방사선의학 웹진

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Abstract

PURPOSE:

Oncotype DX, a 21-gene expression assay, provides a recurrence score (RS) which predicts prognosis and the benefit from adjuvant chemotherapy in patients with early-stage, estrogen receptor-positive (ER-positive), and human epidermal growth factor receptor 2-negative (HER2-negative) invasive breast cancer. However, Oncotype DX tests are expensive and not readily available in all institutions. The purpose of this study was to investigate whether metabolic parameters on 18F-FDG PET/CT are associated with the Oncotype DX RS and whether 18F-FDG PET/CT can be used to predict the Oncotype DX RS.

METHODS:

The study group comprised 38 women with stage I/II, ER-positive/HER2-negative invasive breast cancer who underwent pretreatment 18F-FDG PET/CT and Oncotype DX testing. On PET/CT, maximum (SUVmax) and average standardized uptake values, metabolic tumor volume, and total lesion glycolysis were measured. Partial volume-corrected SUVmax (PVC-SUVmax) determined using the recovery coefficient method was also evaluated. Oncotype DX RS (0 - 100) was categorized as low (<18), intermediate (18 - 30), or high (≥31). The associations between metabolic parameters and RS were analyzed. Multivariate logistic regression was used to identify significant independent predictors of low versus intermediate-to-high RS.

RESULTS:

Of the 38 patients, 22 (58 %) had a low RS, 13 (34 %) had an intermediate RS, and 3 (8 %) had a high RS. In the analysis with 38 index tumors, PVC-SUVmax was higher in tumors in patients with intermediate-to-high RS than in those with low RS (5.68 vs. 4.06; P = 0.067, marginally significant). High PVC-SUVmax (≥4.96) was significantly associated with intermediate-to-high RS (odds ratio, OR, 10.556; P = 0.004) in univariate analysis. In multivariate analysis with clinicopathologic factors, PVC-SUVmax ≥4.96 (OR 8.459; P = 0.013) was a significant independent predictor of intermediate-to-high RS.

CONCLUSIONS:

High PVC-SUVmax on 18F-FDG PET/CT was significantly associated with an intermediate-to-high Oncotype DX RS. PVC metabolic parameters on 18F-FDG PET/CT can be used to predict the Oncotype DX RS in patients with early-stage, ER-positive/HER2-negative breast cancer. 

Author information

Lee SH1, Ha S2,3, An HJ2,4, Lee JS2,4, Han W5, Im SA6, Ryu HS7, Kim WH8, Chang JM1, Cho N1, Moon WK9,10,11, Cheon GJ12,13,14.​

1Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

2Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

3Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine or College of Pharmacy, Seoul National University, Seoul, South Korea.

4Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.

5Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

6Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

7Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

8Department of Radiology, Kyungpook National University Hospital, Daegu, South Korea.

9Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. moonwk@snu.ac.kr.

10Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. moonwk@snu.ac.kr.

11Radiation Medicine Research Institute, Seoul National University College of Medicine, Seoul, South Korea. moonwk@snu.ac.kr.

12Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. larrycheon@gmail.com.

13Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. larrycheon@gmail.com.

14Radiation Medicine Research Institute, Seoul National University College of Medicine, Seoul, South Korea. larrycheon@gmail.com.