Preoperative 18F-FDG PET/CT predicts disease-free survival in patients with primary invasive ductal breast cancer

Abstract

Background

Previous studies have correlated the maximum standardized uptake value (SUV_max) of breast cancer lesions with histological and biological characteristics such as tumor size, histologic grade, or hormonal receptor expression status. However, controversy remains concerning the prognostic value of SUV_max in breast cancer.

Purpose

To determine if the SUV_max of a tumor on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is associated with disease-free survival in patients with primary invasive ductal breast cancer.

Material and Methods

The institutional review board of our hospital approved this retrospective study. From 2009 to 2011, 508 women (mean age, 53.6 years; age range, 26–85 years) with newly diagnosed invasive ductal breast cancer who had undergone preoperative 18F-FDG PET/CT followed by surgery were identified. Clinicopathological variables and FDG uptake quantified by SUV_max were analyzed. The Cox proportional hazards model was used to evaluate the association between SUV_max and disease-free survival after controlling for clinicopathological parameters.

Results

There were 21 recurrences at a median follow-up of 46 months. The mean SUV_max of the primary tumor was significantly higher in patients with a recurrence than those who remained disease-free (9.5 ± 3.5 vs. 6.6 ± 4.2, P < 0.001). A receiver operating characteristic curve indicated that a SUV_max of 5.95 was the optimal cut-off value to predict disease-free survival. Multivariate analysis identified a high SUV_max (≥5.95) and high T stage as independent significant variables associated with worse disease-free survival.

Conclusion

A high primary tumor SUV_max on 18F-FDG PET/CT was an independent factor associated with worse disease-free survival in patients with primary invasive ductal breast cancer.