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Alcázar de San Juan, Spain

Garcia Vicente A.M.,University of Castilla - La Mancha | Soriano Castrejon A.,University of Castilla - La Mancha | Leon Martin A.,University of Castilla - La Mancha | Relea Calatayud F.,University of Castilla - La Mancha | And 4 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2014

Purpose: To determine the utility of 18F-FDG (FDG) PET/CT performed in an early and delayed phase during neoadjuvant chemotherapy in the prediction of lymph node histopathological response in patients with locally advanced breast cancer. Methods: FDG PET/CT studies performed in 76 patients (mean age 53 years) at baseline (PET-1), after the second course of chemotherapy (PET-2) and after the last course of chemotherapy (PET-3) were prospectively analysed. Inclusion criteria were lymph node involvement detected by PET/CT and non-sentinel node biopsy before or after the baseline PET/CT scan. Following the recommendations of the 12th International Breast Conference (St. Gallen), the patients were divided into five subgroups in relation to biological prognostic factors by immunohistochemistry. For diagnosis visual and semiquantitative analyses was performed. Absence of detectable lymph node uptake on the PET-2 or PET-3 scan with respect to the PET-1 scan was considered metabolic complete response (mCR). Lymph nodes were histopathologically classified according the lymph node regression grade and in response groups as pathological complete response (pCR) or not pCR (type A/D or B/C of the Smith grading system, respectively). ROC analysis was performed to determine a cut-off value of Δ% SUV1-2 and SUV1-3 for prediction of nodal status after chemotherapy. An association between mCR and pCR was found (Cohen's kappa analysis), and associations between phenotypes and metabolic behaviour and the final histopathological status were also found. Results: Lymph node pCR was seen in 34 patients. The sensitivity, specificity, and positive and negative predictive values of PET-2 and PET-3 in establishing the final status of the axilla after chemotherapy were 52 %, 45 %, 50 % and 47 %, and 33 %, 84 %, 67 % and 56 %, respectively. No significant relationship was observed between mCR on PET-2 and PET-3 and pCR (p=0.31 and 0.99, respectively). Lymph node metabolism on PET-1 was not able to predict the final histopathological status, whereas basal carcinomas showed a higher rate of pCR (70.6 %) than the other groups (p=0.03). Conclusion: FDG PET/CT seems to have limitations in both the early and delayed evaluation of lymph node status after chemotherapy, with reduced predictive values. © 2014 Springer-Verlag.

Garcia Vicente A.M.,University of Castilla - La Mancha | Cruz Mora M.A.,Virgen de la Salud Hospital | Leon Martin A.A.,University of Castilla - La Mancha | Munoz Sanchez M.M.,Virgen de la Luz Hospital | And 5 more authors.
Tumor Biology | Year: 2014

The purpose of the present study is to explore the relation between glycolytic metabolism assessed by 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and final neoadjuvant chemotherapy (NC) response in locally advanced breast tumors. Of women with breast cancer, 126 were prospectively evaluated. All patients underwent 18F-FDG PET/CT previous to NC. Standard uptake value (SUV) max was calculated in the primary tumor. After NC, residual primary tumor specimen was histopathologically classified according to Miller and Payne tumor regression grades (TRG), from G1 to G5 and in response groups as good responders (G4 or G5), partial responders (G2 or G3), and non-responders (G1). Furthermore, residual lesions were classified following a binary assessment as responders (G4 or G5) and non-responders (the rest of cases). The relationship between SUV max with TRG and response groups was evaluated. Of tumors, 127 were assessed (a patient had bilateral breast lesions). TRG were as follows: G1 (27), G2 (27), G3 (32), G4 (11), and G5 (30). Forty-one were classified as good responders, 59 as partial responders, and 27 as non-responders. For the binary assessment, 41 lesions were classified as responders and 86 as non-responders. We found statistical differences (p = 0.02) between the mean SUV max and TRG with greater SUV values for G5 compared to the other TRG. Good responders showed greater mean SUV max ± SD compared to partial responders and non-responders (10.51 ± 6.64 for good responders, 6.94 ± 5.81 for partial responders, and 5.23 ± 2.76 for non-responders; p = 0.001). Baseline tumor metabolism assessing by FDG PET/CT was associated with the final histopathologic status after neoadjuvant chemotherapy, with greater SUV max values for good responders compared to the less responder cancers. © 2014, International Society of Oncology and BioMarkers (ISOBM).

Garcia Vicente A.M.,University of Castilla - La Mancha | Soriano Castrejon A.,University of Castilla - La Mancha | Leon Martin A.,University of Castilla - La Mancha | Chacon Lopez-Muniz I.,Virgen de la Salud Hospital | And 5 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2013

Purpose: To determine whether the metabolic features of breast tumours differ among molecular subtypes. Methods: This prospective study included 168 women diagnosed with locally advanced breast cancer. PET/CT was requested in the initial staging before neoadjuvant treatment (multicentre study, FISCAM grant). All patients underwent an 18F-FDG PET/CT scan with a dual time-point acquisition. Both examinations (PET-1 and PET-2) were evaluated qualitatively and semiquantitatively with calculation of SUVmax (SUV-1 and SUV-2, respectively), and the percentage variation in the SUVs and retention indexes (RI) between PET-1 and PET-2 in the breast tumour were calculated. Biological prognostic parameters, including the steroid receptor status, HER-2 expression, proliferation rate (Ki-67) and grading, were determined from primary tumour tissue. Tumour subtypes were classified following the recommendations of the 12th International Breast Conference, by immunohistochemical surrogates as luminal A, luminal B-HER2(-), luminal B-HER2(+), HER2(+) or basal. Metabolic semiquantitative parameters and molecular subtypes were correlated. Results: Of the 168 tumours, 151 were classified: 16 were luminal A, 53 were luminal B-HER2(-), 29 were luminal B-HER2(+), 18 were HER2(+) and 35 were basal. There were significant differences between SUV-1 and SUV-2 and the different subtypes, with higher SUVs in HER2(+) and basal tumours. No significant differences were found with respect to RI. Conclusion: Semiquantitative metabolic parameters showed statistically significant differences among the molecular subtypes of the tumours evaluated. Therefore, there seems to be a relationship between molecular and glycolytic phenotypes. © 2013 Springer-Verlag Berlin Heidelberg.

Garcia Vicente A.M.,University of Castilla - La Mancha | Soriano Castrejon T.,University of Castilla - La Mancha | Cruz Mora M.,Virgen de la Salud Hospital | Ortega Ruiperez C.,Virgen de la Luz Hospital | And 4 more authors.
Revista Espanola de Medicina Nuclear e Imagen Molecular | Year: 2014

Aim: To assess dual time point 2-deoxy-2-[18F]fluoro-d-glucose 18FFDG PET-CT accuracy in nodal staging and in detection of extra-axillary involvement. Material and methods: Dual time point [18F] FDG PET/CT scan was performed in 75 patients. Visual and semiquantitative assessment of lymph nodes was performed. Semiquantitative measurement of SUV and ROC-analysis were carried out to calculate SUVmax cut-off value with the best diagnostic performance. Axillary and extra-axillary lymph node chains were evaluated. Results: Sensitivity and specificity of visual assessment was 87.3% and 75%, respectively. SUVmax values with the best sensitivity were 0.90 and 0.95 for early and delayed PET, respectively. SUVmax values with the best specificity were 1.95 and 2.75, respectively. Extra-axillary lymph node involvement was detected in 26.7%. Conclusion: FDG PET/CT detected extra-axillary lymph node involvement in one-fourth of the patients. Semiquantitative lymph node analysis did not show any advantage over the visual evaluation. © 2013 Elsevier España, S.L. and SEMNIM.

Garcia Vicente A.M.,University of Castilla - La Mancha | Soriano Castrejon A.,University of Castilla - La Mancha | Cruz Mora M.A.,Virgen de la Salud Hospital | Gonzalez Ageitos A.,Nuestra Sra. Del Prado Hospital | And 8 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2013

Purpose: The aim of this study was to analyse the correlation between dual-time-point 18F-2-deoxy-2-fluoro-D-glucose (FDG) uptakes in lymph nodes assessed by positron emission tomography (PET)/CT and histopathological and immunohistochemical prognostic factors. Methods: Seventy-five women with locally advanced breast cancer were prospectively evaluated. PET/CT was requested in the initial staging previous to adjuvant chemotherapy (multicentre study). All of the patients underwent 18F-FDG PET/CT with a dual-time-point acquisition. Both examinations were evaluated qualitatively and semi-quantitatively with calculation of maximum standardized uptake values (SUVmax) in PET-1 (SUV-1) and in PET-2 (SUV-2) and the percentage variation of the SUV or retention index (RI) between PET-1 and PET-2 in lymph nodes with the greater 18F-FDG uptake. The biological prognostic parameters such as the steroid receptor status, p53 and HER2 expression, proliferation rate (Ki-67) and grading were determined from tissue of the primary tumour. Metabolic and biological parameters were correlated using Spearman's rank-order correlation coefficient and Mann-Whitney U and Kruskal-Wallis tests. Results: Negative receptor status was correlated with higher SUV-1, SUV-2 and RI in lymph nodes. The results were significant for progesterone receptor status. p53 over-expression and triple-negative status were associated with greater semi-quantitative parameters in lymph nodes. Higher tumoural grades were related with greater semi-quantitative parameters (p > 0.05). Conclusion: Biological factors of bad prognosis were correlated with higher semi-quantitative metabolic values in lymph nodes. Therefore these results appear to reveal biological significance of lymph node 18F-FDG accumulation. © 2012 Springer-Verlag.

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