Association of Standardized Uptake Values of Primary Breast Cancer on [18F]FDG PET/CT With Immunohistochemistry and Molecular Subtypes Correlation of SUV of primary BC with molecular subtypes

Nishita Goyal (1), Periakaruppan Gokulakrishnan (2), Arunan Murali (3), Leena Joseph Dennis (4), Rajeswaran Rangasami (5), Bhawna Dev (6)
(1) Department of Radio-diagnosis, Sri Ramachandra Institute Of Higher Education & Research, Porur, Chennai, India, India,
(2) Department of radio-diagnosis, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai. India, India,
(3) Department of Radio diagnosis Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India, India,
(4) Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India., India,
(5) Deprtment of Radio-diagnosis Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India., India,
(6) Department of Radio-diagnosis, Sri Ramachandra Institute of Higher Education & Research, Porur Chennai, India., India

Abstract

Background: The prognostic factors for breast cancer include pretreatment staging, nodal and distant metastasis, hormone receptor status, ki67 index, and molecular subtype. For adequate treatment, [18F]FDG PET/CT is now being used to prognosticate the course and response of treatment in breast cancer patients. Our study aims to find the association between the metabolic activity of primary breast tumors as PET/CT SUV uptake and prognostic factors such as ER/PgR/Her2neu receptor status, molecular subtypes, ki67 labeling index, and nodal/distant metastasis.


Methods: A retrospective observational study at our tertiary care institute included 228 breast cancer patients from March 2017 to April 2021. Pretreatment PET/CT imaging was done. The immunohistochemical analysis was performed on a biopsy/surgical specimen to determine the molecular subtype of breast cancer. Further, statistical analysis was performed to find the association between PET/CT findings with immunohistochemistry and thus, molecular subtypes of breast cancers.


Results: Significantly higher SUV max was seen in tumors with ER-negative (Mean SUVmax-11.6; P-value=0.002), PgR negative (Mean SUVmax-11.1; p value-0.0005), triple-negative receptor status (Mean SUVmax-13.7; P-value=0.004) and high Ki67 index (P-value=<0.01). Further Luminal A (Mean SUV max:6.0±5.5 & Median SUV max:3.9±3.6) and Luminal B (Mean SUV max: 8.9±4.9 & Median SUV max:7.6±4.0) subtypes showed lower SUV max as compared to Her2neu (Mean SUV max: 9.4±5.5 & Median SUV max:8.6±6.2) and TNBC (Mean SUV max: 13.7±12.4 & Median SUV max:10.0±7.6) subtypes. However, only a weak correlation was found for axillary nodal spread p-value – 0.02) and no significant correlation was seen for Her2 receptor status (Mean SUVmax-9.7; p value-0.178) and distant metastasis (P-value=0.26).


Conclusion: The values for different molecular subtypes can be used as Mean SUV or Median SUV uptake. However, owing to data skewing in practical scenarios, we suggest the use of median values with interquartile range for predicting the molecular subtypes of breast cancer on PET/CT imaging: Luminal A – Median SUV – 3.9 (IQR – 3.6); Luminal B ­­– Median SUV – 7.6 (IQR – 4.0); Her2neu Enriched – Median SUV 8.6 (IQR - 6.2); Triple-negative breast cancer - Median SUV 10.0 (IQR - 7.6).

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Authors

Nishita Goyal
Periakaruppan Gokulakrishnan
Arunan Murali
Leena Joseph Dennis
Rajeswaran Rangasami
Bhawna Dev
bhawnadev@sriramachandra.edu.in (Primary Contact)
Author Biographies

Nishita Goyal, Department of Radio-diagnosis, Sri Ramachandra Institute Of Higher Education & Research, Porur, Chennai, India

Department of Radio-diagnosis,

Sri Ramachandra Institute Of Higher Education & Research, Porur,

Chennai, India

Periakaruppan Gokulakrishnan, Department of radio-diagnosis, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai. India

Professor,

Department of radio-diagnosis

Sri Ramachandra Institute of Higher Education and Research, Porur,

Chennai.

Arunan Murali, Department of Radio diagnosis Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India

Professor - Department of Radio diagnosis

Sri Ramachandra Institute of Higher Education and Research, Porur,

Chennai, India

Leena Joseph Dennis, Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India.

Professor, Department of Pathology

Sri Ramachandra Institute of Higher Education and Research, Porur,

Chennai, India.

Rajeswaran Rangasami, Deprtment of Radio-diagnosis Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India.

Professor and Head of the Department, 

Deprtment of Radio-diagnosis

Sri Ramachandra Institute of Higher Education and Research, Porur,

Chennai, India.

Bhawna Dev, Department of Radio-diagnosis, Sri Ramachandra Institute of Higher Education & Research, Porur Chennai, India.

Professor, Department of Radio-diagnosis

Sri Ramachandra Institute of Higher Education & Research, Porur

Chennai, India.

1.
Goyal N, Gokulakrishnan P, Murali A, Dennis LJ, Rangasami R, Dev B. Association of Standardized Uptake Values of Primary Breast Cancer on [18F]FDG PET/CT With Immunohistochemistry and Molecular Subtypes : Correlation of SUV of primary BC with molecular subtypes. Arch Breast Cancer [Internet]. 2023 Mar. 10 [cited 2024 Jul. 16];10(2):175-86. Available from: https://archbreastcancer.com/index.php/abc/article/view/668

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