Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Is there utility for fluorine-18-fluorodeoxyglucose positron-emission tomography scan before surgery in breast cancer? A 15-year overall survival analysis
Justine Perrin, Karim Farid, Hilde Van Parijs, Olena Gorobets, Vincent Vinh-Hung, Nam P Nguyen, Navid Djassemi, Mark De Ridder, Hendrik Everaert
Justine Perrin, Karim Farid, Nuclear Medicine, CHU de Martinique, Fort-de-France 97200, Martinique
Hilde Van Parijs, Vincent Vinh-Hung, Mark De Ridder, Department of Radiotherapy, UZ Brussel, Brussels 1090, Belgium
Olena Gorobets, Head and Neck Surgery, CHU de Martinique, Fort-de-France 97200, Martinique
Vincent Vinh-Hung, Department of Radiotherapie, Centre Hospitalier de Polynésie française, Papeete 98713, Tahiti, French Polynesia
Nam P Nguyen, Department of Radiation Oncology, Howard University, Washington, DC 20060, United States
Navid Djassemi, Department of Pediatry, Hackensack University Medical Center, Hackensack, NJ 07601, United States
Navid Djassemi, Rady Children's Hospital, University of California San Diego, San Diego, CA 92123, United States
Hendrik Everaert, Department of Nuclear Medicine, UZ Brussel, Brussels 1090, Belgium
Author contributions: Vinh-Hung V and Everaert H were responsible for conception and design of the study; Vinh-Hung V, Everaert H and Van Parijs H were responsible for acquisition of the data; Vinh-Hung V, Hendrik Everaert, Gorobets O, Perrin J and De Ridder M were responsible for drafting of the manuscript; Perrin J, Vinh-Hung V, Nguyen NP and Djassemi N were responsible for reviewing the literature; Vinh-Hung V was responsible for analysis of the data; Perrin J, Farid K, Djassemi N, De Ridder M, Nguyen NP and Everaert H were responsible for further writing of the manuscript; Vinh-Hung V, Gorobets O and Perrin J were responsible for generating the tables and figures; all authors performed critical review and gave final approval of the version to be published.
Institutional review board statement: The study was reviewed and approved by the UZ Brussel Ethics Committee. All diagnostic and therapeutic procedures were performed in accordance with the local national guidelines and the Declaration of Helsinki 1964. The study registration occurred on 12 May 2020, No. ISRCTN17962845 (
https://www.isrctn.com/ISRCTN17962845).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to the diagnosis and treatment procedures by written consent.
Conflict-of-interest statement: The authors declare that they have no financial relationships to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Vincent Vinh-Hung, MD, MSc, PhD, Doctor, Department of Radiotherapy, UZ Brussel, Laarbeeklaan 101, Brussels 1090, Belgium. vh@onco.be
Received: November 15, 2021
Peer-review started: November 15, 2021
First decision: February 8, 2022
Revised: February 22, 2022
Accepted: April 4, 2022
Article in press: April 4, 2022
Published online: April 24, 2022
BACKGROUND
The prognostic value of preoperative fluorine-18-fluorodeoxyglucose positron-emission tomography (18F-FDG PET) scan for determining overall survival (OS) in breast cancer (BC) patients is controversial.
AIM
To evaluate the OS predictive value of preoperative PET positivity after 15 years.
METHODS
We performed a retrospective search of the Universitair Ziekenhuis Brussel patient database for nonmetastatic patients who underwent preoperative PET between 2002-2008. PET positivity was determined by anatomical region of interest (AROI) findings for breast and axillary, sternal, and distant sites. The prognostic role of PET was examined as a qualitative binary factor (positive vs negative status) and as a continuous variable [maximum standard uptake value (SUVmax)] in multivariate survival analyses using Cox proportional hazards models. Among the 104 identified patients who received PET, 36 were further analyzed for the SUVmax in the AROI.
RESULTS
Poor OS within the 15-year study period was predicted by PET-positive status for axillary (P = 0.033), sternal (P = 0.033), and combined PET-axillary/sternal (P = 0.008) nodes. Poor disease-free survival was associated with PET-positive axillary status (P = 0.040) and combined axillary/sternal status (P = 0.023). Cox models confirmed the long-term prognostic value of combined PET-axillary/sternal status [hazard ratio (HR): 3.08, 95% confidence interval: 1.42-6.69]. SUVmax of ipsilateral breast and axilla as continuous covariates were significant predictors of long-term OS with HRs of 1.25 (P = 0.048) and 1.54 (P = 0.029), corresponding to relative increase in the risk of death of 25% and 54% per SUVmax unit, respectively. In addition, the ratio of the ipsilateral axillary SUVmax over the contralateral axillary SUVmax was the most significant OS predictor (P = 0.027), with 1.94 HR, indicating a two-fold relative increase of mortality risk.
CONCLUSION
Preoperative PET is valuable for prediction of long-term survival. Ipsilateral axillary SUVmax ratio over the uninvolved side represents a new prognostic finding that warrants further investigation.
Core Tip: In our study population of nonmetastatic breast cancer patients, preoperative fluorine-18-fluorodeoxyglucose positron-emission tomography (18F-FDG PET) scan provided valuable overall survival prognostic information. This retrospective study included the longest (15-year) follow-up observation period to date in a series of these patients. Data from anatomical regions of interest and statistical analyses determined that the ipsilateral axillary maximum standard uptake value (SUVmax) with reference to the contralateral uninvolved axilla was the strongest predictor of survival.
