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Biological correlates of tumor perfusion and its heterogeneity in newly diagnosed breast cancer using dynamic first-pass 18F-FDG PET/CT

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Abstract

Purpose

The aim of this prospective study is to analyze the global tumor blood flow (BF) and its heterogeneity in newly diagnosed breast cancer (BC) according to tumor biological characteristics and molecular subtypes. These perfusion parameters were compared to those classically derived from metabolic studies to investigate links between perfusion and metabolism.

Methods

Two hundred seventeen newly diagnosed BC patients underwent a 18F-FDG PET/CT exam before any treatment. A 2-min dynamic acquisition, centered on the chest, was performed immediately after intravenous injection of 3 MBq/kg of 18F-FDG, followed by a two-step static acquisition 90 min later. Tumor BF was calculated (in ml/min/g) using a single compartment kinetic model. In addition to standard PET parameters, texture features (TF) describing the heterogeneity of tumor perfusion and metabolism were extracted. Patients were divided into three groups: Luminal (HR+/HER2-), HER2 (HER2+), and TN (HR-/HER2-). Global and TF parameters of BF and metabolism were compared in different groups of patients according to tumor biological characteristics.

Results

Tumors with lymph node involvement showed a higher perfusion, whereas no significant differences in SUV_max or SUV_mean were reported. TN tumors had a higher metabolic activity than HER2 and luminal tumors but no significant differences in global BF values were noted. HER2 tumors exhibited a larger tumor heterogeneity of both perfusion and metabolism compared to luminal and TN tumors. Heterogeneity of perfusion appeared well correlated to that of metabolism.

Conclusions

The study of breast cancer perfusion shows a higher BF in large tumors and in tumors with lymph node involvement, not paralleled by similar modifications in tumor global metabolism. In addition, the observed correlation between the perfusion heterogeneity and the metabolism heterogeneity suggests that tumor perfusion and consequently the process of tumor angiogenesis might be involved in the metabolism heterogeneity previously shown in BC.

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Acknowledgements

The authors thank the technologists from the Department of Nuclear Medicine of the Georges-François Leclerc Center for their help in the development of this study, Genevieve Laporte for her help with the clinical database, and Isabel Gregoire for the English revision of the manuscript.

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Authors and Affiliations

  1. ImViA EA 7535, University of Burgundy, Dijon, France

    Neree Payan, Benoit Presles, François Brunotte, Jean-Marc Vrigneaud & Alexandre Cochet

  2. Department of Surgical Oncology, Georges-François Leclerc Cancer Center, Dijon, France

    Charles Coutant

  3. Department of Medical Oncology, Georges-François Leclerc Cancer Center, Dijon, France

    Isabelle Desmoulins

  4. Department of Nuclear Medicine, Georges-François Leclerc Cancer Center, Dijon, France

    Jean-Marc Vrigneaud & Alexandre Cochet

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  1. Neree Payan
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Correspondence to Neree Payan.

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This study was conducted in accordance with the Declaration of Helsinki and approved by the institutional ethics committee of the Georges-François Leclerc Center.

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The patient non-opposition was recorded in source documents by the medical team and used as patient informed consent.

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Payan, N., Presles, B., Brunotte, F. et al. Biological correlates of tumor perfusion and its heterogeneity in newly diagnosed breast cancer using dynamic first-pass 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 47, 1103–1115 (2020). https://doi.org/10.1007/s00259-019-04422-4

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