Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Is there utility for fluorine-18-fluorodeoxyglucose positron-emission tomography scan before surgery in breast cancer? A 15-year overall survival analysis
Justine Perrin, Karim Farid, Hilde Van Parijs, Olena Gorobets, Vincent Vinh-Hung, Nam P Nguyen, Navid Djassemi, Mark De Ridder, Hendrik Everaert
Justine Perrin, Karim Farid, Nuclear Medicine, CHU de Martinique, Fort-de-France 97200, Martinique
Hilde Van Parijs, Vincent Vinh-Hung, Mark De Ridder, Department of Radiotherapy, UZ Brussel, Brussels 1090, Belgium
Olena Gorobets, Head and Neck Surgery, CHU de Martinique, Fort-de-France 97200, Martinique
Vincent Vinh-Hung, Department of Radiotherapie, Centre Hospitalier de Polynésie française, Papeete 98713, Tahiti, French Polynesia
Nam P Nguyen, Department of Radiation Oncology, Howard University, Washington, DC 20060, United States
Navid Djassemi, Department of Pediatry, Hackensack University Medical Center, Hackensack, NJ 07601, United States
Navid Djassemi, Rady Children's Hospital, University of California San Diego, San Diego, CA 92123, United States
Hendrik Everaert, Department of Nuclear Medicine, UZ Brussel, Brussels 1090, Belgium
Author contributions: Vinh-Hung V and Everaert H were responsible for conception and design of the study; Vinh-Hung V, Everaert H and Van Parijs H were responsible for acquisition of the data; Vinh-Hung V, Hendrik Everaert, Gorobets O, Perrin J and De Ridder M were responsible for drafting of the manuscript; Perrin J, Vinh-Hung V, Nguyen NP and Djassemi N were responsible for reviewing the literature; Vinh-Hung V was responsible for analysis of the data; Perrin J, Farid K, Djassemi N, De Ridder M, Nguyen NP and Everaert H were responsible for further writing of the manuscript; Vinh-Hung V, Gorobets O and Perrin J were responsible for generating the tables and figures; all authors performed critical review and gave final approval of the version to be published.
Institutional review board statement: The study was reviewed and approved by the UZ Brussel Ethics Committee. All diagnostic and therapeutic procedures were performed in accordance with the local national guidelines and the Declaration of Helsinki 1964. The study registration occurred on 12 May 2020, No. ISRCTN17962845 (
https://www.isrctn.com/ISRCTN17962845).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to the diagnosis and treatment procedures by written consent.
Conflict-of-interest statement: The authors declare that they have no financial relationships to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Vincent Vinh-Hung, MD, MSc, PhD, Doctor, Department of Radiotherapy, UZ Brussel, Laarbeeklaan 101, Brussels 1090, Belgium. vh@onco.be
Received: November 15, 2021
Peer-review started: November 15, 2021
First decision: February 8, 2022
Revised: February 22, 2022
Accepted: April 4, 2022
Article in press: April 4, 2022
Published online: April 24, 2022
ARTICLE HIGHLIGHTS
Research background
The role of preoperative fluorine-18-fluorodeoxyglucose positron-emission tomography (18F-FDG PET) scan (referred to hereafter as FDG-PET) in early operable breast cancer (BC) is considered controversial and is even discouraged by clinical guidelines.
Research motivation
In dissension with guidelines, the evidence indicates that FDG-PET is a metabolic indicator of aggressive disease, warranting reconsideration of its role in the preoperative evaluation of BC.
Research objectives
Long-term follow-up is needed to address the importance of any marker. The study evaluates the very long-term (15-year) prognostic role of preoperative FDG-PET.
Research methods
The medical records of clinically nonmetastatic BC patients receiving preoperative FDG-PET were retrieved. Survivals were compared according to FDG-PET positive/negative status using the restricted mean survival time at a time horizon of 15 years. Multivariate analyses was performed with Cox proportional hazard models. In addition, the survival impact of absolute maximum standard uptake value (SUVmax) and ratios of SUVmax relative to the contralateral uninvolved side were evaluated.
Research results
Among 104 patients, regional FDG-PET positivity in the axillary or the sternal region was found to be a strong predictor of 15-year overall survival (P = 0.008). Patients with a positive regional PET status had an expected survival that was 2.6 years shorter than patients with negative regional PET status. Statistical significance was maintained for tumors > 20 mm, though not for tumors ≤ 20 mm. Cox models demonstrated the independent prognostic role. In addition, in a subgroup of 36 patients for whom quantitative SUV was available, representing 36 × 15 years = 540 patient-years follow-up and hence no lesser importance than a study of 189 patients but with only 3 years of follow-up, the ratio of ipsilateral axillary SUVmax vs uninvolved contralateral axillary SUVmax was the most significant among other SUV measures (P = 0.027).
Research conclusions
This study involved the longest known follow-up of preoperative FDG-PET in early operable BC. It provides survival information heretofore unavailable. Predicting an expected survival difference of 2.6 years out of a time horizon of 15 years can be a major consideration in the initial management of BC. In addition, the SUVmax ratio of ipsilateral over uninvolved side might represent a new finding that warrants investigation.
Research perspectives
FDG-PET might have a predominant role in the workup of BC. The present research did not have sufficient power to address the role of preoperative FDG-PET in tumors ≤ 20 mm. Future studies should consider accruing patients presenting with small tumors.
