Champion Laurence, Lerebours Florence, Alberini Jean-Louis, Fourme Emmanuelle, Gontier Eric, Bertrand Françoise, Wartski Myriam
Service de Médecine Nucléaire, Institut Curie, Saint-Cloud, France
Service d'Oncologie Médicale, Institut Curie, Saint-Cloud, France.
J Nucl Med. 2015 Sep;56(9):1315-21. doi: 10.2967/jnumed.115.158287. Epub 2015 Jul 9.
The aim of this prospective study was to assess the predictive value of (18)F-FDG PET/CT imaging for pathologic response to neoadjuvant chemotherapy (NACT) and outcome in inflammatory breast cancer (IBC) patients.
Twenty-three consecutive patients (51 y ± 12.7) with newly diagnosed IBC, assessed by PET/CT at baseline (PET1), after the third course of NACT (PET2), and before surgery (PET3), were included. The patients were divided into 2 groups according to pathologic response as assessed by the Sataloff classification: pathologic complete response for complete responders (stage TA and NA or NB) and non-pathologic complete response for noncomplete responders (not stage A for tumor or not stage NA or NB for lymph nodes). In addition to maximum standardized uptake value (SUVmax) measurements, a global breast metabolic tumor volume (MTV) was delineated using a semiautomatic segmentation method. Changes in SUVmax and MTV between PET1 and PET2 (ΔSUV1-2; ΔMTV1-2) and PET1 and PET3 (ΔSUV1-3; ΔMTV1-3) were measured.
Mean SUVmax on PET1, PET2, and PET3 did not statistically differ between the 2 pathologic response groups. On receiver-operating-characteristic analysis, a 72% cutoff for ΔSUV1-3 provided the best performance to predict residual disease, with sensitivity, specificity, and accuracy of 61%, 80%, and 65%, respectively. On univariate analysis, the 72% cutoff for ΔSUV1-3 was the best predictor of distant metastasis-free survival (P = 0.05). On multivariate analysis, the 72% cutoff for ΔSUV1-3 was an independent predictor of distant metastasis-free survival (P = 0.01).
Our results emphasize the good predictive value of change in SUVmax between baseline and before surgery to assess pathologic response and survival in IBC patients undergoing NACT.
本前瞻性研究的目的是评估(18)F-FDG PET/CT成像对新辅助化疗（NACT）病理反应的预测价值以及炎性乳腺癌（IBC）患者的预后。
纳入23例连续的新诊断IBC患者（51岁±12.7岁），在基线时（PET1）、NACT第三疗程后（PET2）以及手术前（PET3）进行PET/CT评估。根据Sataloff分类法评估的病理反应将患者分为2组：完全缓解者的病理完全缓解（TA期和NA期或NB期）和未完全缓解者的非病理完全缓解（肿瘤非A期或淋巴结非NA期或NB期）。除了测量最大标准化摄取值（SUVmax）外，还使用半自动分割方法勾勒出全乳代谢肿瘤体积（MTV）。测量PET1与PET2之间（ΔSUV1-2；ΔMTV1-2）以及PET1与PET3之间（ΔSUV1-3；ΔMTV1-3）SUVmax和MTV的变化。
两个病理反应组在PET1、PET2和PET3上的平均SUVmax在统计学上无差异。在受试者工作特征分析中，ΔSUV1-3的72%截断值对预测残留疾病的性能最佳，敏感性、特异性和准确性分别为61%、80%和65%。单因素分析中，ΔSUV1-3的72%截断值是无远处转移生存期的最佳预测指标（P = 0.05）。多因素分析中，ΔSUV1-3的72%截断值是无远处转移生存期的独立预测指标（P = 0.01）。
我们的结果强调了基线与手术前SUVmax变化对评估接受NACT的IBC患者病理反应和生存的良好预测价值。
