Subtype-Guided 18 F-FDG PET/CT in Tailoring Axillary Surgery Among Patients with Node-Positive Breast Cancer Treated with Neoadjuvant Chemotherapy: A Feasibility Study

The oncologist

article

Siyu Wu¹  Jingyi Cheng²  Guangyu Liu¹  Yujie Wang³  Jianwei Li¹  Na Zhang¹  Miao Mo⁴  Suzanne Klimberg⁵  Virginia Kaklamani⁶  Alexandre Cochet⁷  Zhiming Shao¹ 

[1] Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University;Department of Nuclear Medicine, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University;Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine;Clinical Statistics Center, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University;Division of Breast Surgical Oncology, Department of Surgery, University of Texas Medical Branch;Division of Hematology and Oncology, Northwestern University;Department of Nuclear Medicine, Centre Georges-François Leclerc, University Hospital of Dijon

关键词: Subtype-guided;    18[F]-fluorodeoxyglucose positron emission tomography/computed tomography;    Response;    Axillary surgery;    Neoadjuvant chemotherapy;   

DOI  :  10.1634/theoncologist.2019-0583

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background The purpose of this study was to investigate the value of 18 [F]-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) in tailoring axillary surgery by predicting nodal response among patients with node-positive breast cancer after neoadjuvant chemotherapy (NAC). Methods One hundred thirty-three patients with breast cancer with biopsy-confirmed nodal metastasis were prospectively enrolled. 18 F-FDG PET/CT scan was performed before NAC (a second one after two cycles with baseline maximum standardized uptake value [SUV max ] ≥2.5), and a subset of patients underwent targeted axillary dissection (TAD). All the patients underwent axillary lymph node dissection (ALND). The accuracy was calculated by a comparison with the final pathologic results. Results With the cutoff value of 2.5 for baseline SUV max and 78.4% for change in SUV max , sequential 18 F-FDG PET/CT scans demonstrated a sensitivity of 79.0% and specificity of 71.4% in predicting axillary pathologic complete response with an area under curve (AUC) of 0.75 (95% confidence interval, 0.65–0.84). Explorative subgroup analyses indicated little value for estrogen receptor (ER)-negative, human epidermal growth factor receptor 2 (HER2)-positive patients (AUC, 0.55; sensitivity, 56.5%; specificity, 50.0%). Application of 18 F-FDG PET/CT could spare 19 patients from supplementary ALNDs and reduce one of three false-negative cases in TAD among the remaining patients without ER-negative/HER2-positive subtype. Conclusion Application of the subtype-guided 18 F-FDG PET/CT could accurately predict nodal response and aid in tailoring axillary surgery among patients with node-positive breast cancer after NAC, which includes identifying candidates appropriate for TAD or directly proceeding to ALND. This approach might help to avoid false-negative events in TAD. Implications for Practice This feasibility study showed that 18 [F]-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) could accurately predict nodal response after neoadjuvant chemotherapy (NAC) among patients with breast cancer with initial nodal metastasis except in estrogen receptor-negative, human epidermal growth factor receptor 2-positive subtype. Furthermore, the incorporation of 18 F-FDG PET/CT can tailor subsequent axillary surgery by identifying patients with residual nodal disease, thus sparing those patients supplementary axillary lymph node dissection. Finally, we have proposed a possibly feasible flowchart involving 18 F-FDG PET/CT that might be applied in post-NAC axillary evaluation.

【 授权许可】

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