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Association between partial-volume corrected SUVmax and Oncotype DX recurrence score in early-stage, ER-positive/HER2-negative invasive breast cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Oncotype DX, a 21-gene expression assay, provides a recurrence score (RS) which predicts prognosis and the benefit from adjuvant chemotherapy in patients with early-stage, estrogen receptor-positive (ER-positive), and human epidermal growth factor receptor 2-negative (HER2-negative) invasive breast cancer. However, Oncotype DX tests are expensive and not readily available in all institutions. The purpose of this study was to investigate whether metabolic parameters on 18F-FDG PET/CT are associated with the Oncotype DX RS and whether 18F-FDG PET/CT can be used to predict the Oncotype DX RS.

Methods

The study group comprised 38 women with stage I/II, ER-positive/HER2-negative invasive breast cancer who underwent pretreatment 18F-FDG PET/CT and Oncotype DX testing. On PET/CT, maximum (SUVmax) and average standardized uptake values, metabolic tumor volume, and total lesion glycolysis were measured. Partial volume-corrected SUVmax (PVC-SUVmax) determined using the recovery coefficient method was also evaluated. Oncotype DX RS (0 – 100) was categorized as low (<18), intermediate (18 – 30), or high (≥31). The associations between metabolic parameters and RS were analyzed. Multivariate logistic regression was used to identify significant independent predictors of low versus intermediate-to-high RS.

Results

Of the 38 patients, 22 (58 %) had a low RS, 13 (34 %) had an intermediate RS, and 3 (8 %) had a high RS. In the analysis with 38 index tumors, PVC-SUVmax was higher in tumors in patients with intermediate-to-high RS than in those with low RS (5.68 vs. 4.06; P = 0.067, marginally significant). High PVC-SUVmax (≥4.96) was significantly associated with intermediate-to-high RS (odds ratio, OR, 10.556; P = 0.004) in univariate analysis. In multivariate analysis with clinicopathologic factors, PVC-SUVmax ≥4.96 (OR 8.459; P = 0.013) was a significant independent predictor of intermediate-to-high RS.

Conclusions

High PVC-SUVmax on 18F-FDG PET/CT was significantly associated with an intermediate-to-high Oncotype DX RS. PVC metabolic parameters on 18F-FDG PET/CT can be used to predict the Oncotype DX RS in patients with early-stage, ER-positive/HER2-negative breast cancer.

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Acknowledgments

This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (no. 2015R1A2A1A05001860) and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health & Welfare, Republic of Korea (grant no. HI14C1072).

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    Authors and Affiliations

    1. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

      Su Hyun Lee, Jung Min Chang, Nariya Cho & Woo Kyung Moon

    2. Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

      Seunggyun Ha, Hyun Joon An, Jae Sung Lee & Gi Jeong Cheon

    3. Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine or College of Pharmacy, Seoul National University, Seoul, South Korea

      Seunggyun Ha

    4. Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea

      Hyun Joon An & Jae Sung Lee

    5. Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

      Wonshik Han

    6. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

      Seock-Ah Im

    7. Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

      Han Suk Ryu

    8. Department of Radiology, Kyungpook National University Hospital, Daegu, South Korea

      Won Hwa Kim

    9. Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea

      Woo Kyung Moon & Gi Jeong Cheon

    10. Radiation Medicine Research Institute, Seoul National University College of Medicine, Seoul, South Korea

      Woo Kyung Moon & Gi Jeong Cheon

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    Funding

    This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (no. 2012R1A2A1A01010846) and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant no. HI14C1072).

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    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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    This retrospective study was approved by institutional review board. The requirement for written informed consent was waived due to the retrospective design.

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    Su Hyun Lee and Seunggyun Ha contributed equally to this work.

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    Lee, S.H., Ha, S., An, H.J. et al. Association between partial-volume corrected SUVmax and Oncotype DX recurrence score in early-stage, ER-positive/HER2-negative invasive breast cancer. Eur J Nucl Med Mol Imaging 43, 1574–1584 (2016). https://doi.org/10.1007/s00259-016-3418-1

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