Value of early metabolic response for predicting axillary pathological complete response during neoadjuvant systemic therapy in triple negative and HER2-amplified breast cancers: impact of tumor subtypes.
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引用次数: 0
Abstract
Background: In the era of therapeutic de-escalation, the opportunity to move from systematic axillary lymph node dissection (ALND) to sentinel lymph node biopsy in axillary node-positive breast cancer patients after neoadjuvant systemic therapy (NST) is currently considered. The purpose of this study was to identify FDG-PET parameters associated with axillary pathological complete response (pRAx) in the most proliferative tumor subtypes, eg Triple Negative (TN) and HER2-amplified.
Methods: Patients with newly-diagnosed TN or HER2-amplified breast cancer, with pathologically-proven axillary node metastasis, no distant metastasis and indication of NST were prospectively included from September 2017 to December 2021. Sequential FDG-PET/CT scans were performed at baseline and after one cycle of NST. Metabolic parameters at baseline and their changes (Delta in %) of axillary nodes were assessed: SUVmax, SUVratio (SUVmax/SUVmax liver), SUVpeak, SUVmean, TLG and MTV. Logistic regressions with ROC curves were used to determine parameters associated with pRAx.
Results: Sixty-one patients (24 TN, 19 ER-negative/HER2-amplified and 18 ER-positive/HER2-amplified) were recruited. Median value of Axillary SUVmax at baseline were 7.9, 7.0 and 5.2 and Delta Axillary SUVmax were -62%,-60% and -47% in these 3 subgroups, respectively. In univariate model, in the whole population, Delta Axillary SUVmax showed the greatest AUC for prediction of pRAx of 0.72 (95%CI: 0.59-0.85), whereas AUC of Axillary SUVmax at baseline was not statistically significant (AUC = 0.6 (95%CI: 0.46-0.74)). Specificity, sensitivity, PPV and NPV of Delta Axillary SUVmax were 96%, 49%, 94% and 58% respectively for predicting pRAx with a threshold of -68.7%. Odd Ratio associated with Delta Axillary SUVmax < -68.7% compared to ≥ -68.7% was 24.0 (95%CI: 2.9-194). In multivariate model, adjusted on tumor subtypes, Delta Axillary SUVmax was still significantly associated with pRAx (OR = 20.7 (95%IC: 2.5-172). AUCs adjusted on the tumor subtype were not significantly modified compared to univariate model (p = 0.45 compared to unadjusted AUC) suggesting that thresholds were not significantly different in each tumor subtype.
Conclusions: Delta Axillary SUVmax seems to be the most relevant metabolic parameter to predict an axillary pathological complete response and early metabolic response could be a valuable tool for selecting patients eligible for axillary surgical de-escalation after NST, regardless tumor subtypes.
Cancer ImagingONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
7.00
自引率
0.00%
发文量
66
审稿时长
>12 weeks
期刊介绍:
Cancer Imaging is an open access, peer-reviewed journal publishing original articles, reviews and editorials written by expert international radiologists working in oncology.
The journal encompasses CT, MR, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumours, plus new developments, techniques and innovations. Topics of interest include:
Breast Imaging
Chest
Complications of treatment
Ear, Nose & Throat
Gastrointestinal
Hepatobiliary & Pancreatic
Imaging biomarkers
Interventional
Lymphoma
Measurement of tumour response
Molecular functional imaging
Musculoskeletal
Neuro oncology
Nuclear Medicine
Paediatric.