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Comparison of the volumetric and radiomics findings of 18F-FDG PET/CT images with immunohistochemical prognostic factors in local/locally advanced breast cancer

Acar, Eminea,c; Turgut, Bülenta; Yiğit, Seyranb; Kaya, GamzeÇapad

Nuclear Medicine Communications: July 2019 - Volume 40 - Issue 7 - p 764–772
doi: 10.1097/MNM.0000000000001019

Objective The aim of this study was to determine the change in volumetric and radiomics parameters of fluorine-18 fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) imaging in local/locally advanced cancer patients according to immunohistochemical findings.

Patients and methods A total of 72 patients who were diagnosed with local/locally advanced breast cancer and then examined by 18F-FDG PET/CT for staging were included in this study. Immunohistochemical prognostic factors [estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (Her-2), p53 mutation, Ki-67 proliferation index] and histological grades were determined. Standardized uptake value (SUV)-based, volume-based, and radiomics findings were obtained from 18F-FDG PET/CT images.

Results In cases of ER and PR negativity, Her-2 positivity, presence of the p53 mutation, and Ki-67 index of at least 20% patients, total volumetric parameters were significantly higher in paired comparisons. The results of the ER-negative group were significantly higher than those of ER-positive patients in GLRLM_GLNU, GLRLM_RLNU, GLZLM_GLNU, and GLZLM_ZLNU comparisons. In grade 3 patients, mean SUV, maximum SUV, and GLRLM_LRHGE values were higher than those of grade 2 patients. SUV and volumetric parameters were significantly higher in patients with Ki-67 index of at least 20% than those with less than 20%. Maximum SUV, breast tumor lesion glycolysis values, and entropy in nuclear polymorphism in the 3+ patient group were found to be higher compared with the 2+ patient group. Moreover, patients with mitosis 3+ had significantly higher breast metabolic tumor volume, breast tumor lesion glycolysis, and kurtosis values than the 1+ group.

Conclusion ER negativity, triple negativity, high tumor grade, and high nuclear polymorphism were associated with tumor heterogeneity. With respect to ER negativity, PR negativity, high tumor grade, high mitosis number, high Ki-67 index, Her-2 positivity, and the presence of p53 mutation, an increased tumor load were observed. In addition to immunohistochemical parameters, the use of radiomics data is believed to contribute to breast cancer management.

Departments of aNuclear Medicine

bPathology, Ataturk Training and Research Hospital, İzmir Kâtip Celebi University

cDepartment of Translational Oncology, Institute of Oncology

dDepartment of Nuclear Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey

Correspondence to Emine Acar, MD, Department of Nuclear Medicine, Ataturk Training and Research Hospital, İzmir Kâtip Celebi University, Karabağlar, Izmir 35100, Turkey Tel: +90 535 463 8081; fax: +90 232 412 4251; e-mail:

Received February 11, 2019

Accepted March 18, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.