Utility of 18F-FDG PET/CT in pre-surgical risk stratification of patients with breast cancer

Objective: To determine the correlation between fluorine-18-fluorodeoxyglucose (F-18-FDG)uptake values and clinicopathological prognostic markers using preoperative F-18-FDG positron emission tomography/computed tomography (PET/CT) in primary breast cancer (BC). Subjects and Methods: One hunrded and twelve patients with primary BC were studied prospectively. Pretreatment F-18-FDG PET/CT was performed. Maximum standardized uptake values (SUVmax) were compared with various clinicopathological variables. Results: In a univariate analysis, SUVmax correlated well with the following prognostic variables: T stage, absence of progesterone receptor (PR), absence of estrogen receptor (ER), triple negative lesions (ER/PR and Her 2 negative) and high histologic grade. Metastatic lesions and ductal lesions had higher SUVmax than lobular carcinoma. No significant correlation was found between SUVmax, and human epidermal growth factor receptor 2 (Her-2) status or perineural and lymphovascular invasion. Multivariate analyses showed that breast density, tumor size and PR negativity were significantly correlated with SUVmax (P=0.046 and 0.009, respectively). Conclusion:The pre-treatment tumor SUVmax could be utilized as an independent imaging biomarker of the tumor aggressiveness and poor prognosis. Risk stratification based on this index could play a pivotal role in alteration of treatment planning, such as neoadjuvant chemotherapy (precision oncology).