea

    Gi Jeong Cheon, Jung Min Lee & Hoon Young Suh

  7. Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

    In-Ae Park

  8. Department of Radiology, College of Medicine, Yeungnam University, Daegu, Republic of Korea

    Young Seon Kim

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  1. Nariya Cho
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  9. Jung Min Lee
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Corresponding author

Correspondence to Seock-Ah Im.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Cho, N., Im, SA., Cheon, G.J. et al. Integrated 18F-FDG PET/MRI in breast cancer: early prediction of response to neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging 45, 328–339 (2018). https://doi.org/10.1007/s00259-017-3849-3

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  • DOI: https://doi.org/10.1007/s00259-017-3849-3

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