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Journal Club: Diagnostic value of (18)F-FDG PET/CT and MRI in predicting the clinicopathologic subtypes of invasive breast cancer.

AJR. American journal of roentgenology (2014-07-24)
Kanae Kawai Miyake, Yuji Nakamoto, Shotaro Kanao, Shiro Tanaka, Tomoharu Sugie, Yoshiki Mikami, Masakazu Toi, Kaori Togashi
ABSTRACT

The purpose of this study was to assess the diagnostic value of (18)F-FDG PET/CT and MRI in predicting the clinicopathologic subtypes of breast cancer. The cases of 89 patients with mass-type invasive breast cancer who underwent FDG PET/CT and MRI before therapy were retrospectively analyzed. Eight imaging variables-maximum standardized uptake value (SUVmax), apparent diffusion coefficient, size, shape, margin, intratumoral enhancement, dynamic kinetics, and high intratumoral signal intensity on T2-weighted images-were compared with results for the pathologic markers Ki-67 antibody, estrogen receptor (ER), progesterone receptor (PR), and ERBB2 (formerly HER2 or HER2/neu). The diagnostic performance of the imaging variables for sub-typing was evaluated, and the predictors of the subtypes were elucidated. Higher SUVmax was significantly associated with a high Ki-67 index (p < 0.0001), ER-negative status (p = 0.0001), and PR-negative status (p = 0.047). Significant correlation was also found between size and ER status (p = 0.002) and between shape and PR status (p = 0.044). The AUC exceeded 0.7 only in identification of the luminal A sub-type by application of cutoff values for SUVmax (AUC, 0.751). When smaller tumors were excluded, AUC increased (AUC, 0.803 for tumors > 16 mm). Multivariate analysis showed that SUVmax was the sole independent predictor of luminal A subtype (odds ratio per SD, 0.291; p < 0.0001). SUVmax was significantly lower for luminal A (4.4 ± 2.2) than non-luminal A (8.1 ± 4.4; p < 0.0001) tumors. A cutoff value of 5.4 yielded 79% sensitivity and 68% specificity for prediction that a tumor was the luminal A subtype. FDG PET/CT findings may contribute to differentiation of the luminal A and non-luminal A subtypes of invasive breast cancer.

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