Research ArticleClinical Studies

The Role of Interim 18F-FDG PET/CT in Predicting Early Response to Neoadjuvant Chemotherapy in Breast Cancer

KISOO PAHK, SEUNGHONG RHEE, JAEHYUK CHO, MINHEE SEO, SINAE LEE, TAEGYU PARK, SOYEON PARK, EUNSUB LEE, KYUNG HWA PARK, CHULHAN KIM, JAE SEON EO, SUNGEUN KIM and JAE GOL CHOE
Anticancer Research August 2014, 34 (8) 4447-4455;

Abstract

Aim: The aim of this study was to prove the diagnostic value of interim 18F-Fluorodeoxyglucose-positron-emission tomography combined with computed tomography (PET/CT) scan for predicting pathological complete response (pCR) compared to other factors in neoadjuvant chemotheraphy. Patients and Methods: Twenty-seven patients with breast cancer were included in this retrospective study. They all underwent scheduled neoadjuvant chemotherapy. Patients underwent PET/CT at baseline, mid-point (interim), and preoperatively (after completion of chemotherapy). The metabolic response was calculated as follows: ΔStandardized uptake value (SUV)(%)=(1st SUVmax–2nd SUVmax)/1st SUVmax×100. Results: The change in SUVmax between baseline and interim PET/CT scans was significantly larger than between interim and preoperative PET/CT scan. An optimal cut-off ΔSUV value of 78.3% was proposed for discriminating patients with pCR from those without pCR. Metabolic CR, defined as a change of SUVmax greater than the cut-off value, can predict pCR according to univariate analysis (p=0.012; Relative risk (RR)=25.3). Furthermore, metabolic CR was the most powerful factor for predicting pCR than other possible factors according to multivariate analysis (p=0.003). Conclusion: It is possible to use interim 18F-FDG PET-CT as an effective method to predict early response in patients with breast cancer treated with neoadjuvant chemotherapy.

Neoadjuvant chemotherapy has been regarded as an effective way to treat patients with locally advanced breast cancer to reduce tumor volume and enhance the opportunity for breast-conserving surgery (1, 2). Pathological complete response (pCR) to neoadjuvant chemotherapy has been proven to be a significant prognostic factor for disease-free and overall survival (3-5). That is to say, pCR following neoadjuvant chemotherapy improves the prognosis of patients with breast cancer. Previous studies have shown that 13%-26% of patients show pCR after completion of neoadjuvant chemotherapy (1, 6). The Nottingham histological grading system is the most widely used method to predict prognosis of those patients (7-9). Therefore, it is thought that early prediction of pathological response in neoadjuvant chemotherapy may provide an early opportunity to change the treatment plan in case of ineffectiveness. It is also possible to avoid unnecessary side-effects from ineffective chemotherapy, such as nausea, alopecia, hematological toxicity, cardiotoxicity, or neurotoxicity (10).

Positron-emission tomography combined with computed tomography (PET/CT) using 18F-fluorodeoxyglucose (FDG) is widely used in patients with malignant cancer. It can be used in detection of the malignant lesion, finding the metastatic lesion, staging the tumor, and monitoring the response to therapeutic approaches. In addition, 18F-FDG PET/CT has been playing a major role for the early prediction of response to neoadjuvant chemotherapy in many types of malignant cancers such as esophageal, rectal and lung cancer and some types of aggressive lymphomas (11-14).

View this table:
Table I.

Study population.

18F-FDG PET/CT is regarded as one of the essential imaging modalities for evaluation of breast cancer in patients (15, 16). Several studies have reported a correlation between early changes in 18F-FDG uptake after one or two cycles of neoadjuvant chemotherapy with the pathological response in patients with breast cancer (10, 17-18).

The aim of this study was i) to assess the feasibility of interim 18F-FDG PET/CT scan for early response evaluation, ii) to propose an optimal cut-off value of ΔSUV(%) for predicting pCR, and iii) to justify the effectiveness of an optimal cut-off value for predicting pCR compared to other possible factors.

Patients and Methods

Patients. Twenty-seven patients [mean (±SD) age=50±9 years] with newly diagnosed, non-inflammatory, large or locally advanced breast cancer, were included in this study, retrospectively (four patients with stage IIA, 21 patients with stage IIIA and two patients with IIIC). The study population and the characteristics of the 27 patients are shown in Tables I and II. Initial core needle biopsy was performed in all patients. One patient had invasive lobular carcinoma and the others had invasive ductal carcinoma subtype. They then underwent 4, 6 or 8 cycles of neoadjuvant chemotherapy. PET/CT scan was taken at baseline (before initiating neoadjuvant chemotherapy), and after the 2nd, 3rd or 4th cycle of chemotherapy (interim). Additionally, among the 27 patients, 19 patients also underwent preoperative PET/CT scan after completion of neoadjuvant chemotherapy. Breast surgery was performed for all patients and final pathological reports were also presented. This study was approved by the Hospital Institutional Review Board (AN 13022-002).

Neoadjuvant chemotherapy. Three different regimens were used for chemotherapy in this patient series. Twenty patients (74%) received six cycles of docetaxel/epirubicin (75/75 mg/m2 of body surface area). Six patients (22%) received an initial four cycles of doxorubicin/cyclophosphamide (60/600 mg/ m2 of body surface area) and followed by four cycles of docetaxel (75 mg/m2 of body surface area). One patient (4%) received four cycles of doxorubicin/cyclophsphamide (60/600 mg/m2 of body surface area). Chemotherapy was repeated every three weeks.

View this table:
Table II.

Overall characteristics of patients.

Response to chemotherapy. All specimens were confirmed by histopathological analysis after breast surgery. Pathological response was classified into two groups: pCR and non-pCR. pCR was defined as no invasive and no in situ residuals in breast and regional lymph nodes. Pathological grades were assessed as grade 1 to 3 according to the Nottingham histological grade (11-13). In addition, biological subgroups were defined as using hormonal receptor and Ki-67 status (luminal A type: Estrogen receptor positive (ER+)/Human epidermal growth factor receptor 2-negative (HER2−) and Ki-67 expression <20%; luminal B type: ER+HER2− and Ki-67 expression ≥20%, HER2 type: ER−PR− and HER2+; triple-negative type: ER−PR− and HER2−).

PET/CT imaging. Images were obtained with PET-CT scanner (Gemini TF, Philips Medical Systems, Cleveland, OH, USA). All patients fasted for at least six hours and serum glucose level was less than 180 mg/dl before scanning. Forty-five to sixty minutes after intravenous injection of 370 to 480 MBq (10 to13 mCi) 18F-FDG, CT scans were obtained followed by PET emission scans for one minute per bed. The PET unit had an axial field of view of 18 cm and a spatial resolution of 4.4 mm. A low-dose CT scan was obtained for attenuation correction and for localization, with a 16-slice multidetector helical CT unit, using the following parameters: 120 kVp; 50 mA; 0.75-s rotation time; 0.75-mm slice collimation; 4-mm scan reconstruction, with a reconstruction index of 4 mm; 60-cm field of view; and 512×512 matrix. PET data were reconstructed iteratively using a 3-dimensional row action maximum likelihood algorithmwith low-dose CT datasets for attenuation correction. Maximum intensity projection and cross sectional views and fusion images were generated and reviewed.

PET/CT image analysis. Two experienced nuclear physicians evaluated the PET/CT images. Malignant breast lesions were classified as positive if there was focally increased 18F-FDG uptake, compared with the uptake in surrounding normal soft-tissue. A region of interest (ROI) was targeted on each malignant breast lesion by manual adjustment. The maximum standardized uptake value (SUV) was calculated as follows:

SUV=Mean activity (ROI) (MBq/ml)/injected dose (MBq)/total body weight (g)

From these SUVs from targeted ROIs, the maximum standardized uptake values (SUVmax) were acquired for analysis. The metabolic response after the interim PET/CT was calculated as follows: ΔSUV(%)=(baseline SUVmax – interim SUVmax)/baseline SUVmax ×100 (%)

Statistical analysis. The Mann-Whitney U-test, receiver-operating characteristic (ROC), logistic regression analysis, and multivariate regression anlysis were used as statistical methods. A value of p<0.05 was defined as being statisticaIly significant. SPSS 17.0 (SPSS inc, Chicago, IL, USA) and Medcalc software (Medcalc Software, Mariakerke, Belgium) were used for data analysis.

Results

A total of 27 lesions were identified on baseline PET/CT scan in 27 patients. SUVmax of the lesion in baseline and interim PET/CT scan was 8.6±3.8 (mean±SD) and 2.7±1.9, respectively (p<0.001) (Figure 1). ΔSUV(%) was 66.9±14.9%.

Interim and preoperative PET/CT scans. In the 19 patients that underwent baseline, interim, and preoperative PET/CT scans, SUVmax of the lesion in baseline, interim, and preoperative PET/CT scan was 8.7±4.1, 2.6±2.0, and 1.9±1.2 respectively. The SUVmax of the baseline was significantly higher than interim and preoperative PET/CT scan (p<0.001). There was no significant statistical difference between the SUVmax of the interim and preoperative PET/CT scan (p=0.07) (Figure 2a). ΔSUV(%) between baseline and interim and between interim and preoperative PET/CT scan was 67.8±15.0% and 22.6±14.4%, respectively (p<0.001) (Figure 2b).

Figure 1.
Figure 1.

Comparison of glucose metabolism between baseline and interim group in a total of 27 patients.

pCR group vs. non-pCR group. Among the 27 patients, five were confirmed as having pCR, but 22 patients had residual invasive cancer (non-pCR). SUVmax of pCR and non-pCR groups in the baseline PET/CT scan were 8.9±5.1 and 8.6±3.5, respectively (p=0.74) (Figure 3a). SUVmax of pCR and non-pCR groups in the interim PET/CT scan were 1.6±0.3 and 3.0±2.0, respectively (p=0.03) (Figure 3b). ΔSUV(%) between baseline and interim PET/CT scan of pCR and non-pCR groups were 75.8±15.9% and 64.9±14.3%, respectively (p=0.04) (Figure 3c).

Determination of ΔSUV cut-off value to discriminate the pCR group from non-pCR group. ROC analyses were performed to determine the optimal cut-off value of ΔSUV(%) to differentiate pCR from non-pCR patients. The ROC curve is presented in Figure 4. A cut-off ΔSUV(%) of 78.3% was found to identify those patients with pCR. The area under the ROC curve (AUC) was 0.8 [standard error=0.1; 95% confidence interval (CI)=0.6-0.9]. The sensitivity and specificity were 80.0% and 90.9%, respectively

Metabolic CR and pCR. We defined metabolic CR (complete response) as a change of SUVmax greater than the cut-off value. Univariate analysis was performed on the pCR-related factors. As shown in Table III, metabolic CR significantly predicted the pCR through univariate analysis (p=0.012; relative risk (RR)=25.3; 95% CI=2.1-310.8). Furthermore, according to multivariate analysis, metabolic CR showed superior predictability of the pCR to other known parameters such as HER2 type and Ki-67 status (p=0.003 vs. p=0.171 and 0.131, respectively).

Possible variables and metabolic CR. Possible variables that may have an effect on the metabolic CR were assessed by univariate analysis through separate logistic regression analysis. The variables included age, clinical stage, tumor grade, receptor status of ER, PR, HER2, Ki-67 expression status, and biological subgroups mentioned above. According to the logistic regression analysis, luminal B type group had a significant possibility of presenting metabolic CR (p=0.049; RR=5.427; 95% CI=1.007-29.255) (Table IV). As shown in Table IV, those in the triple-negative type group might also have a possibility of presenting metabolic CR. The p-value was of marginal significance (p=0.061; RR=0.111; 95% CI=0.011-1.106).

Discussion

Systemic neoadjuvant chemotherapy is increasingly being used nowadays and has been proven useful in patients with locally advanced breast cancer (19, 20). The main purpose of the study was to evaluate early changes caused by neoadjuvant chemotherapy in malignant tumor FDG uptake that have highly predictive value for the pathological response in patients with breast cancer.

Therefore, firstly, we assessed the feasibility of interim PET/CT scan for early response evaluation. Secondly, we attempted to propose an optimal cut-off value for predicting pCR. Thirdly, we tried to justify the effectiveness of the optimal cut-off value for predicting pCR compared to other possible factors.

As shown in Figure 2, the change in the SUVmax was greater between baseline and interim PET/CT than between interim and preoperative PET/CT scan (p<0.001). There was no significant statistical difference between the SUVmax of the interim and preoperative PET/CT scan (p=0.07). From these observations, we could expect that the therapeutic effect of neoadjuvant chemotherapy was early with interim PET/CT and the metabolic change was maintained until preoperative PET/CT scans. Therefore, if the chemotherapy regimen was not effective, it is possible to give an early insight using interim PET/CT to enable the treatment plan to be modified and to avoid adverse side-effects. It is feasible to use interim PET/CT scan for early assessment of response to neoadjuvant chemotherapy.

Figure 2.
Figure 2.

a: Comparison of glucose metabolism between three positron-emission tomography combined with computed tomography (PET/CT) scans in 19 patients (baseline, interim, and preoperative PET/CT scan), b: Comparison of changes in glucose metabolism between three PET/CT scans in 19 patients. 1st Interval: between baseline and interim, 2nd interval: between interim and preoperative PET/CT scan.

This retrospective study demonstrated that patients with pCR can be distinguished by interim 18F-FDG PET/CT during the interim neoadjuvant chemotherapy. The pCR and non-pCR goups had similar mean SUVmax in baseline PET/CT scan. However, the pCR group presented significantly lower mean SUVmax than the non-pCR group on the interim PET/CT scan (p=0.03). Furthermore, the pCR group had a significantly larger change in SUVmax than did the non-pCR group (p=0.04). An optimal cut-off ΔSUV value of 78.3% was proposed for discriminating pCR patients (change of SUVmax greater than cut-off value) from non-pCR patients in ROC analysis.

Similar to our results, several studies have suggested a cut-off value of ΔSUV in neoadjuvant chemotherapy for discriminating pCR from non-pCR patients, acquiring values ranging from 40 to 88% (17, 18, 21-23). Thus, differentiation of the pCR from non-pCR group using interim PET/CT scan may be possible. However, the wide range of cut-off values limits application in clinical practice. Several factors can contribute to the wide range of cut-off values (24). Firstly, the timing of PET/CT evaluation is very variable. Many groups performed PET/CT after one or two cycles of neoadjuvant chemotherapy (21, 22). McDermott et al. took PET/CT at midpoint and end of neoadjuvant chemotherapy (23). Secondly, breast carcinomas consist of different subtypes depending on hormonal receptors, such as ER+ tumors, HER2 overexpression, and triple-negative tumors. Thus, heterogenous characteristics of tumor biology can cause differences in response to neoadjuvant chemotherapy.

Using a cut-off ΔSUV(%) of 78.3%, patients were classified according to metabolic CR (change of SUVmax greater than the cut-off value). According to univariate analysis, metabolic CR significantly predicted the pCR. As shown in Table III, in predicting pCR, relative risks of Ki-67 status and HER2 type were quite high but the p-values were not significant. These factors are well-known for predicting pCR on receiving neoadjuvant treatment (25-28). Considering these factors, the present study demonstrated that metabolic CR was a strong or predictor for pCR than other variables.

Regarding metabolic CR, as shown in Table IV, luminal B type was significantly associated with metabolic CR than in patients non-luminal B type. Luminal B type had been known to be more responsive to chemotherapy than luminal A type (28). Luminal B type was also regarded as more proliferative than luminal A type (29). Therefore, these factors might explain the association of metabolic CR and luminal B type.

Figure 3.
Figure 3.
Figure 3.

a: Comparison of glucose metabolism between pathologic complete response (pCR) and non-pCR groups in baseline positron-emission tomography combined with computed tomography (PET/CT) scan, b: Comparison of glucose metabolism between pCR and non-pCR groups in interim PET/CT scan. c: Comparison of changes in glucose metabolism (ΔSUV) between pCR and non-pCR groups.

Another impressive finding was the triple-negative type group might also have a greater possibility of achieving metabolic CR (p=0.061) than the non triple-negative type. Patients with triple-negative breast cancer are known to have better responsiveness to neoadjuvant chemotherapy than those with ER+ tumor (30). In other words, metabolic CR could be interpreted as a good response to neoadjuvant chemotherapy.

Although a limitation of this study is the small number of patients, it clearly identifies the feasibility of interim PET/CT scan for early response evaluation and presents an optimal cut-off ΔSUV value to predict pCR. Metabolic CR is proven to be a powerful predictor of pCR.

Figure 4.
Figure 4.

Receiver-operating characteristic (ROC) analysis to differentiate patients with pCR from those without pCR. Cut-off Δstandardized uptake value (SUV) (%): 78.3%, area under the curve: 0.8, Standard error=0.1, 95%, confidence interval=0.6-0.9, sensitivity=80.0%, specificity=90.9%.

View this table:
Table III.

Uni- and multivariate analysis of factors for pathological complete response (pCR)

View this table:
Table IV.

Univariate analysis of factors for metabolic complete response (CR).

Conclusion

In patients with breast cancer treated with neoadjuvant chemotherapy, the change in 18F-FDG uptake at midpoint (interim) of chemotherapy provides valuable information of therapeutic response in early time. An optimal cut-off ΔSUV value of 78.3% was proposed for discriminating patients with pCR from those non-pCR. Using this cut-off value, metabolic CR in interim PET-CT showed better predictability for pCR than other possible factors. It is possible to use interim 18F-FDG PET/CT as a valuable method for predicting early response of neoadjuvant chemotherapy. This may be helpful for establishing individual treatment strategies for patients with breast cancer.

Acknowledgements

This study was partly supported by Korea University Clinical Research Grants (2011-K1132941).

Footnotes

  • Conflicts of Interest

    The Authors have no conflicts of interests.

  • Received May 8, 2014.
  • Revision received June 16, 2014.
  • Accepted June 17, 2014.

References

  1. ↵
    1. Fisher B,
    2. Bryant J,
    3. Wolmark N,
    4. Mamounas E,
    5. Brown A,
    6. Fisher ER,
    7. Wickerham DL,
    8. Begovic M,
    9. DeCillis A,
    10. Robidoux A,
    11. Margolese RG,
    12. Cruz AB Jr..,
    13. Hoehn JL,
    14. Dimitrov NV,
    15. Bear HD
    : Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol 16(8): 2672-2685, 1998.
    OpenUrlAbstract
  2. ↵
    1. Honkoop AH,
    2. van Diest PJ,
    3. de Jong JS,
    4. Linn SC,
    5. Giaccone G,
    6. Hoekman K,
    7. Wagstaff J,
    8. Pinedo HM
    : Prognostic role of clinical, pathological and biological characteristics in patients with locally advanced breast cancer. Br J Cancer 77: 621-626, 1998.
    OpenUrlPubMed
  3. ↵
    1. Verril MW,
    2. Ashley SE,
    3. Walsh GA,
    4. Ellis P,
    5. Sacks N,
    6. Gui G
    : Pathological complete response (pCR) in patients treated with neoadjuvant chemotherapy for operable breast cancer. Breast Cancer Res Treat 50: 328-328, 1998 (abstract 549).
    OpenUrl
    1. Kuerer HM,
    2. Newman LA,
    3. Smith TL,
    4. Ames FC,
    5. Hunt KK,
    6. Dhingra K,
    7. Theriault RL,
    8. Singh G,
    9. Binkley SM,
    10. Sneigh N,
    11. Buchholz TA,
    12. Ross MI,
    13. McNeese MD,
    14. Buzdar AU,
    15. Hortobagyi GN,
    16. Singletary SE
    : Clinical course of breast cancer patients with complete pathological primary tumour and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy. J Clin Oncol 17: 460-469, 1999.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Rastogi P,
    2. Anderson SJ,
    3. Bear HD,
    4. Geyer CE,
    5. Kahlenberg MS,
    6. Robidoux A,
    7. Margolese RG,
    8. Hoehn JL,
    9. Vogel VG,
    10. Dakhil SR,
    11. Tamkus D,
    12. King KM,
    13. Pajon ER,
    14. Wright MJ,
    15. Robert J,
    16. Paik S,
    17. Mamounas EP,
    18. Wolmark N
    : Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol 26(5): 778-785, 2008.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Bear HD,
    2. Anderson S,
    3. Smith RE,
    4. Geyer CE Jr..,
    5. Mamounas EP,
    6. Fisher B,
    7. Brown AM,
    8. Robidoux A,
    9. Margolese R,
    10. Kahlenberg MS,
    11. Paik S,
    12. Soran A,
    13. Wickerham DL,
    14. Wolmark N
    : Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 24(13): 2019-2027, 2006.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Bloom HJ,
    2. Richardson WW
    : Histological grading and prognosis in breast cancer: a study of 1409 cases of which 359 have been followed for 15 years. Br J Cancer 11: 359-377, 1957.
    OpenUrlCrossRefPubMed
    1. Elston CW,
    2. Ellis IO
    : Pathological prognostic factors in breast cancer I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19: 403-410, 1991.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Rakha EA,
    2. El-Sayed ME,
    3. Lee AH,
    4. Elston CW,
    5. Grainge MJ,
    6. Hodi Z,
    7. Blamey RW,
    8. Ellis IO
    : Prognostic significance of Nottingham histologic grade in invasive breast carcinoma, J Clin Oncol 26: 3153-3158, 2008.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Schwarz JD,
    2. Bader M,
    3. Jenicke L,
    4. Hemminger G,
    5. Jänicke F,
    6. Avril N
    : Early prediction of response to chemotherapy in metastatic breast cancer using sequential 18F-FDG PET. J Nucl Med 46: 1144-1150, 2005.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Westerterp M,
    2. van Westreenen HL,
    3. Reitsma JB,
    4. Hoekstra OS,
    5. Stoker J,
    6. Fockens P,
    7. Jaqer PL,
    8. Van Eck-Smit BL,
    9. Plukker JT,
    10. van Lanschot JJ,
    11. Sloof GW
    : Esophageal cancer: CT, endoscopic US and FDG PET for assessment of response to neoadjuvant therapy-systematic review. Radiology 236: 841-851, 2005.
    OpenUrlPubMed
    1. Kalff V,
    2. Duong C,
    3. Drummond EG,
    4. Matthews JP,
    5. Hicks RJ
    : Findings of 18F-FDG PET scans after neoadjuvant chemoradiation provides prognostic stratification in patients with locally advanced rectal carcinoma subsequently treated by radical surgery. J Nucl Med 47: 14-22, 2006.
    OpenUrlAbstract/FREE Full Text
  13. ↵
    1. Yamamoto Y,
    2. Nishiyama Y,
    3. Monden T,
    4. Sasakawa Y,
    5. Ohkawa M,
    6. Gotoh M,
    7. Kameyama K,
    8. Haba R
    : Correlation of FDG PET findings with histopathology in the assessment of response to induction chemoradiotherapy in non-small cell lung cancer. Eur J Nucl Med Mol Imaging 33: 140-147, 2006.
    OpenUrlCrossRefPubMed
  14. ↵
    1. Gallamini A,
    2. Hutchings M,
    3. Rigacci L,
    4. Specht L,
    5. Merli F,
    6. Hansen M,
    7. Patti C,
    8. Loft A,
    9. Di Raimondo F,
    10. D'Amore F,
    11. Biqqi A,
    12. Vitolo U,
    13. Stelitano C,
    14. Sancetta R,
    15. Trentin L,
    16. Luminari S,
    17. Iannitto E,
    18. Viviani S,
    19. Pierri I,
    20. Levis A
    : Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron-emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin's lymphoma: a report from a joint Italian–Danish study. J Clin Oncol 25: 3746-3752, 2007.
    OpenUrlAbstract/FREE Full Text
  15. ↵
    1. Eubank WB,
    2. Mankoff DA
    : Evolving role of positron-emission tomography in breast cancer imaging. Semin Nucl Med 35(2): 84-99, 2005.
    OpenUrlCrossRefPubMed
  16. ↵
    1. Quon A,
    2. Gambhir SS
    : FDG-PET and beyond: molecular breast cancer imaging. J Clin Oncol 23(8): 1664-1673, 2005.
    OpenUrlFREE Full Text
  17. ↵
    1. Rousseau C,
    2. Devillers A,
    3. Sagan C,
    4. Ferrer L,
    5. Bridji B,
    6. Campion L,
    7. Ricaud M,
    8. Bourbouloux E,
    9. Doutriaux I,
    10. Clouet M,
    11. Berton-Riqaud D,
    12. Bouriel C,
    13. Delecroix V,
    14. Garin E,
    15. Rouquette S,
    16. Resche I,
    17. Kerbrat P,
    18. Chatal JF,
    19. Campone M
    : Monitoring of early response to neoadjuvant chemotherapy in stage II and III breast cancer by [18F]fluorodeoxyglucose positron emission tomography. J clin Oncol 24: 5366-5372, 2006.
    OpenUrlAbstract/FREE Full Text
  18. ↵
    1. Berriolo-Riedinger A,
    2. Touzery C,
    3. Riedinger JM,
    4. Toubeau M,
    5. Coudert B,
    6. Arnould L,
    7. Boichot C,
    8. Cochet A,
    9. Fumoleau P,
    10. Brunotte F
    : [18F]FDG-PET predicts complete pathological response of breast cancer to neoadjuvant chemotherapy. Eur J Nucl Med Mol Imaging 34: 1915-1924, 2007.
    OpenUrlCrossRefPubMed
  19. ↵
    1. Yamashiro H,
    2. Toi M
    : Update of evidence in chemotherapy for breast cancer. Int J Clin Oncol 13: 3-7, 2008.
    OpenUrlPubMed
  20. ↵
    1. Fisher B,
    2. Brown A,
    3. Mamounas E,
    4. Wieand S,
    5. Robidoux A,
    6. Marqolese RG,
    7. Cruz AB Jr..,
    8. Fisher ER,
    9. Wickerham DL,
    10. Wolmark N,
    11. DeCillis A,
    12. Hoehan JL,
    13. Lees AW,
    14. Dimitrov NV
    : Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: Findings from National Surgical Adjuvant Breast and bowel Project B-18. J Clin Oncol 15: 2483-2493, 1997.
    OpenUrlAbstract/FREE Full Text
  21. ↵
    1. Fisher B,
    2. Brown A,
    3. Mamounas E,
    4. Wieand S,
    5. Robidoux A,
    6. Marqolese RG,
    7. Cruz AB Jr..,
    8. Fisher ER,
    9. Wickerham DL,
    10. DeCillis A,
    11. Hoehan JL,
    12. Lees AW,
    13. Dimitrov NV
    : Positron-emission tomography using [(18)F] Fluorodeoxyglucose for monitoring primary chemotherapy in breast cancer. J Clin Oncol 18(8): 1689-1695, 2000.
    OpenUrlAbstract/FREE Full Text
  22. ↵
    1. Duch J,
    2. Fuster D,
    3. Munoz M,
    4. Fernandez PL,
    5. Paredes P,
    6. Fontanillas M,
    7. Guzman F,
    8. Rubi S,
    9. Lomena FJ,
    10. Pons F
    : 18F-FDG PET/CT for early prediction of response to neoadjuvant chemotherapy in breast cancer. Eur J Nucl Med Mol Imaging 36(10): 1551-1557, 2009.
    OpenUrlCrossRefPubMed
  23. ↵
    1. McDermott GM,
    2. Welch A,
    3. Staff RT,
    4. Gilbert FJ,
    5. Schweiger L,
    6. Semple SI,
    7. Smith TA,
    8. Hutcheon AW,
    9. Miller ID,
    10. Smith IC,
    11. Heys SD
    : Monitoring primary breast cancer throughout chemotherapy using FDG-PET. Breast Cancer Res Treat 102(1): 75-84, 2007.
    OpenUrlCrossRefPubMed
  24. ↵
    1. Groheux D,
    2. Giacchetti S,
    3. Espie M,
    4. Rubello D,
    5. Moretti JL,
    6. Hindle E
    : Early monitoring of response to neoadjuvant chemotherapy in breast cancer with 18F-FDG PET/CT: defining a clinical aim. Eur J Nucl Med Mol Imaging 38(3): 419-425, 2011.
    OpenUrlCrossRefPubMed
  25. ↵
    1. Yerushalmi R,
    2. Woods R,
    3. Ravdin PM,
    4. Hayes MM,
    5. Gelmon KA
    : Ki-67 in breast cancer: prognostic and predictive potential. Lancet Oncol 11: 174-183, 2010.
    OpenUrlCrossRefPubMed
    1. Fasching PA,
    2. Heusinger K,
    3. Haeberle L,
    4. Niklos M,
    5. Hein A,
    6. Bayer CM,
    7. Rauh C,
    8. Schulz-Wendtland R,
    9. Bani MR,
    10. Schrauder M,
    11. Kahmann L,
    12. Lux MP,
    13. Strehl JD,
    14. Hartmann A,
    15. Dimmler A,
    16. Beckmann MW,
    17. Wachter DL
    : Ki-67, chemotherapy response, and prognosis in breast cancer patients receiving neoadjuvant treatment. BMC cancer 11: 486-486, 2011.
    OpenUrlCrossRefPubMed
    1. Yoshioka T,
    2. Hosoda M,
    3. Yamamoto M,
    4. Taguchi T,
    5. Hatanaka KC,
    6. Takakuwa E,
    7. Hatanaka Y,
    8. Matsuno Y,
    9. Yamashita H
    : Prognostic significance of pathologic complete response and Ki-67 expression after neoadjuvant chemotherapy in breast cancer. Breast cancer May 5, 2013 (online).
  28. ↵
    1. Esserman LJ,
    2. Berry DA,
    3. DeMichele A,
    4. Carey L,
    5. Davis SE,
    6. Buxton M,
    7. Hudis C,
    8. Gray JW,
    9. Perou C,
    10. Yau C,
    11. Livasy C,
    12. Krontiras H,
    13. Montgomery L,
    14. Tripathy D,
    15. Lehman C,
    16. Liu MC,
    17. Olopade OI,
    18. Rugo HS,
    19. Carpenter JT,
    20. Dressler L,
    21. Chhieng D,
    22. Singh B,
    23. Mies C,
    24. Rabban J,
    25. Chen YY,
    26. Giri D,
    27. van‘t Veer L,
    28. Hylton N
    : Pathologic complete response predicts recurrence-free survival more effectively by cancer subject: results from the I-SPY 1 TRIAL-CALGB 150007/150012, ACRIN6657. J Clin Oncol 30: 3242-3249, 2012.
    OpenUrlAbstract/FREE Full Text
  29. ↵
    1. Wirapati P,
    2. Sortiriou C,
    3. Kunkel S,
    4. Farmer P,
    5. Pradervand S,
    6. Haibe-Kains B,
    7. Desmedt C,
    8. Iqnatiadis M,
    9. Sengstag T,
    10. Schütz F,
    11. Goldstein DR,
    12. Piccart M,
    13. Delorenzi M
    : Meta-analysis of gene expression profiles in breast cancer: toward a unified understanding of breast cancer subtyping and prognosis signatures. Breast Cancer Res 10(4): R65, 2008.
    OpenUrlCrossRefPubMed
  30. ↵
    1. Carey LA,
    2. Dees EC,
    3. Sawyer L,
    4. Gatti L,
    5. Moore DT,
    6. Collichio F,
    7. Ollila DW,
    8. Sartor CI,
    9. Graham ML,
    10. Perou CM
    : The triple-negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res 13: 2329-2334, 2007.
    OpenUrlAbstract/FREE Full Text
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Reprints and Permissions
The Role of Interim 18F-FDG PET/CT in Predicting Early Response to Neoadjuvant Chemotherapy in Breast Cancer
KISOO PAHK, SEUNGHONG RHEE, JAEHYUK CHO, MINHEE SEO, SINAE LEE, TAEGYU PARK, SOYEON PARK, EUNSUB LEE, KYUNG HWA PARK, CHULHAN KIM, JAE SEON EO, SUNGEUN KIM, JAE GOL CHOE
Anticancer Research Aug 2014, 34 (8) 4447-4455;
Twitter logo Facebook logo Mendeley logo

Jump to section

Keywords