Originally published as JCO Early Release 10.1200/JCO.2008.17.2650 on December 15 2008

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Monitoring Primary Systemic Therapy of Large and Locally Advanced Breast Cancer by Using Sequential Positron Emission Tomography Imaging With [¹⁸F]Fluorodeoxyglucose

From the Departments of Gynecology, Nuclear Medicine, and Pathology, Universitätsklinikum Hamburg-Eppendorf, Hamburg; Departments of Gynecology, Nuclear Medicine, and Pathology, Ludwig-Maximilians Universität; and Departments of Gynecology, Nuclear Medicine, and Pathology, Technische Universität München, Munich, Germany.

Corresponding author: Norbert Avril, MD, Department of Nuclear Medicine, Barts and The London, Queen Mary, University of London, West Smithfield (QE II), London EC1A 7BE, United Kingdom; e-mail: n.e.avril{at}qmul.ac.uk.

Purpose To evaluate positron emission tomography (PET) using [¹⁸F]fluorodeoxyglucose (FDG) for prediction of histopathologic response early during primary systemic therapy of large or locally advanced breast cancer.

Patients and Methods In a prospective multicenter trial, 272 FDG-PET scans were performed in 104 patients at baseline (n = 104) and after the first (n = 87) and second cycle (n = 81) of chemotherapy. The level and relative changes in standardized uptake value (SUV) of FDG uptake were assessed regarding their ability to predict histopathologic response. All patients underwent surgery after chemotherapy, and histopathologic response defined as minimal residual disease or gross residual disease served as the reference standard.

Results Seventeen (16%) of 104 patients were histopathologic responders and 87 were (84%) nonresponders. All patients for whom baseline SUV was less than 3.0 (n = 24) did not achieve a histopathologic response. SUV decreased by 51% ± 18% after the first cycle of chemotherapy in histopathologic responders (n = 15), compared with 37% ± 21% in nonresponders (n = 54; P = .01). A threshold of 45% decrease in SUV correctly identified 11 of 15 responders, and histopathologic nonresponders were identified with a negative predictive value of 90%. Similar results were found after the second cycle when using a threshold of 55% relative decrease in SUV.

Conclusion FDG-PET allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after each cycle of chemotherapy. Moreover, relative changes in SUV after the first and second cycle are a strong predictor of response. Thus, FDG-PET may be helpful for individual treatment stratification in breast cancer patients.

Supported by Deutsche Krebshilfe and Bristol-Myers Squibb GmbH, Munich, Germany.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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