Impact of physiological hormonal fluctuations on 18F-fluorodeoxyglucose uptake in breast cancer
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Premenopausal physiologic steroid levels change cyclically, in contrast to steady state low levels seen in postmenopausal patients. The purpose of this study was to evaluate whether 18F-fluorodeoxyglucose (18F-FDG) uptake in breast cancer is influenced by physiological hormonal fluctuations.
A total of 160 primary invasive breast cancers from 155 females (54 premenopausal, 101 postmenopausal) who underwent 18F-FDG positron emission tomography/computed tomography before therapy were retrospectively analyzed. The maximal standardized uptake values (SUVmax) of tumors were compared with menstrual phases and menopausal status according to the following subgroups: ‘luminal A-like,’ ‘luminal B-like,’ and ‘non-luminal.’ Additionally, the effect of estradiol (E2) on 18F-FDG uptake in breast cancer cells was evaluated in vitro.
Among premenopausal patients, SUVmax during the periovulatory-luteal phase was significantly higher than that during the follicular phase in luminal A-like tumors (n = 25, p = 0.004), while it did not differ between the follicular phase and the periovulatory-luteal phase in luminal B-like (n = 24) and non-luminal tumors (n = 7). Multiple regression analysis showed menstrual phase, tumor size, and Ki-67 index are independent predictors for SUVmax in premenopausal luminal A-like tumors. There were no significant differences in SUVmax between pre- and postmenopausal patients in any of the subgroups. In in vitro studies, uptake in estrogen receptor-positive cells was significantly augmented when E2 concentration was increased from 0.01 to ≥ 1 nM.
Our data suggest that 18F-FDG uptake may be impacted by physiological hormonal fluctuations during menstrual cycle in luminal A-like cancers, and that E2 could be partly responsible for these events.
KeywordsBreast cancer 18F-FDG PET Menstrual cycle Hormonal dependency Metabolic flare
The authors thank Hiroyuki Kimura, Ph.D. (Division of Molecular Imaging, Radioisotope Research Center, Kyoto University, and Department of Analytical and Bioinorganic Chemistry, Kyoto Pharmaceutical University) for his great assistance in the in vitro radioisotope experiments.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This project was performed in compliance with the relevant ethical standards in Japan.
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