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Vaz SC, Woll JPP, Cardoso F, Groheux D, Cook GJR, Ulaner GA, Jacene H, Rubio IT, Schoones JW, Peeters MJV, Poortmans P, Mann RM, Graff SL, Dibble EH, de Geus-Oei LF. Joint EANM-SNMMI guideline on the role of 2-[ 18F]FDG PET/CT in no special type breast cancer : (endorsed by the ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA). Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06696-9. [PMID: 38740576 DOI: 10.1007/s00259-024-06696-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/20/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION There is much literature about the role of 2-[18F]FDG PET/CT in patients with breast cancer (BC). However, there exists no international guideline with involvement of the nuclear medicine societies about this subject. PURPOSE To provide an organized, international, state-of-the-art, and multidisciplinary guideline, led by experts of two nuclear medicine societies (EANM and SNMMI) and representation of important societies in the field of BC (ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA). METHODS Literature review and expert discussion were performed with the aim of collecting updated information regarding the role of 2-[18F]FDG PET/CT in patients with no special type (NST) BC and summarizing its indications according to scientific evidence. Recommendations were scored according to the National Institute for Health and Care Excellence (NICE) criteria. RESULTS Quantitative PET features (SUV, MTV, TLG) are valuable prognostic parameters. In baseline staging, 2-[18F]FDG PET/CT plays a role from stage IIB through stage IV. When assessing response to therapy, 2-[18F]FDG PET/CT should be performed on certified scanners, and reported either according to PERCIST, EORTC PET, or EANM immunotherapy response criteria, as appropriate. 2-[18F]FDG PET/CT may be useful to assess early metabolic response, particularly in non-metastatic triple-negative and HER2+ tumours. 2-[18F]FDG PET/CT is useful to detect the site and extent of recurrence when conventional imaging methods are equivocal and when there is clinical and/or laboratorial suspicion of relapse. Recent developments are promising. CONCLUSION 2-[18F]FDG PET/CT is extremely useful in BC management, as supported by extensive evidence of its utility compared to other imaging modalities in several clinical scenarios.
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Affiliation(s)
- Sofia C Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal.
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - David Groheux
- Nuclear Medicine Department, Saint-Louis Hospital, Paris, France
- University Paris-Diderot, INSERM U976, Paris, France
- Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France
| | - Gary J R Cook
- Department of Cancer Imaging, King's College London, London, UK
- King's College London and Guy's & St Thomas' PET Centre, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, USA
- University of Southern California, Los Angeles, CA, USA
| | - Heather Jacene
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Cancer Center Clinica Universidad de Navarra, Navarra, Spain
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium
- University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Ritse M Mann
- Radiology Department, RadboudUMC, Nijmegen, The Netherlands
| | - Stephanie L Graff
- Lifespan Cancer Institute, Providence, Rhode Island, USA
- Legorreta Cancer Center at Brown University, Providence, Rhode Island, USA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands.
- Department of Radiation Science & Technology, Technical University of Delft, Delft, The Netherlands.
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Jacene H, Dietsche E, Specht J. The Current and Future Roles of Precision Oncology in Advanced Breast Cancer. J Nucl Med 2024; 65:349-356. [PMID: 38302151 DOI: 10.2967/jnumed.122.264882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Breast cancer is a common but heterogeneous disease characterized by several biologic features, including tumor grade, hormone receptor status, human epidermal growth factor receptor 2 status, and gene expression assays. These biologic and genomic features drive treatment decisions. In the advanced disease setting, inter- and intrapatient tumor heterogeneity is increasingly recognized as a challenge for optimizing treatment. Recent evidence and the recent approval of novel radiopharmaceuticals have increased recognition and acceptance of the potential of molecular imaging as a biomarker to impact and guide management decisions for advanced breast cancer.
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Affiliation(s)
- Heather Jacene
- Imaging/Radiology, Dana-Farber/Brigham Cancer Center, Boston, Massachusetts;
| | - Eric Dietsche
- Department of Radiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Jennifer Specht
- Fred Hutch Cancer Center, Divisions of Hematology and Oncology and of Clinical Research, Department of Medicine, University of Washington, Seattle, Washington
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Chen L, Zheng S, Chen L, Xu S, Wu K, Kong L, Xue J, Chen X, Miao W, Zhu Y. 68Ga-Labeled Fibroblast Activation Protein Inhibitor PET/CT for the Early and Late Prediction of Pathologic Response to Neoadjuvant Chemotherapy in Breast Cancer Patients: A Prospective Study. J Nucl Med 2023; 64:1899-1905. [PMID: 37918866 PMCID: PMC10690122 DOI: 10.2967/jnumed.123.266079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/27/2023] [Indexed: 11/04/2023] Open
Abstract
68Ga-labeled fibroblast activation protein inhibitor (68Ga-FAPI) PET/CT has demonstrated promising clinical results, with a higher SUVmax and tumor-to-background ratio (TBR) in breast cancer (BC) patients than 18F-FDG PET/CT. Here, we aimed to evaluate the suitability of 68Ga-FAPI PET/CT for the early and late prediction of the pathologic response to neoadjuvant chemotherapy (NAC) in BC. Methods: Twenty-two consecutive patients with newly diagnosed BC and an indication for NAC were prospectively included. All patients underwent standard chemotherapy and 68Ga-FAPI PET/CT at baseline, after 2 cycles of NAC (PET2), and 1 wk before surgery (PET3). SUVmax was measured in the primary tumor region and positive regional lymph nodes. The expression of fibroblast activation protein in the primary lesion was analyzed by immunohistochemistry. Results: Seven patients (31.8%) achieved a pathologic complete response (pCR), and 15 (68.2%) had residual tumors. Thirteen patients (59.1%) showed concentric withdrawal of the primary tumor, and 9 (40.9%) showed diffuse withdrawal. Between PET2 and PET3, the ΔSUVmax of the primary tumor (R 2 = 0.822; P = 0.001) and metastatic lymph nodes (R 2 = 0.645; P = 0.002) were significantly correlated. The absolute values of SUVmax and TBR at PET2 and PET3 were lower in patients with pCR than in those without pCR (P < 0.05). Moreover, a larger ΔSUVmax at any time point was strongly associated with pCR (P < 0.05). Similar downward trends in SUVmax, TBR, and ΔSUVmax were observed in the pattern of primary tumor reduction. For predicting pCR, the optimal cutoff values for ΔSUVmax after 2 chemotherapy cycles, ΔSUVmax before surgery, TBR after 2 chemotherapy cycles, and TBR before surgery of the primary tumor were 3.4 (area under the curve [AUC], 0.890), 1.1 (AUC, 0.978), -63.8% (AUC, 0.879), -90.8% (AUC, 0.978), 7.6 (AUC, 0.848), and 1.4 (AUC, 0.971), respectively. Immunohistochemistry showed that the SUVmax and TBR of 68Ga-FAPI PET/CT were positively correlated with fibroblast activation protein expression (P < 0.001 for both). Conclusion: Assessment of early changes in 68Ga-FAPI uptake during NAC by 68Ga-FAPI PET/CT can predict pCR and primary tumor concentric withdrawal in BC patients. 68Ga-FAPI PET/CT has great potential for the early and late prediction of the pathologic response to NAC in BC.
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Affiliation(s)
- Ling Chen
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shan Zheng
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Linying Chen
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; and
| | - Sunwang Xu
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Kunlin Wu
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lingjun Kong
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jiajie Xue
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiangjin Chen
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China;
| | - Weibing Miao
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China;
| | - Youzhi Zhu
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Thyroid and Breast Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Sunassee ED, Jardim-Perassi BV, Madonna MC, Ordway B, Ramanujam N. Metabolic Imaging as a Tool to Characterize Chemoresistance and Guide Therapy in Triple-Negative Breast Cancer (TNBC). Mol Cancer Res 2023; 21:995-1009. [PMID: 37343066 PMCID: PMC10592445 DOI: 10.1158/1541-7786.mcr-22-1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/07/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
After an initial response to chemotherapy, tumor relapse is frequent. This event is reflective of both the spatiotemporal heterogeneities of the tumor microenvironment as well as the evolutionary propensity of cancer cell populations to adapt to variable conditions. Because the cause of this adaptation could be genetic or epigenetic, studying phenotypic properties such as tumor metabolism is useful as it reflects molecular, cellular, and tissue-level dynamics. In triple-negative breast cancer (TNBC), the characteristic metabolic phenotype is a highly fermentative state. However, during treatment, the spatial and temporal dynamics of the metabolic landscape are highly unstable, with surviving populations taking on a variety of metabolic states. Thus, longitudinally imaging tumor metabolism provides a promising approach to inform therapeutic strategies, and to monitor treatment responses to understand and mitigate recurrence. Here we summarize some examples of the metabolic plasticity reported in TNBC following chemotherapy and review the current metabolic imaging techniques available in monitoring chemotherapy responses clinically and preclinically. The ensemble of imaging technologies we describe has distinct attributes that make them uniquely suited for a particular length scale, biological model, and/or features that can be captured. We focus on TNBC to highlight the potential of each of these technological advances in understanding evolution-based therapeutic resistance.
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Affiliation(s)
- Enakshi D. Sunassee
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | | | - Megan C. Madonna
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Bryce Ordway
- Department of Cancer Physiology, Moffitt Cancer Center, Tampa, FL 33612, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27708, USA
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Abstract
Metabolic PET, most commonly 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT), has had a major impact on the imaging of breast cancer and can have important clinical applications in appropriate patients. While limited for screening, FDG PET/CT outperforms conventional imaging in locally advanced breast cancer. FDG PET/CT is more sensitive than conventional imaging in assessing treatment response, accurately predicting complete response or nonresponse in early-stage cases. It also aids in determining disease extent and treatment response in the metastatic setting. Further research, including randomized controlled trials with FDG and other metabolic agents such as fluciclovine, is needed for optimal breast cancer imaging.
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Affiliation(s)
- Katherine Cecil
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Laura Huppert
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Rita Mukhtar
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Sophia R O'Brien
- Divisions of Molecular Imaging and Therapy Breast Imaging, Department of Radiology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Irvine, CA, USA; Departments of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | - Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
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Bulut G, Atilgan HI, Çınarer G, Kılıç K, Yıkar D, Parlar T. Prediction of pathological complete response to neoadjuvant chemotherapy in locally advanced breast cancer by using a deep learning model with 18F-FDG PET/CT. PLoS One 2023; 18:e0290543. [PMID: 37708209 PMCID: PMC10501592 DOI: 10.1371/journal.pone.0290543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES The aim of the study is 18F-FDG PET/CT imaging by using deep learning method are predictive for pathological complete response pCR after Neoadjuvant chemotherapy (NAC) in locally advanced breast cancer (LABC). INTRODUCTION NAC is the standard treatment for locally advanced breast cancer (LABC). Pathological complete response (pCR) after NAC is considered a good predictor of disease-free survival (DFS) and overall survival (OS).Therefore, there is a need to develop methods that can predict the pCR at the time of diagnosis. METHODS This article was designed as a retrospective chart study.For the convolutional neural network model, a total of 355 PET/CT images of 31 patients were used. All patients had primary breast surgery after completing NAC. RESULTS Pathological complete response was obtained in a total of 9 patients. The study results show that our proposed deep convolutional neural networks model achieved a remarkable success with an accuracy of 84.79% to predict pathological complete response. CONCLUSION It was concluded that deep learning methods can predict breast cancer treatment.
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Affiliation(s)
- Gülcan Bulut
- Division of Medical Oncology, International Medicana Hospital, Izmir, Turkey
| | - Hasan Ikbal Atilgan
- Department of Nuclear Medicine, Mustafa Kemal University Medical School, Hatay, Turkey
| | - Gökalp Çınarer
- Department of Computer Engineering, Faculty of Engineering and Architecture, Bozok University, Yozgat, Turkey
| | - Kazım Kılıç
- Department of Computer Programming, Yozgat Vocational High School, Bozok University, Yozgat, Turkey
| | - Deniz Yıkar
- Division of Nuclear Medicine, Hatay Training and Research Hospital, Hatay, Turkey
| | - Tuba Parlar
- Department of Computer Technologies, Mustafa Kemal University, Hatay, Türkiye
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7
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Schreier A, Zappasodi R, Serganova I, Brown KA, Demaria S, Andreopoulou E. Facts and Perspectives: Implications of tumor glycolysis on immunotherapy response in triple negative breast cancer. Front Oncol 2023; 12:1061789. [PMID: 36703796 PMCID: PMC9872136 DOI: 10.3389/fonc.2022.1061789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/17/2022] [Indexed: 01/11/2023] Open
Abstract
Triple negative breast cancer (TNBC) is an aggressive disease that is difficult to treat and portends a poor prognosis in many patients. Recent efforts to implement immune checkpoint inhibitors into the treatment landscape of TNBC have led to improved outcomes in a subset of patients both in the early stage and metastatic settings. However, a large portion of patients with TNBC remain resistant to immune checkpoint inhibitors and have limited treatment options beyond cytotoxic chemotherapy. The interplay between the anti-tumor immune response and tumor metabolism contributes to immunotherapy response in the preclinical setting, and likely in the clinical setting as well. Specifically, tumor glycolysis and lactate production influence the tumor immune microenvironment through creation of metabolic competition with infiltrating immune cells, which impacts response to immune checkpoint blockade. In this review, we will focus on how glucose metabolism within TNBC tumors influences the response to immune checkpoint blockade and potential ways of harnessing this information to improve clinical outcomes.
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Affiliation(s)
- Ashley Schreier
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, United States
| | - Roberta Zappasodi
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, United States,Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, United States,Parker Institute for Cancer Immunotherapy, San Francisco, CA, United States
| | - Inna Serganova
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, United States,Human Oncology & Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kristy A. Brown
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Sandra Demaria
- Department of Radiation Oncology and Department of Pathology, Weill Cornell Medicine, New York, NY, United States
| | - Eleni Andreopoulou
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, United States,*Correspondence: Eleni Andreopoulou,
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Wang H, Lu Y, Li Y, Li S, Zhang X, Geng C. Nomogram for Early Prediction of Pathological Complete Response to Neoadjuvant Chemotherapy in Breast Cancer Combining Both Clinicopathological and Imaging Indicators. Curr Probl Cancer 2022; 46:100914. [PMID: 36351312 DOI: 10.1016/j.currproblcancer.2022.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/02/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
To construct a nomogram for early prediction of pathological complete response (pCR) in patients with breast cancer (BC) after neoadjuvant chemotherapy (NAC). A total of 257 patients with BC from the fourth hospital of Hebei Medical University were included in the study. The patients were divided into training (n = 128) and validation groups (n = 129). Variables were screened using univariate and multivariate logistic regression analyses, and the nomogram model was set up based on the training group. The training and validation groups were validated using the receiver operating characteristic (ROC) curves and calibration plots. The diagnostic value of the nomogram was evaluated using decision curve analysis (DCA). Indicators such as hormone receptor status, clinical TNM stage, and change rate in apparent diffusion coefficient of breast magnetic resonance imaging after two NAC cycles were used for nomogram construction. The calibration plots showed high consistency between nomogram-predicted and actual pCR probabilities in the training and validation groups. The areas under the curve of the ROC curve with discrimination ability were 0.942 and 0.921 in the training and validation groups, respectively. This showed an excellent discrimination ability of our nomogram for pCR prediction. Further, DCA showed favorable diagnostic value in our model. The nomogram may be instructive to clinicians for early prediction of pCR and helpful to adjust the treatment program on time in neoadjuvant management.
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Affiliation(s)
- Haoqi Wang
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuyang Lu
- Thyroid and Breast Department, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Yilun Li
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Sainan Li
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xi Zhang
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Cuizhi Geng
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Giacchetti S, Faucheux L, Gardair C, Cuvier C, de Roquancourt A, Campedel L, Groheux D, de Bazelaire C, Lehmann-Che J, Miquel C, Cahen Doidy L, Amellou M, Madelaine I, Reyal F, Someil L, Hocini H, Hennequin C, Teixeira L, Espié M, Chevret S, Soumelis V, Hamy AS. Negative Relationship between Post-Treatment Stromal Tumor-Infiltrating Lymphocyte (TIL) and Survival in Triple-Negative Breast Cancer Patients Treated with Dose-Dense Dose-Intense NeoAdjuvant Chemotherapy. Cancers (Basel) 2022; 14:cancers14051331. [PMID: 35267639 PMCID: PMC8909288 DOI: 10.3390/cancers14051331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Patients with triple-negative breast cancers (TNBC) have a poor prognosis unless a pathological complete response (pCR) is achieved after neoadjuvant chemotherapy (NAC). Few studies have analyzed changes in TIL levels following dose-dense dose-intense (dd-di) NAC. Patients and methods: From 2009 to 2018, 117 patients with TNBC received dd-di NAC at our institution. We aimed to identify factors associated with pre- and post-NAC TIL levels, and oncological outcomes relapse-free survival (RFS), and overall survival (OS). Results: Median pre-NAC and post-NAC TIL levels were 15% and 3%, respectively. Change in TIL levels with treatment was significantly correlated with metabolic response (SUV) and pCR. High post-NAC TIL levels were associated with a weak metabolic response after two cycles of NAC, with the presence of residual disease and nodal involvement at NAC completion. In multivariate analyses, high post-NAC TIL levels independently predicted poor RFS and poor OS (HR = 1.4 per 10% increment, 95%CI (1.1; 1.9) p = 0.014 and HR = 1.8 per 10% increment 95%CI (1.3−2.3), p < 0.0001, respectively). Conclusion: Our results suggest that TNBC patients with TIL enrichment after NAC are at higher risk of relapse. These patients are potential candidates for adjuvant treatment, such as immunotherapy, in clinical trials.
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Affiliation(s)
- Sylvie Giacchetti
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
- Correspondence:
| | - Lilith Faucheux
- ECSTRRA Team, Statistic and Epidemiologic Research Center, INSERM UMR-1153, Université de Paris, F-75010 Paris, France; (L.F.); (S.C.)
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
| | - Charlotte Gardair
- Department of Anatomopathology, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.G.); (A.d.R.); (C.M.)
| | - Caroline Cuvier
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
| | - Anne de Roquancourt
- Department of Anatomopathology, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.G.); (A.d.R.); (C.M.)
| | - Luca Campedel
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
| | - David Groheux
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
- Department of Nuclear Medicine, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | | | - Jacqueline Lehmann-Che
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
- Immunology, Biology and Histocompatibility Laboratory, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | - Catherine Miquel
- Department of Anatomopathology, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.G.); (A.d.R.); (C.M.)
| | | | - Malika Amellou
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
| | - Isabelle Madelaine
- Department of Pharmacy, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France;
| | - Fabien Reyal
- Department of Surgery, Institut Curie, 26 rue d’Ulm, University Paris, F-75005 Paris, France;
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, 26 rue d’Ulm, University Paris, F-75005 Paris, France;
| | - Laetitia Someil
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
| | - Hamid Hocini
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
| | | | - Luis Teixeira
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
| | - Marc Espié
- Breast Disease Unit (Sénopole), AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.C.); (L.C.); (M.A.); (L.S.); (H.H.); (L.T.); (M.E.)
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
| | - Sylvie Chevret
- ECSTRRA Team, Statistic and Epidemiologic Research Center, INSERM UMR-1153, Université de Paris, F-75010 Paris, France; (L.F.); (S.C.)
- Department of Biostatistics and Medical Information, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | - Vassili Soumelis
- INSERM U976, Université de Paris, F-75010 Paris, France; (D.G.); (J.L.-C.); (V.S.)
- Department of Anatomopathology, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France; (C.G.); (A.d.R.); (C.M.)
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, 26 rue d’Ulm, University Paris, F-75005 Paris, France;
- Department of Oncology, Institut Curie St Cloud–35 rue Dailly, St Cloud, F-92210 Paris, France
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Liu H, Lv L, Gao H, Cheng M. Pathologic Complete Response and Its Impact on Breast Cancer Recurrence and Patient's Survival after Neoadjuvant Therapy: A Comprehensive Meta-Analysis. Comput Math Methods Med 2021; 2021:7545091. [PMID: 35003324 PMCID: PMC8741368 DOI: 10.1155/2021/7545091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Earlier research has illustrated prognostic significance of pathologic complete response (pCR) in neoadjuvant therapy (NAT) for breast cancer, whereas correlation between treatment after achieving pCR and survival improvement remains underexplored. We attempted to measure the relation between pCR achieved after NAT and breast cancer recurrence or patient's survival. METHODS We searched PubMed, EMBASE, Web of Science, and The Cochrane Library databases to find relevant articles from their inception to November 2020. According to eligibility criteria, studies were selected and basic data were extracted. The primary endpoint was the correlation between pCR achieved after NAT and event-free survival (EFS) or overall survival (OS). The results were obtained by directly extracting specific information from the literature or estimating individual data by survival curves on DigitizeIt software, presented with HR and 95% CI. All data were processed on Stata 14.0 software. RESULTS Among 4338 articles, there were 25 eligible articles involving 8767 patients. The EFS of patients achieved pCR after NAT improved obviously (HR = 0.27; 95% CI, 0.24-0.31), especially in triple negative (HR = 0.17; 95% CI, 0.12-0.24) and HER2 positive (HR = 0.24; 95% CI, 0.20-0.30) breast cancer patients. As such, pCR after NAT was implicated in significantly increased OS (HR = 0.32; 95% CI, 0.27-0.37). CONCLUSION Achieving pCR after NAT was notably related to the improvement of EFS and OS, especially for patients with triple-negative and HER2-positive breast cancer. pCR can be a surrogate indicator for outcome of breast cancer patients after NAT, as well as a predictor of treatment efficacy after NAT. Besides, well-designed studies are still warranted for confirmation.
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Affiliation(s)
- Hui Liu
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - Liqiong Lv
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - Hui Gao
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
| | - Ming Cheng
- Department of Breast Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi Province, China
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Liu Y, Zhou Q, Song S, Tang S. Integrating metabolic reprogramming and metabolic imaging to predict breast cancer therapeutic responses. Trends Endocrinol Metab 2021; 32:762-775. [PMID: 34340886 DOI: 10.1016/j.tem.2021.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/26/2021] [Accepted: 07/04/2021] [Indexed: 01/10/2023]
Abstract
Metabolic reprogramming is not only an emerging hallmark of cancer, but also an essential regulator of cancer cell adaptation to the microenvironment. Metabolic imaging targeting metabolic signatures has been widely used for breast cancer diagnosis. However, limited implications have been explored for monitoring breast cancer therapy response, although metabolic plasticity is notably associated with therapy resistance. In this review, we focus on the metabolic alterations upon breast cancer therapy and their potential for evaluating breast cancer therapeutic responses. We summarize the metabolic network and regulatory changes upon breast cancer therapy in terms of cancer pathological and genetic differences and discuss the implications of metabolic imaging with various probes in selecting target beneficiaries for precision treatment.
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Affiliation(s)
- Yi Liu
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai 200032, PR China; Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, PR China
| | - Qian Zhou
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai 200032, PR China
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, PR China.
| | - Shuang Tang
- Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai 200032, PR China; Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, PR China; Shanghai Key Laboratory of Radiation Oncology, Shanghai 201321, PR China.
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Zhao H, Meng H, Wen J, Wang C, Liu J, Huang G. Noninvasive Classification of Human Triple Negative Breast Cancer by PET Imaging with GRP78-Targeted Molecular Probe [ 68Ga]DOTA-VAP. Mol Imaging Biol 2020; 22:772-9. [PMID: 31452065 DOI: 10.1007/s11307-019-01416-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE There is currently no effective noninvasive method for accurate molecular typing of triple negative breast cancer (TNBC) except needle biopsy. Glucoregulated Protein 78 (GRP78) is overexpressed in TNBC cells and tumors which closely related to the invasion, metastasis, and drug resistance of cancer. Meanwhile, it has been verified that VAP peptide bind specifically to GRP78 in vitro and in vivo. In this study, we constructed a GRP78-targeted molecular probe Ga-68-radiolabeled DOTA-VAP conjugate ([68Ga]DOTA-VAP) based on VAP peptide, and evaluated its potential to distinguish TNBC from non-TNBC tumors. PROCEDURES DOTA-VAP was synthesized and then radiolabeled with Ga-68 to obtain [68Ga]DOTA-VAP. The expression of GRP78 in TNBC MDA-MB-231 and non-TNBC MCF-7 cells was validated by Western Blot, and cell binding or uptake experiments with both [68Ga]DOTA-VAP and 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) were also performed. Biodistribution analysis and positron emission tomography (PET) imaging of [68Ga]DOTA-VAP were carried out in subcutaneous MDA-MB-231 and MCF-7 human breast cancer tumor models with [18F]FDG PET imaging as comparison. RESULTS [68Ga]DOTA-VAP was prepared with high radiochemical purity which showed excellent stability in vitro. The MDA-MB-231 tumors were clearly visualized by [68Ga]DOTA-VAP PET imaging with a low background, except for the relatively high liver uptake. Cells and tumors of MDA-MB-231 could be distinguished from MCF-7 by [68Ga]DOTA-VAP instead of [18F]FDG. Biodistribution results were consistent with the imaging results. The blocking study with excess cold peptide showed significantly reduced tumor uptake, which indicated the specificity of [68Ga]DOTA-VAP targeting MDA-MB-231 tumors in vivo. CONCLUSIONS GRP78-targeted PET imaging with [68Ga]DOTA-VAP provided an effective approach for the noninvasive accurate classification of TNBC from other breast cancer subtypes comparing with [18F]FDG. GRP78 may be a potential target for the diagnosis and treatment of TNBC. For clinical transformation, efforts should be made to overcome deficiencies of [68Ga]DOTA-VAP such as relative high uptake in normal tissues.
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Lian W, Liu C, Gu B, Zhang J, Lu L, Pan H, Yao Z, Wang M, Song S, Zhang Y, Yang Z. The early prediction of pathological response to neoadjuvant chemotherapy and prognosis: comparison of PET Response Criteria in Solid Tumors and European Organization for Research and Treatment of Cancer criteria in breast cancer. Nucl Med Commun 2020; 41:280-7. [PMID: 32032193 DOI: 10.1097/MNM.0000000000001145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To compare the predictive value of European Organization for Research and Treatment of Cancer (EORTC) criteria and PET Response Criteria in Solid Tumors (PERCIST), for the pathological response and prognosis of patients with breast cancer receiving neoadjuvant chemotherapy (NAC). METHODS Consecutive PET/computed tomography scans in 128 operable female patients at baseline and after two courses of NAC were performed. Patients were categorized by complete metabolic response (CMR) and non-CMR groups using 2 PET criteria. CMR and non-CMR were used to predict pathological complete response (pCR) by diagnostic test evaluation, and to predict progression-free survival (PFS) using Kaplan-Meier plots and Cox proportional hazards regression. RESULTS Ninety-two patients were finally analyzed. The sensitivity, specificity, and accuracy for pCR prediction were 69.7, 76.3, and 73.9% with EORTC criteria, and 69.7, 77.9, and 75.0% with PERCIST, respectively. Peak standardized uptake value normalized to lean body mass (SULpeak), maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), and metabolic tumor volume (MTV) were pCR response with accuracy of 70.7, 60.0, 75.0, and 71.4%, respectively. CMR by the EORTC (P = 0.021) and PERCIST (P = 0.007) was significantly related to a longer PFS. The univariate and multivariate analysis suggested that CMR by PERCIST was an independent predictor of recurrence (P = 0.008). CONCLUSION EORTC criteria and PERCIST had early predictive value to long-term outcome, but moderate value for pCR. Furthermore, PERCIST might show more potential than the EORTC criteria and conventional PET-based parameters to predict prognosis in breast cancer patients following two cycles of neoadjuvant chemotherapy.Video abstract: see http://links.lww.com/NMC/A162.
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Han S, Choi JY. Prognostic value of 18F-FDG PET and PET/CT for assessment of treatment response to neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis. Breast Cancer Res 2020; 22:119. [PMID: 33129348 DOI: 10.1186/s13058-020-01350-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022] Open
Abstract
Background We performed a systematic review and meta-analysis to evaluate the prognostic significance of 18F-FDG PET and PET/CT for evaluation of responses to neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods We searched PubMed, Embase, and the Cochrane Library databases until June 2020 to identify studies that assessed the prognostic value of 18F-FDG PET scans during or after NAC with regard to overall (OS) and disease-free survival (DFS). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were pooled meta-analytically using a random-effects model. Results Twenty-one studies consisting of 1630 patients were included in the qualitative synthesis. Twelve studies investigated the use of PET scans for interim response evaluation (during NAC) and 10 studies assessed post-treatment PET evaluation (after NAC). The most widely evaluated parameter distinguishing metabolic responders from poor responders on interim or post-treatment PET scans was %ΔSUVmax, defined as the percent reduction of SUVmax compared to baseline PET, followed by SUVmax and complete metabolic response (CMR). For the 17 studies included in the meta-analysis, the pooled HR of metabolic responses on DFS was 0.21 (95% confidence interval [CI], 0.14–0.32) for interim PET scans and 0.31 (95% CI, 0.21–0.46) for post-treatment PET scans. Regarding the influence of metabolic responses on OS, the pooled HRs for interim and post-treatment PET scans were 0.20 (95% CI, 0.09–0.44) and 0.26 (95% CI, 0.14–0.51), respectively. Conclusions The currently available literature suggests that the use of 18F-FDG PET or PET/CT for evaluation of response to NAC provides significant predictive value for disease recurrence and survival in breast cancer patients and might allow risk stratification and guide rational management.
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Huang M, O'Shaughnessy J, Zhao J, Haiderali A, Cortés J, Ramsey SD, Briggs A, Hu P, Karantza V, Aktan G, Qi CZ, Gu C, Xie J, Yuan M, Cook J, Untch M, Schmid P, Fasching PA. Association of Pathologic Complete Response with Long-Term Survival Outcomes in Triple-Negative Breast Cancer: A Meta-Analysis. Cancer Res 2020; 80:5427-5434. [DOI: 10.1158/0008-5472.can-20-1792] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 11/16/2022]
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Li P, Wang X, Xu C, Liu C, Zheng C, Fulham MJ, Feng D, Wang L, Song S, Huang G. 18F-FDG PET/CT radiomic predictors of pathologic complete response (pCR) to neoadjuvant chemotherapy in breast cancer patients. Eur J Nucl Med Mol Imaging 2020; 47:1116-26. [PMID: 31982990 DOI: 10.1007/s00259-020-04684-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/03/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) is commonly accepted as the gold standard to assess outcome after NAC in breast cancer patients. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has unique value in tumor staging, predicting prognosis, and evaluating treatment response. Our aim was to determine if we could identify radiomic predictors from PET/CT in breast cancer patient therapeutic efficacy prior to NAC. METHODS This retrospective study included 100 breast cancer patients who received NAC; there were 2210 PET/CT radiomic features extracted. Unsupervised and supervised machine learning models were used to identify the prognostic radiomic predictors through the following: (1) selection of the significant (p < 0.05) imaging features from consensus clustering and the Wilcoxon signed-rank test; (2) selection of the most discriminative features via univariate random forest (Uni-RF) and the Pearson correlation matrix (PCM); and (3) determination of the most predictive features from a traversal feature selection (TFS) based on a multivariate random forest (RF). The prediction model was constructed with RF and then validated with 10-fold cross-validation for 30 times and then independently validated. The performance of the radiomic predictors was measured in terms of area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The PET/CT radiomic predictors achieved a prediction accuracy of 0.857 (AUC = 0.844) on the training split set and 0.767 (AUC = 0.722) on the independent validation set. When age was incorporated, the accuracy for the split set increased to 0.857 (AUC = 0.958) and 0.8 (AUC = 0.73) for the independent validation set and both outperformed the clinical prediction model. We also found a close association between the radiomic features, receptor expression, and tumor T stage. CONCLUSION Radiomic predictors from pre-treatment PET/CT scans when combined with patient age were able to predict pCR after NAC. We suggest that these data will be valuable for patient management.
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Wu S, Wang Y, Li J, Zhang N, Mo M, Klimberg S, Kaklamani V, Cochet A, Shao Z, Cheng J, Liu G. Subtype-Guided 18 F-FDG PET/CT in Tailoring Axillary Surgery Among Patients with Node-Positive Breast Cancer Treated with Neoadjuvant Chemotherapy: A Feasibility Study. Oncologist 2019; 25:e626-e633. [PMID: 32297448 DOI: 10.1634/theoncologist.2019-0583] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/25/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the value of 18 [F]-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) in tailoring axillary surgery by predicting nodal response among patients with node-positive breast cancer after neoadjuvant chemotherapy (NAC). METHODS One hundred thirty-three patients with breast cancer with biopsy-confirmed nodal metastasis were prospectively enrolled. 18 F-FDG PET/CT scan was performed before NAC (a second one after two cycles with baseline maximum standardized uptake value [SUVmax ] ≥2.5), and a subset of patients underwent targeted axillary dissection (TAD). All the patients underwent axillary lymph node dissection (ALND). The accuracy was calculated by a comparison with the final pathologic results. RESULTS With the cutoff value of 2.5 for baseline SUVmax and 78.4% for change in SUVmax , sequential 18 F-FDG PET/CT scans demonstrated a sensitivity of 79.0% and specificity of 71.4% in predicting axillary pathologic complete response with an area under curve (AUC) of 0.75 (95% confidence interval, 0.65-0.84). Explorative subgroup analyses indicated little value for estrogen receptor (ER)-negative, human epidermal growth factor receptor 2 (HER2)-positive patients (AUC, 0.55; sensitivity, 56.5%; specificity, 50.0%). Application of 18 F-FDG PET/CT could spare 19 patients from supplementary ALNDs and reduce one of three false-negative cases in TAD among the remaining patients without ER-negative/HER2-positive subtype. CONCLUSION Application of the subtype-guided 18 F-FDG PET/CT could accurately predict nodal response and aid in tailoring axillary surgery among patients with node-positive breast cancer after NAC, which includes identifying candidates appropriate for TAD or directly proceeding to ALND. This approach might help to avoid false-negative events in TAD. IMPLICATIONS FOR PRACTICE This feasibility study showed that 18 [F]-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) could accurately predict nodal response after neoadjuvant chemotherapy (NAC) among patients with breast cancer with initial nodal metastasis except in estrogen receptor-negative, human epidermal growth factor receptor 2-positive subtype. Furthermore, the incorporation of 18 F-FDG PET/CT can tailor subsequent axillary surgery by identifying patients with residual nodal disease, thus sparing those patients supplementary axillary lymph node dissection. Finally, we have proposed a possibly feasible flowchart involving 18 F-FDG PET/CT that might be applied in post-NAC axillary evaluation.
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Affiliation(s)
- Siyu Wu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Yujie Wang
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jianwei Li
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Na Zhang
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Miao Mo
- Clinical Statistics Center, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Suzanne Klimberg
- Division of Breast Surgical Oncology, Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Virginia Kaklamani
- Division of Hematology and Oncology, Northwestern University, Chicago, Illinois, USA
| | - Alexandre Cochet
- Department of Nuclear Medicine, Centre Georges-François Leclerc, University Hospital of Dijon, Dijon, France
| | - Zhiming Shao
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Jingyi Cheng
- Department of Nuclear Medicine, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Guangyu Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
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Watanabe M, Nakamoto Y, Ishimori T, Saga T, Kido A, Hamanishi J, Hamanaka Y, Togashi K. Prognostic utility of FDG PET/CT in advanced ovarian, fallopian and primary peritoneal high-grade serous cancer patients before and after neoadjuvant chemotherapy. Ann Nucl Med 2020; 34:128-35. [DOI: 10.1007/s12149-019-01424-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
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Arenas M, Fernández-Arroyo S, Rodríguez-Tomàs E, Sabater S, Murria Y, Gascón M, Amillano K, Melé M, Camps J, Joven J. Effects of radiotherapy on plasma energy metabolites in patients with breast cancer who received neoadjuvant chemotherapy. Clin Transl Oncol 2019; 22:1078-1085. [PMID: 31679126 DOI: 10.1007/s12094-019-02232-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/17/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Neoadjuvant chemotherapy (NACT) is employed in patients with breast cancer (BC) with the aim of reducing tumor burden and improving surgical outcomes. We evaluated the levels of energy metabolites pre- and post-radiotherapy (RT) in breast cancer (BC) patients who previously received NACT and investigated the alterations of these metabolites in relation to the patient achieving a pathologic complete response to NACT. MATERIALS AND METHODS We included 37 BC patients who were treated with NACT following surgery and analyzed the concentrations of energy balance-related metabolites using targeted metabolomics before and one month after the end of RT. The control group was composed of 44 healthy women. RESULTS Pre-radiotherapy, patients had significant decreases in the plasma levels of 12 metabolites. RT corrected these alterations and the improvement was superior in patients with a pathologic complete response. CONCLUSION Our results highlight the importance of metabolism in the outcomes of patients with BC.
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Affiliation(s)
- M Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain.
| | - S Fernández-Arroyo
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - E Rodríguez-Tomàs
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - S Sabater
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Y Murria
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - M Gascón
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - K Amillano
- Department of Medical Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - M Melé
- Department of Medical Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - J Camps
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - J Joven
- Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
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Groheux D. Now Is the Time to Use 18F-FDG PET/CT to Optimize Neoadjuvant Treatment in Triple-Negative Breast Cancer! J Nucl Med 2018; 59:863-864. [DOI: 10.2967/jnumed.118.210922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/12/2018] [Indexed: 11/16/2022] Open
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Abstract
After an overview of the principles of fludeoxyglucose-PET/computed tomography (CT) in breast cancer, its advantages and limits to evaluate treatment response are discussed. The metabolic information is helpful for early assessment of the response to neoadjuvant chemotherapy and could be used to monitor treatment, especially in aggressive breast cancer subtypes. PET/CT is also a powerful method for early assessment of the treatment response in the metastatic setting. It allows evaluation of different sites of metastases in a single examination and detection of a heterogeneous response. However, to use PET/CT to assess responses, methodology for image acquisition and analysis needs standardization.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, 1 Avenue Claude Vellefaux, Paris 75475 Cedex 10, France.
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Groheux D, Biard L, Lehmann-Che J, Teixeira L, Bouhidel FA, Poirot B, Bertheau P, Merlet P, Espié M, Resche-Rigon M, Sotiriou C, de Cremoux P. Tumor metabolism assessed by FDG-PET/CT and tumor proliferation assessed by genomic grade index to predict response to neoadjuvant chemotherapy in triple negative breast cancer. Eur J Nucl Med Mol Imaging 2018; 45:1279-1288. [DOI: 10.1007/s00259-018-3998-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/21/2018] [Indexed: 12/18/2022]
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Nguyen-Thu H, Hanaoka H, Nakajima T, Yamaguchi A, Nguyen-Cong T, Kartamihardja AAP, Tsushima Y. Early prediction of triple negative breast cancer response to cisplatin treatment using diffusion-weighted MRI and 18F-FDG-PET. Breast Cancer 2018; 25:334-342. [DOI: 10.1007/s12282-018-0834-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 01/15/2018] [Indexed: 12/27/2022]
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Zeng C, Kinahan PE, Qian H, Harrison RL, Champley KM, MacDonald LR. Simulation study of quantitative precision of the PET/X dedicated breast PET scanner. J Med Imaging (Bellingham) 2017; 4:045502. [PMID: 29134188 PMCID: PMC5661484 DOI: 10.1117/1.jmi.4.4.045502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 09/27/2017] [Indexed: 11/14/2022] Open
Abstract
The goal for positron emission tomography (PET)/X is measuring changes in radiotracer uptake for early assessment of response to breast cancer therapy. Upper bounds for detecting such changes were investigated using simulation and two image reconstruction algorithms customized to the PET/X rectangular geometry. Analytical reconstruction was used to study spatial resolution, comparing results with the distance of the closest approach (DCA) resolution surrogate that is independent of the reconstruction method. An iterative reconstruction algorithm was used to characterize contrast recovery in small targets. Resolution averaged [Formula: see text] full width at half maximum when using depth-of-interaction (DOI) information. Without DOI, resolution ranged from [Formula: see text] to [Formula: see text] for scanner crystal thickness between 5 and 15 mm. The DCA resolution surrogate was highly correlated to image-based FWHM. Receiver-operating characteristic analysis showed specificity and sensitivity over 95% for detecting contrast change from 5:1 to 4:1 (area under curve [Formula: see text]). For PET/X parameters modeled here, the ability to measure contrast changes benefited from higher photon absorption efficiency of thicker crystals while being largely unaffected by degraded resolution obtained with thicker crystals; DOI provided marginal improvements. These results assumed perfect data corrections and other idealizations, and thus represent an upper bound for detecting changes in small lesion radiotracer uptake of clinical interest using the PET/X system.
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Affiliation(s)
- Chengeng Zeng
- University of Washington, Radiology Department, Seattle, Washington, United States
| | - Paul E. Kinahan
- University of Washington, Radiology Department, Seattle, Washington, United States
| | - Hua Qian
- GE Global Research Center, Niskayuna, New York, United States
| | - Robert L. Harrison
- University of Washington, Radiology Department, Seattle, Washington, United States
| | - Kyle M. Champley
- Lawrence Livermore National Laboratory, Livermore, California, United States
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Ueda S, Saeki T, Osaki A, Yamane T, Kuji I. Bevacizumab Induces Acute Hypoxia and Cancer Progression in Patients with Refractory Breast Cancer: Multimodal Functional Imaging and Multiplex Cytokine Analysis. Clin Cancer Res 2017; 23:5769-5778. [PMID: 28679773 DOI: 10.1158/1078-0432.ccr-17-0874] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/29/2017] [Accepted: 06/30/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Bevacizumab, an antibody against endothelial growth factor, is a key but controversial drug in the treatment of metastatic breast cancer. We, therefore, aimed to determine the intrinsic resistance to bevacizumab at the physiologic and molecular levels in advanced breast cancer using PET, dynamic contrast-enhanced MRI, diffuse optical spectroscopic imaging (DOSI), and multiplex cytokine assays.Experimental Design: In total, 28 patients diagnosed with advanced stage III/IV breast cancer receiving single-agent bevacizumab for 1 week followed by paclitaxel combined with bevacizumab underwent 18F-fluorodeoxyglucose (FDG)-PET, 18F-fluoromisonidazole (FMISO)-PET, and MRI at both baseline and two courses after treatment initiation. Hemodynamic measurement using DOSI and blood sample collection were performed at baseline and multiple times during the first week after the initiation of single-agent bevacizumab. We distinguished nonresponders from responders by serial FDG-PET based on their glycolytic changes to chemotherapy.Results: Nonresponders showed significantly higher hypoxic activity on FMISO-PET and less tumor shrinkage than responders. Hemodynamic parameters showed higher tumor blood volume and a remarkable decrease in the tissue oxygen level in nonresponders compared with responders after the infusion of single-agent bevacizumab. Multiplex cytokine assays revealed increased plasma levels of both proangiogenic and hypoxia-related inflammatory cytokines in nonresponders and decreased levels in responders.Conclusions: Nonresponders exhibited a higher degree of angiogenesis with more severe hypoxia than responders during bevacizumab treatment. These findings demonstrated that the addition of bevacizumab to paclitaxel treatment under hypoxic conditions could be ineffective and may result in acute hypoxia and increased cytokine secretion associated with cancer progression. Clin Cancer Res; 23(19); 5769-78. ©2017 AACR.
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Affiliation(s)
- Shigeto Ueda
- Department of Breast Oncology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan.
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Akihiko Osaki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Tomohiko Yamane
- Department of Nuclear Medicine, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Ichiei Kuji
- Department of Nuclear Medicine, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
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26
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Tian F, Shen G, Deng Y, Diao W, Jia Z. The accuracy of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant chemotherapy in patients with breast cancer: a meta-analysis and systematic review. Eur Radiol 2017; 27:4786-96. [DOI: 10.1007/s00330-017-4831-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 12/22/2022]
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Chen S, Ibrahim NK, Yan Y, Wong ST, Wang H, Wong FC. Complete Metabolic Response on Interim 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography to Predict Long-Term Survival in Patients with Breast Cancer Undergoing Neoadjuvant Chemotherapy. Oncologist 2017; 22:526-534. [PMID: 28377466 DOI: 10.1634/theoncologist.2016-0334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/05/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study aims to investigate the prognostic role of complete metabolic response (CMR) on interim 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in patients with breast cancer (BC) receiving neoadjuvant chemotherapy (NAC) according to tumor subtypes and PET timing. PATIENTS AND METHODS Eighty-six consecutive patients with stage II/III BC who received PET/CT during or following NAC were included. Time-dependent receiver operating characteristic analysis and Kaplan-Meier analysis were used to determine correlation between metabolic parameters and survival outcomes. RESULTS The median follow-up duration was 71 months. Maximum standardized uptake value (SUVmax) on an interim PET/CT independently correlated with survival by multivariate analysis (overall survival [OS]: hazard ratio: 1.139, 95% confidence interval: 1.058-1.226, p = .001). By taking PET timing into account, best association of SUVmax with survival was obtained on PET after two to three cycles of NAC (area under the curve [AUC]: 0.941 at 1 year after initiation of NAC) and PET after four to five (AUC: 0.871 at 4 years), while PET after six to eight cycles of NAC had less prognostic value. CMR was obtained in 62% of patients (23/37) with estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-negative (HER2-) BC, in 48% (12/25) triple-negative BC (TNBC), and in 75% (18/24) HER2-positive (HER2+) tumors. Patients with CMR on an early-mid PET had 5-year OS rates of 92% for ER+/HER2- tumors and 80% for TNBC, respectively. Among HER2+ subtype, 89% patients (16/18) with CMR had no relapse. CONCLUSION CMR indicated a significantly better outcome in BC and may serve as a favorable imaging prognosticator. The Oncologist 2017;22:526-534 IMPLICATIONS FOR PRACTICE: This study shows a significantly better outcome for breast cancer (BC) patients who achieved complete metabolic response (CMR) on 18F-fluorodeoxyglucose emission tomography/computed tomography (PET/CT) during neoadjuvant chemotherapy, especially for hormone receptor-positive tumors and triple negative BC. Moreover, PET/CT performed during an early- or mid-course neoadjuvant therapy is more predictive for long-term survival outcome than a late PET/CT. These findings support that CMR may serve as a favorable imaging prognosticator for BC and has potential for application to daily clinical practice.
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Affiliation(s)
- Suyun Chen
- Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nuhad K Ibrahim
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yuanqing Yan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen T Wong
- Department of System Medicine and Bioengineering, Methodist Hospital Research Institution, Weill Cornell Medical College, Houston, Texas, USA
| | - Hui Wang
- Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Franklin C Wong
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Rauch GM, Adrada BE, Kuerer HM, van la Parra RFD, Leung JWT, Yang WT. Multimodality Imaging for Evaluating Response to Neoadjuvant Chemotherapy in Breast Cancer. AJR Am J Roentgenol 2017; 208:290-299. [DOI: 10.2214/ajr.16.17223] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Gaiane M. Rauch
- Department of Diagnostic Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009
| | - Beatriz Elena Adrada
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Henry Mark Kuerer
- Department of Breast Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raquel F. D. van la Parra
- Department of Breast Surgical Oncology, Unit 1434, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jessica W. T. Leung
- Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei Tse Yang
- Department of Diagnostic Radiology, Unit 1459, The University of Texas MD Anderson Cancer Center, Houston, TX
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Groheux D, Mankoff D, Espié M, Hindié E. 18F-FDG PET/CT in the early prediction of pathological response in aggressive subtypes of breast cancer: review of the literature and recommendations for use in clinical trials. Eur J Nucl Med Mol Imaging 2016; 43:983-93. [DOI: 10.1007/s00259-015-3295-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
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