Comparison of diffusion-weighted MR imaging and FDG PET/CT to predict pathological complete response to neoadjuvant chemotherapy in patients with breast cancer

AbstractObjectiveTo compare the use of diffusion-weighted MR imaging (DWI) and 18F-FDG PET/CT to predict pathological complete response (pCR) in breast cancer patients receiving neoadjuvant chemotherapy.MethodsThirty-four women with 34 invasive breast cancers underwent DWI and PET/CT before and after chemotherapy and before surgery. The percentage changes in the apparent diffusion coefficient (ADC) and the standardised uptake value (SUV) were calculated, and the diagnostic performances for predicting pCR were evaluated using receiver operating characteristic (ROC) curve analysis.ResultsAfter surgery, 7/34 patients (20.6%) were found to have pCR. Az values for DWI, PET/CT and the combined use of DWI and PET/CT were 0.910, 0.873 and 0.944, respectively. The best cut-offs for differentiating pCR from non-pCR were a 54.9% increase in the ADC and a 63.9% decrease in the SUV. DWI showed 100% (7/7) sensitivity and 70.4% (19/27) specificity and PET/CT showed 100% sensitivity and 77.8% (21/27) specificity. When DWI and PET/CT were combined, there was a trend towards improved specificity compared with DWI.ConclusionsDWI and FDG PET/CT show similar diagnostic accuracy for predicting pCR to neoadjuvant chemotherapy in breast cancer patients. The combined use of DWI and FDG PET/CT has the potential to improve specificity in predicting pCR. Key Points • DWI breast MR and PET/CT show similar accuracy for predicting pathological response • The combined use of DWI and PET/CT can potentially improve specificity • This can assist individualised treatment in breast cancer patients receiving neoadjvant chemotherapy

[1]  J. Bryant,et al.  Pathobiology of preoperative chemotherapy , 2002 .

[2]  M. van Glabbeke,et al.  New guidelines to evaluate the response to treatment in solid tumors , 2000, Journal of the National Cancer Institute.

[3]  U. Sharma,et al.  Longitudinal study of the assessment by MRI and diffusion‐weighted imaging of tumor response in patients with locally advanced breast cancer undergoing neoadjuvant chemotherapy , 2009, NMR in biomedicine.

[4]  Norbert Avril,et al.  Response to Therapy in Breast Cancer , 2009, Journal of Nuclear Medicine.

[5]  A. Olshen,et al.  Imaging of oncologic patients: benefit of combined CT and FDG PET in the diagnosis of malignancy. , 1998, AJR. American journal of roentgenology.

[6]  M Van Glabbeke,et al.  New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. , 2000, Journal of the National Cancer Institute.

[7]  C. Balu-Maestro,et al.  Imaging in evaluation of response to neoadjuvant breast cancer treatment benefits of MRI. , 2005, Breast cancer research and treatment.

[8]  B. Palumbo,et al.  Relationship between PET-FDG and MRI apparent diffusion coefficients in brain tumors. , 2009, The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of....

[9]  J. Bryant,et al.  Pathobiology of preoperative chemotherapy: findings from the National Surgical Adjuvant Breast and Bowel (NSABP) protocol B-18. , 2002, Cancer.

[10]  Roland Hustinx,et al.  Imaging gliomas with positron emission tomography and single-photon emission computed tomography. , 2003, Seminars in nuclear medicine.

[11]  Thomas E Yankeelov,et al.  Integration of quantitative DCE-MRI and ADC mapping to monitor treatment response in human breast cancer: initial results. , 2007, Magnetic resonance imaging.

[12]  Peter Gibbs,et al.  Diffusion changes precede size reduction in neoadjuvant treatment of breast cancer. , 2006, Magnetic resonance imaging.

[13]  C. V. D. van de Velde,et al.  Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  S. Paik,et al.  Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  Q. Chan,et al.  Quantitative Assessment of Diffusion-Weighted MR Imaging in Patients with Primary Rectal Cancer: Correlation with FDG-PET/CT , 2010, Molecular Imaging and Biology.

[16]  C. Ganter,et al.  Restricted Water Diffusibility as Measured by Diffusion-weighted MR Imaging and Choline Uptake in 11C-Choline PET/CT are Correlated in Pelvic Lymph Nodes in Patients with Prostate Cancer , 2011, Molecular Imaging and Biology.

[17]  Mary Scott Soo,et al.  Detection of primary breast carcinoma with a dedicated, large-field-of-view FDG PET mammography device: initial experience. , 2005, Radiology.

[18]  Ferdia A Gallagher,et al.  A comparison between radiolabeled fluorodeoxyglucose uptake and hyperpolarized (13)C-labeled pyruvate utilization as methods for detecting tumor response to treatment. , 2009, Neoplasia.

[19]  E. Winer,et al.  Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  Winfried Brenner,et al.  Monitoring primary systemic therapy of large and locally advanced breast cancer by using sequential positron emission tomography imaging with [18F]fluorodeoxyglucose. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  Min-Ying Su,et al.  MRI evaluation of pathologically complete response and residual tumors in breast cancer after neoadjuvant chemotherapy (Cancer (2008) 112, (17-26)) , 2008 .

[22]  A. Rieber,et al.  Breast MRI for monitoring response of primary breast cancer to neo-adjuvant chemotherapy , 2002, European Radiology.

[23]  Woo Kyung Moon,et al.  Diffusion-weighted MR imaging: pretreatment prediction of response to neoadjuvant chemotherapy in patients with breast cancer. , 2010, Radiology.

[24]  David A Mankoff,et al.  FDG PET, PET/CT, and breast cancer imaging. , 2007, Radiographics : a review publication of the Radiological Society of North America, Inc.

[25]  Pathological complete response and residual DCIS following neoadjuvant chemotherapy for breast carcinoma , 2006, British Journal of Cancer.

[26]  P. Choyke,et al.  Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. , 2009, Neoplasia.

[27]  Gerald Q. Maguire,et al.  Improving Specificity of Breast MRI Using Prone PET and Fused MRI and PET 3D Volume Datasets , 2007, Journal of Nuclear Medicine.

[28]  K. Herholz,et al.  Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. , 1999, European journal of cancer.

[29]  R. Gillies,et al.  Changes in water mobility measured by diffusion MRI predict response of metastatic breast cancer to chemotherapy. , 2004, Neoplasia.

[30]  A. Herneth,et al.  Apparent diffusion coefficient: a quantitative parameter for in vivo tumor characterization. , 2003, European journal of radiology.

[31]  Olav Haraldseth,et al.  Measurement of cell density and necrotic fraction in human melanoma xenografts by diffusion weighted magnetic resonance imaging , 2000, Magnetic resonance in medicine.

[32]  M. Brennan,et al.  Locally advanced and inflammatory breast cancer. , 2005, Australian family physician.

[33]  C. Meyer,et al.  Evaluation of the functional diffusion map as an early biomarker of time-to-progression and overall survival in high-grade glioma. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[34]  M. Campone,et al.  FDG PET evaluation of early axillary lymph node response to neoadjuvant chemotherapy in stage II and III breast cancer patients , 2011, European Journal of Nuclear Medicine and Molecular Imaging.

[35]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[36]  J. Bryant,et al.  Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. , 2001, Journal of the National Cancer Institute. Monographs.

[37]  L. Shen,et al.  Apparent diffusion coefficient: potential imaging biomarker for prediction and early detection of response to chemotherapy in hepatic metastases. , 2008, Radiology.

[38]  D. Narayanan,et al.  Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. , 2011, Radiology.

[39]  D. Mankoff,et al.  Combined use of MRI and PET to monitor response and assess residual disease for locally advanced breast cancer treated with neoadjuvant chemotherapy. , 2004, Academic radiology.

[40]  J. Ro,et al.  Predictive value of [18F]FDG PET for pathological response of breast cancer to neo-adjuvant chemotherapy. , 2004, Annals of oncology : official journal of the European Society for Medical Oncology.