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Abstract
Objectives: PET using F-fluorodeoxyglucose (FDG) has proven to be valuable in staging and monitoring of treatment response in breast cancer. We aimed to assess the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with breast cancer.

Methods: A systematic search of MEDLINE and EMBASE was performed using the keywords of breast cancer, PET, and volume. Inclusion criteria were F-FDG PET used as an initial imaging tool; studies limited to patients with breast cancer who had not undergone any treatment before PET scans; and studies reporting survival data. Event-free survival (EFS) and overall survival (OS) were considered markers of outcome.

Results: Nine studies comprising 975 patients were included in this study. The pooled hazard ratio (HR) for adverse events was 33.73 (P < 0.00001; I = 0%) with MTV from primary tumor and 2.89 (P < 0.00001; I = 45%) with TLG from primary tumor, meaning that primary tumors with high volumetric parameters were associated with progression or recurrence. However, the combined HRs for EFS of MTV, and TLG, and those for OS of MTV from whole-body tumor were NS. The pooled HR for OS of TLG from whole-body tumor was 2.95 (P = 0.18; I = 71%).

Conclusion: Volumetric parameters from F-FDG PET are significant prognostic factors for outcome in patients with breast cancer. Patients with a high MTV or TLG from primary tumor have a higher risk of adverse events. Patients with a high TLG from whole-body tumor have a higher risk of deaths.

Affiliations

Kyoungjune Pak  1 , Ju Won Seok  2 , Hyun Yul Kim  3 , Tuong Linh Nguyen  4 , Keunyoung Kim  1 , Seong Jang Kim  5 , In-Joo Kim  1 , John Hopper  4
1 Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan.
2 Department of Nuclear Medicine, Chung-Ang University College of Medicine, Seoul.
3 Department of Surgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
4 Centre for Epidemiology & Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia.
5 Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.