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Correlation of 18F-FDG PET/CT with pathological features and survival in primary breast cancer

Has Şimşek, Duygua; Şanli, Yaseminb; Külle, Cemil B.c; Karanlik, Hasane; Kiliç, Berkaye; Kuyumcu, Serkanb; Önder, Semend; Özmen, Vahitc

Nuclear Medicine Communications: August 2017 - Volume 38 - Issue 8 - p 694–700
doi: 10.1097/MNM.0000000000000694

Objective The aim of this study was to determine the correlation between the primary tumor (PT) maximum standardized uptake value (SUVmax) and breast cancer prognostic factors, overall survival, and relapse-free survival on the basis of histopathological and molecular characteristics.

Patients and methods In this retrospective study, 436 female patients with breast cancer were evaluated following a pretreatment 18F-FDG PET/CT scan. The PT SUVmax and histopathological/molecular characteristics were determined from primary tumor tissues and analyzed using the Mann–Whitney U and Kruskal–Wallis tests.

Results The median SUVmax of 436 PT was 10.1 (1.7–72). The PT SUVmax values were higher in ER− versus ER+ (P=0.001), PR− versus PR+ (P=0.001), Her2+ versus Her2− (P=0.01), Ki-67% of at least 20 versus Ki-67% of less than 20 (P<0.001), histological grade 3 versus grade 1–2 (P<0.001), nuclear pleomorphism score 3 versus score 1–2 (P<0.001), and mitotic score 3 versus score 1–2 patients (P<0.001). The lowest SUVmax levels were observed in the LumA group and the highest SUVmax levels were observed in the Her2 group (P<0.001). LumA patients with PR values greater than 20% had lower PT SUVmax values than the patients with PR values of 20% or less (P=0.023). The PT SUVmax was higher in patients with recurrence (P=0.03) and died related to disease (P<0.001) independent of time.

Conclusion The PT SUVmax showed a significant correlation with most of the prognostic factors and histopathological subtypes as a noninvasive tool. It is also usable in the prediction of tumor-related deaths or relapse independent of time. Our results could guide future studies to provide new histopathologic subtype definitions on the basis of new PR criteria.

aDepartment of Nuclear Medicine, Ankara Atatürk Training and Research Hospital, Ankara

bDepartment of Nuclear Medicine

cDepartment of Surgery

dDepartment of Pathology, Istanbul Faculty of Medicine

eDepartment of Surgery, Institute of Oncology, Istanbul University, Turkey

Correspondence to Duygu Has Şimşek, MD, Bilkent Street, Çankaya/Ankara 06100, Turkey Tel: +90 505 277 9407; fax: +90 312 291 2525; e-mail:

Received February 17, 2017

Received in revised form April 9, 2017

Accepted May 4, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.