Comparison Between 18F-FDG PET Image-Derived Indices for Early Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer
Comparison Between 18F-FDG PET Image-Derived Indices for Early Prediction of Response to Neoadjuvant Chemotherapy in Breast Cancer
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DOI：
10.2967/jnumed.112.108837
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发表时间：
2013-03-01
影响因子：
9.3
通讯作者：
Cheze-Le Rest, Catherine
中科院分区：
文献类型：
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作者：
Hatt, Mathieu;Groheux, David;Cheze-Le Rest, Catherine
本研究的目的是确定从连续F-18-FDG PET扫描中提取的图像衍生参数中的最佳预测因子，用于乳腺癌新辅助化疗2个周期后的早期肿瘤反应预测。方法：51例乳腺癌患者。根据肿瘤和淋巴结Sataloff量表，通过组织病理学检查确定应答者和非应答者状态。从PET图像中提取基线时的PET指数（最大和平均标准化摄取值[SUV]、代谢活性肿瘤体积和总病变糖酵解[TLG]）及其在2个周期新辅助化疗后的变化（Delta）。使用Mann-Whitney U检验和受试者操作特征分析研究其预测值。还通过分别考虑雌激素受体（ER）阳性/人表皮生长因子受体2（HER 2）阴性、三阴性和HER 2阳性肿瘤进行亚组分析。还使用迭代去卷积算法研究了部分体积校正的影响。结果：病理学无应答者24例，应答者27例。基线PET参数均与缓解无关。在2个新辅助化疗周期后，每个参数的降低与反应显著相关，用Delta TLG获得反应的最佳预测（96%的灵敏度，92%的特异性和94%的准确性），其曲线下面积显著更高（0.91 vs. 0.82，P = 0.01）比Delta SUVmax（63%的灵敏度，92%的特异性和77%的准确性）。亚组分析证实，对于ER阳性/HER阴性肿瘤，Delta TLG的准确性显著高于Delta SUV，但对于三阴性和HER 2阳性肿瘤，准确性不显著。部分容积校正对任何PET图像衍生参数的预测值没有影响，尽管其绝对值发生了显著变化。结论：我们的研究结果表明，2个新辅助化疗周期后，原发性肿瘤代谢活性体积测量值（如Delta TLG）的减少预测组织病理学肿瘤缓解的准确性高于Delta SUV测量值，尤其是对于ER阳性/HER 2阴性乳腺癌。这些结果应该在更大的患者群体中得到证实，因为它们可能会增加F-18-FDG PET用于早期预测新辅助化疗反应的临床价值和效率。
The goal of this study was to determine the best predictive factor among image-derived parameters extracted from sequential F-18-FDG PET scans for early tumor response prediction after 2 cycles of neoadjuvant chemotherapy in breast cancer. Methods: 51 breast cancer patients were included. Responder and nonresponder status was determined by histopathologic examination according to the tumor and node Sataloff scale. PET indices (maximum and mean standardized uptake value [SUV], metabolically active tumor volume, and total lesion glycolysis [TLG]), at baseline and their variation (Delta) after 2 cycles of neoadjuvant chemotherapy were extracted from the PET images. Their predictive value was investigated using Mann-Whitney U tests and receiver-operating-characteristic analysis. Subgroup analysis was also performed by considering estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, triple-negative, and HER2-positive tumors separately. The impact of partial-volume correction was also investigated using an iterative deconvolution algorithm. Results: There were 24 pathologic nonresponders and 27 responders. None of the baseline PET parameters was correlated with response. After 2 neoadjuvant chemotherapy cycles, the reduction of each parameter was significantly associated with response, the best prediction of response being obtained with Delta TLG (96% sensitivity, 92% specificity, and 94% accuracy), which had a significantly higher area under the curve (0.91 vs. 0.82, P = 0.01) than did Delta SUVmax (63% sensitivity, 92% specificity, and 77% accuracy). Subgroup analysis confirmed a significantly higher accuracy for Delta TLG than Delta SUV for ER-positive/HER-negative but not for triple-negative and HER2-positive tumors. Partial-volume correction had no impact on the predictive value of any of the PET image-derived parameters despite significant changes in their absolute values. Conclusion: Our results suggest that the reduction after 2 neoadjuvant chemotherapy cycles of the metabolically active volume of primary tumor measurements such as Delta TLG predicts histopathologic tumor response with higher accuracy than does Delta SUV measurements, especially for ER-positive/HER2-negative breast cancer. These results should be confirmed in a larger group of patients as they may potentially increase the clinical value and efficiency of F-18-FDG PET for early prediction of response to neoadjuvant chemotherapy.