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Background: Invasive lobular carcinoma accounts for 10 to 15% of all breast cancers. The first objective of this retrospective study was to assess the diagnostic performance of FDG-PET/CT scanning in women previously treated for invasive lobular carcinoma with suspected first recurrence. The secondary objectives were to evaluate the impact of PET/CT in a change in treatment and its prognostic value on specific survival. Methods: Patients in whom a PET/CT scan was performed from January 2011 to July 2019 in our Cancer Research Center were enrolled. Recurrence was suspected based on clinical symptoms, abnormal findings on conventional imaging, and/or elevated tumor markers. The diagnosis of recurrence was established by the oncologist after integration of all clinical, biological, histological, imaging, and follow-up data. Prognostic factors of recurrence as predicted by PET were determined using univariate logistic regression. KI67, mitotic index, or grade of mitosis were tested. Survival curves were compared using the log-rank test. Sixty-four patients (mean age: 60.3; SD = 12.4 years) were enrolled. The average time from initial diagnosis of the primary tumor to suspicion of recurrence was 5.2 ± 4.1 years. Forty-eight patients (75%) were judged to have recurrence by the oncologist: 7 local and 41 metastatic, with mainly bone (n = 24), lymph node (n = 14) and liver (n = 10) metastases. Results: Sensitivity, specificity, and positive and negative predictive values of PET/CT to predict recurrence were, respectively: 87%, 87%, 95%, and 70%. SUVmax at recurrence sites was generally high (mean: 6.4; SD = 2.9). False negative PET/CT results occurred with local (n = 2), peritoneal (n = 2), meningeal (n = 1), or bladder (n = 1) recurrences. In 40 patients with available histopathological data from suspected sites of recurrence, 30 PET/CT were true positive. In four patients, primary lung (n = 1) or gastric (n = 1) tumors or lymphomas (n = 2) were found. The detection of a recurrence resulted in a change in treatment in 44/48 patients (92%). No association between recurrence predicted by PET and biological biomarkers was found. Median specific survival appears shorter in patients with metastatic recurrence versus patients with local or no recurrence on PET/CT (p = 0.067). Conclusions: FDG-PET/CT is an effective and reliable tool for the detection of invasive lobular carcinoma recurrence, although certain recurrence sites specific to this histological type can impair its diagnostic performance. [ABSTRACT FROM AUTHOR]

Assessment of tumour blood flow (BF) heterogeneity using first-pass FDG PET/CT and textural feature (TF) analysis is an innovative concept. We aim to explore the relationship between BF heterogeneity measured with different TFs calculation methods and the response to neoadjuvant chemotherapy (NAC) in patients with newly diagnosed breast cancer (BC). One hundred and twenty-five patients were enrolled. Dynamic first-pass and delayed FDG PET/CT scans were performed before NAC. Nine TFs were calculated from perfusion and metabolic PET images using relative (RR) or absolute (AR) rescaling strategies with two textural matrix calculation methods. Patients were classified according to presence or absence of a pathologic complete response (pCR) after NAC. The relationship between BF texture features and conventional features were analysed using spearman correlations. The TFs' differences between pCR and non-pCR groups were evaluated using Mann–Whitney tests and descriptive factorial discriminant analysis (FDA). Relation between tumour BF-based TFs and global BF parameters were globally similar to those observed for tumour metabolism. None of the TFs was significantly different between pCR and non-pCR groups in the Mann–Whitney analysis, after Benjamini–Hochberg correction. Using a RR led to better discriminations between responders and non-responders in the FDA analysis. The best results were obtained by combining all the PET features, including BF ones. A better differentiation of patients reaching a pCR was observed using a RR. Moreover, BF heterogeneity might bring a useful information when combined with metabolic PET parameters to predict the pCR after neoadjuvant chemotherapy. • BF-based texture feature values are impacted by the feature computation methodology. • A relative rescaling led to better differentiation between pCR and non-pCR. • No global BF or metabolic parameter was significantly different between patients. • BF and metabolic parameters combined led to the best patient differentiation. [ABSTRACT FROM AUTHOR]

Aim: Evaluate response and predict prognosis of patients with newly diagnosed metastatic breast cancer treated with first line systemic therapy using European Organization for Research and Treatment of Cancer (EORTC) criteria and PET Response Criteria in solid Tumours (PERCIST). Methods: From December 2006 to August 2013, 57 women with newly diagnosed metastatic breast cancer were retrospectively evaluated. FDG-PET/CT was performed within one month before treatment and repeated after at least 3 cycles of treatment. Metabolic response evaluation was evaluated by two readers according to both EORTC criteria and PERCIST, classifying the patients into 4 response groups: complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease (PMD). Results: With EORTC criteria, 22 patients had CMR, 17 PMR, 6 SMD and 12 PMD. With PERCIST, 20 patients had CMR, 15 PMR, 10 SMD and 12 PMD. There was agreement between EORTC and PERCIST in 84% of the patients. By log-rank analysis, metabolic response evaluated with both EORTC criteria and PERCIST was able to predict overall survival (p = 0.028 and 0.002 respectively). CMR patient group had longer median OS than patients in the combined PMR+SMD+PMD group (60 vs 26 months both with EORTC and PERCIST; p = 0.009 and 0.006 respectively). By multivariate analysis, CMR either with EORTC or PERCIST remained an independent predictor of survival. Conclusion: Metabolic response evaluation with EORTC criteria and PERCIST gave similar prognostic stratification for metastatic breast cancer treated with a first line of systemic therapy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the value of F-fluorodeoxyglucose positron emission tomography (F-FDG PET/CT) to predict a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Material and methods: Fifty-seven consecutive women with HER2-positive breast cancer, treated with trastuzumab plus taxane-based NAC, were prospectively included. Maximum Standardized Uptake Value of the primary tumor and axillary nodes were measured at baseline (PET.SUV) and after the first course of NAC (PET.SUV). Tumor metabolic volumes were assessed to determine Total Lesion Glycolysis (TLG). The tumor metabolic response (ΔSUV and ΔTLG) was calculated. Results: In univariate analysis, negative hormonal receptor status ( p = 0.04), high tumor grade ( p = 0.03), and low tumor PET.SUV ( p = 0.001) were predictive of pCR. Tumor ΔSUV correlated with pCR ( p = 0.03), provided that tumors with low metabolic activity at baseline were excluded. ΔTLG did not correlate with pCR. In multivariate analysis, tumor PET.SUV < 2.1 was the best independent predictive factor (Odds ratio =14.3; p = 0.004) with both negative and positive predictive values of 76 %. Although the metabolic features of the primary tumor did not depend on hormonal receptor status, both the baseline metabolism and early response of axillary nodes were higher if estrogen receptors were not expressed ( p = 0.01 and p = 0.03, respectively). Conclusion: In HER2-positive breast cancer, very low tumor residual metabolism after the first cycle of NAC (SUV < 2.1) was the main predictor of pCR. These results should be further explored in multicenter studies and incorporated into the design of clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to assess the impact on management and the prognostic value of F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for initial staging of newly diagnosed large breast cancer (BC) when compared with conventional staging. Methods: We prospectively included 142 patients with newly diagnosed BC and at least grade T2 tumour. All patients were evaluated with complete conventional imaging (CI) procedures (mammogram and/or breast ultrasound, bone scan, abdominal ultrasound and/or CT, X-rays and/or CT of the chest), followed by FDG PET/CT exploration, prior to treatment. The treatment plan based on CI staging was compared with that based on PET/CT findings. CI and PET/CT findings were confirmed by imaging and clinical follow-up and/or pathology when assessable. Progression-free survival (PFS) was analysed using the Cox proportional hazards regression model. Results: According to CI staging, 79 patients (56 %) were stage II, 46 (32 %) stage III and 17 (12 %) stage IV (distant metastases). Of the patients, 30 (21 %) were upstaged by PET/CT, including 12 (8 %) from stage II or III to stage IV. On the other hand, 23 patients (16 %) were downstaged by PET/CT, including 4 (3 %) from stage IV to stage II or III. PET/CT had a high or medium impact on management planning for 18 patients (13 %). Median follow-up was 30 months (range 9-59 months); 37 patients (26 %) experienced recurrence or progression of disease during follow-up and 17 patients (12 %) died. The Cox model indicated that CI staging was significantly associated with PFS ( p = 0.01), but PET/CT staging provided stronger prognostic stratification ( p < 0.0001). Moreover, Cox regression multivariate analysis showed that only PET/CT staging remained associated with PFS ( p < 0.0001). Conclusion: FDG PET/CT provides staging information that more accurately stratifies prognostic risk in newly diagnosed large BC when compared with conventional explorations alone. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to evaluate, in the luminal human epidermal growth factor receptor 2 (HER2)-negative breast cancer subtype, the prognostic value of tumour glucose metabolism at baseline and of its early changes during neoadjuvant chemotherapy (NAC). Methods: This prospective study included 61 women with hormone-sensitive HER2-negative breast cancer treated with NAC. F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) was performed at baseline. Hepatic activity was used as a reference to distinguish between low metabolic and hypermetabolic tumours. In hypermetabolic tumours, a PET exam was repeated after the first course of NAC. The relative change in the maximum standardized uptake value of the tumour (∆SUV) was calculated. Results: Nineteen women had low metabolic luminal breast cancers at baseline, correlated with low proliferation indexes. Forty-two women had hypermetabolic tumours, corresponding to more proliferative breast cancers with higher Ki-67 expression ( p = 0.017) and higher grade ( p = 0.04). The median follow-up period was 64.2 months (range 11.5-93.2). Thirteen women developed recurrent disease, nine of whom died. Worse overall survival was associated with larger tumour size [>5 cm, hazard ratio (HR) = 6.52, p = 0.009] and with hypermetabolic tumours achieving a low metabolic response after one cycle of NAC (ΔSUV < 16 %, HR = 10.63, p = 0.004). Five-year overall survival in these poor responder patients was 49.2 %. Overall survival in women with low metabolic tumours or hypermetabolic/good response tumours was 100 and 96.15 %, respectively. Conclusion: In luminal HER2-negative breast tumours, tumour metabolism at baseline and changes after the first course of NAC are early surrogate markers of patients' survival. A subgroup of women with hypermetabolic/poorly responding tumours, correlated with poor prognosis at 5 years, can be identified early. These results may guide future studies by tailoring the NAC regimen to the metabolic response. [ABSTRACT FROM AUTHOR]

To evaluate, in breast cancer patients treated by neoadjuvant chemotherapy, the predictive value of reduction in FDG uptake with regard to complete pathological response (pCR). Forty-seven women with non-metastatic, non-inflammatory, large or locally advanced breast cancer were included. Tumour uptake of FDG was evaluated before and after the first course of neoadjuvant chemotherapy. Four indices were used: maximal and average SUV without or with correction by body surface area and glycaemia (SUVmax, SUVavg, SUVmax-BSA-G and SUVavg-BSA-G, respectively). The predictive value of reduction in FDG uptake with respect to pCR was studied by logistic regression analysis. Relationships between baseline [18F]FDG uptake and prognostic parameters were assessed. The relative decrease in FDG uptake (ΔSUV) after the first course of neoadjuvant chemotherapy was significantly greater in the pCR group than in the non-pCR group ( p < 0.000066). The four FDG uptake indices were all strongly correlated with each other. A decrease in SUVmax-BSA-G of 85.4% ± 21.9% was found in pCR patients, versus 22.6% ± 36.6% in non-pCR patients. ΔSUVmax-BSA-G <−60% predicted the pCR with an accuracy of 87% and ΔSUVs were found to be only factors predictive of the pCR at multivariate analysis. An elevated baseline SUV was associated with high mitotic activity ( p < 0.0016), tumour grading ( p < 0.004), high nuclear pleomorphism score ( p < 0.03) and negative hormonal receptor status ( p < 0.005). In breast cancer patients, after only one course of neoadjuvant chemotherapy the reduction in FDG uptake is an early and powerful predictor of pCR. [ABSTRACT FROM AUTHOR]

Introduction: The luminal/Human Epidermal growth factor Receptor 2 (HER2) negative subtype of breast cancer has low chemo-sensitivity. When neoadjuvant chemotherapy (NAC) is indicated in this subtype, before a possible breast-conserving surgery (BCS), it is more reasonable to target tumor shrinkage than complete pathological tumor response. We aimed to identify breast and tumor 18Fluoro-deoxy-glucose (18F-FDG) PET-CT scan imaging features for the early prediction of BCS after NAC in luminal/HER2 negative subtypes of breast cancer.Material and Methods: Seventy-seven consecutive women with luminal/HER2-negative breast cancer for whom BCS was initially not feasible and NAC was prescribed, to decrease tumor size before surgery, were included retrospectively. An 18F-FDG PET-CT scan exam was performed before and after the first course of NAC.Results: After NAC, 36% (28/77) of women had a mastectomy and 64% (49/77) underwent BCS. Patients with a mastectomy had lower total breast volume (BVtotal) (p = 0.002), lower decrease in Δmetabolic tumor volume (ΔMTV) (p = 0.03) and lower SUVmax2 (p = 0.05). Using ROC Curve analyses to define the optimal predictive threshold of BVtotal (496 cm3) and ΔMTV (-17.1%), 3 subgroups of women with different odds of BCS after treatment were identified (p = 0.001): low, medium and high probability groups (respectively 29%, 62% and 82%).Conclusions: For patients with Luminal/HER2 negative breast cancer, the combination of the imaging features of the tumor and the mammary gland, obtained with 18F-FDG PET-CT at baseline and after the first cycle of NAC, may allow the physician to evaluate the probability of BCS. [ABSTRACT FROM AUTHOR]