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Annals of Oncology Advance Access published online on June 13, 2008
Annals of Oncology, doi:10.1093/annonc/mdn185
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Preoperative [18F] FDG–PET after chemotherapy in locally advanced breast cancer: prognostic value as compared with histopathology

J. Emmering1, N. C. Krak1, J. J. M. Van der Hoeven2, M. D. Spreeuwenberg3, J. W. R. Twisk3, S. Meijer4, H. M. Pinedo5 and O. S. Hoekstra1,*

1 Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam
2 Department of Medical Oncology, Amstelland Hospital, Amstelveen
3 Department of Epidemiology and Biostatistics, Amsterdam
4 Department of Surgical Oncology, Amsterdam
5 Departmentof Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands

* Correspondence to: Dr O. S. Hoekstra, Department of Nuclear Medicine and PET Research, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands. Tel: +31-20-4442886; Fax: +31-20-4444329; E-mail: os.hoekstra{at}vumc.nl

Background: Established prognosis-based criteria determine the need for further treatment after primary surgery for breast cancer. Such criteria are lacking after neo-adjuvant chemotherapy. We determine the prognostic value of preoperative [18F]-2-fluoro-2-deoxy-D-glucose–positron emission tomography (18FDG–PET) after chemotherapy in locally advanced breast cancer (LABC), both as independent indicator and as add-on to postoperative histopathology.

Patients and methods: Preoperative PET was carried out in 40 LABC patients. Two expert readers assessed residual 18FDG uptake in the primary tumor. At histopathological examination of the surgical specimen, chemotherapy response was graded using the Honkoop criteria. Cox proportional hazards analysis was used to determine prognostic relevance of PET and histopathology.

Results: Median follow-up was 60 months (range 15–94), during which 13 patients had recurrent disease, eight of whom died. 18FDG uptake in the primary tumor was inversely related with disease-free survival (DFS) [hazard ratio (HR) 4.09; 95% confidence interval (CI) 1.26–13.31; P = 0.02] and this was superior to histopathology (HR 2.52; 95% CI 0.77–8.23; P = 0.13). Observer agreement of PET was excellent (intraclass correlation coefficient 0.88). Multivariate Cox regression revealed no added value of histopathology versus PET results.

Conclusion: 18FDG uptake in the primary tumor at PET was inversely associated with DFS and may help to guide adjuvant therapy.

breast cancer, neo-adjuvant chemotherapy, PET, prognostic value

Received for publication March 14, 2007. Revision received March 30, 2008. Accepted for publication March 31, 2008.


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