Journal Article
. 2017 Apr;12(4).
doi: 10.1371/journal.pone.0175048.

Comparison of standardized uptake value of 18F-FDG-PET-CT with 21-gene recurrence score in estrogen receptor-positive, HER2-negative breast cancer

Sung Gwe Ahn 1 Jae-Hoon Lee 2 Hak Woo Lee 1 Tae Joo Jeon 2 Young Hoon Ryu 2 Kun Min Kim 3 Joohyuk Sohn 3 Mijin Yun 4 Seung Ah Lee 5 Joon Jeong 1 Seung Il Kim 6 
  • PMID: 28419166
  •     18 References
  •     5 citations


Background: We investigated the relationship between 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG-PET-CT) standardized uptake value (SUV) and 21-gene recurrence score (RS) in estrogen receptor (ER)-positive/HER2-negative breast cancer.

Materials And Methods: One hundred sixty-seven patients were identified among those who underwent preoperative 18F-FDG-PET-CT and had RS. Maximum SUV was obtained from 18F-FDG-PET-CT; the cut-off point was 4.

Results: The continuous RS and SUV correlated positively (Pearson's R = 0.555; P < 0.001). An inverse correlation was found between progesterone receptor (PR) expression by reverse transcriptase-polymerase chain reaction, and SUV (Pearson's R = -0.408; P < 0.001). Good agreement between dichotomized RS (<26 vs. ≥26) and SUV (<4 vs. ≥4) was observed in 137 of 167 patients (82.0%; 95% confidence interval [CI], 76.2-87.9). Among patients with low SUV, 114 of 115 (99.1% [95% CI, 97.4-100.0]) had tumors with lower RS (<26). Although 23 of 52 women (44.2% [95% CI, 30.7-57.7]) with high SUV had higher RS (≥26), all 13 women with high RS (≥31) had high-SUV tumors. Most cases with disagreements between SUV and RS (n = 30) were classified as high SUV/lower RS (n = 29). The discordant group had higher grade or elevated Ki67 expression (≥20%) compared with the low SUV/lower RS group (n = 109), but higher PR expression compared with the high SUV/higher RS group (n = 23). Multiple logistic regression analysis showed that high SUV were associated with higher RS (≥26).

Conclusions: SUV, as a biologic parameter represented using a continuous variable, was found to associate with RS in ER-positive, HER2-negative breast cancer. Further studies may reveal the biology underlying the discordance between the markers.

Estrogen receptor status by immunohistochemistry is superior to the ligand-binding assay for predicting response to adjuvant endocrine therapy in breast cancer.
J M Harvey, G M Clark, C K Osborne, D C Allred.
J Clin Oncol, 1999 May 20; 17(5). PMID: 10334533
Highly Cited.
Biology of progesterone receptor loss in breast cancer and its implications for endocrine therapy.
Xiaojiang Cui, Rachel Schiff, +2 authors, Adrian V Lee.
J Clin Oncol, 2005 Oct 20; 23(30). PMID: 16234531
Highly Cited. Review.
Prognostic significance of progesterone receptor-positive tumor cells within immunohistochemically defined luminal A breast cancer.
Aleix Prat, Maggie Chon U Cheang, +8 authors, Charles M Perou.
J Clin Oncol, 2012 Dec 13; 31(2). PMID: 23233704    Free PMC article.
Highly Cited.
The relationship between FDG uptake in PET scans and biological behavior in breast cancer.
Wataru Shimoda, Mitsuhiro Hayashi, +2 authors, Masakatsu Sunagawa.
Breast Cancer, 2007 Aug 11; 14(3). PMID: 17690502
An optimized five-gene multi-platform predictor of hormone receptor negative and triple negative breast cancer metastatic risk.
Christina Yau, John Sninsky, +9 authors, Christopher C Benz.
Breast Cancer Res, 2013 Nov 01; 15(5). PMID: 24172169    Free PMC article.
Standardized uptake value of ¹⁸F-fluorodeoxyglucose positron emission tomography for prediction of tumor recurrence in breast cancer beyond tumor burden.
Sung Gwe Ahn, Jong Tae Park, +8 authors, Joon Jeong.
Breast Cancer Res, 2015 Jan 01; 16(6). PMID: 25551703    Free PMC article.
Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013.
A Goldhirsch, E P Winer, +5 authors, Panel members.
Ann Oncol, 2013 Aug 07; 24(9). PMID: 23917950    Free PMC article.
Highly Cited.
Meta-analysis of gene expression profiles in breast cancer: toward a unified understanding of breast cancer subtyping and prognosis signatures.
Pratyaksha Wirapati, Christos Sotiriou, +10 authors, Mauro Delorenzi.
Breast Cancer Res, 2008 Jul 30; 10(4). PMID: 18662380    Free PMC article.
Highly Cited.
American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer.
Lyndsay Harris, Herbert Fritsche, +7 authors, American Society of Clinical Oncology.
J Clin Oncol, 2007 Oct 24; 25(33). PMID: 17954709
Highly Cited. Review.
[18F]-fluorodeoxyglucose positron emission tomography can contribute to discriminate patients with poor prognosis in hormone receptor-positive breast cancer.
Sung Gwe Ahn, Minkyung Lee, +6 authors, Joon Jeong.
PLoS One, 2014 Aug 29; 9(8). PMID: 25167062    Free PMC article.
Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer.
Soonmyung Paik, Gong Tang, +11 authors, Norman Wolmark.
J Clin Oncol, 2006 May 25; 24(23). PMID: 16720680
Highly Cited.
A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer.
Soonmyung Paik, Steven Shak, +12 authors, Norman Wolmark.
N Engl J Med, 2004 Dec 14; 351(27). PMID: 15591335
Highly Cited.
A decision impact, decision conflict and economic assessment of routine Oncotype DX testing of 146 women with node-negative or pNImi, ER-positive breast cancer in the U.K.
S Holt, G Bertelli, +12 authors, C J Phillips.
Br J Cancer, 2013 May 23; 108(11). PMID: 23695023    Free PMC article.
Understanding the Warburg effect: the metabolic requirements of cell proliferation.
Matthew G Vander Heiden, Lewis C Cantley, Craig B Thompson.
Science, 2009 May 23; 324(5930). PMID: 19460998    Free PMC article.
Highly Cited. Review.
Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update.
Antonio C Wolff, M Elizabeth H Hammond, +19 authors, College of American Pathologists.
J Clin Oncol, 2013 Oct 09; 31(31). PMID: 24101045
Highly Cited.
The effects of estrogen, progesterone, and C-erbB-2 receptor states on 18F-FDG uptake of primary breast cancer lesions.
Ayse Mavi, Tevfik F Cermik, +6 authors, Abass Alavi.
J Nucl Med, 2007 Jul 17; 48(8). PMID: 17631558
Expression of centromere protein F (CENP-F) associated with higher FDG uptake on PET/CT, detected by cDNA microarray, predicts high-risk patients with primary breast cancer.
Shigeto Ueda, Nobuo Kondoh, +10 authors, Hidetaka Mochizuki.
BMC Cancer, 2008 Dec 24; 8. PMID: 19102762    Free PMC article.
Prospective Validation of a 21-Gene Expression Assay in Breast Cancer.
Joseph A Sparano, Robert J Gray, +28 authors, George W Sledge.
N Engl J Med, 2015 Sep 29; 373(21). PMID: 26412349    Free PMC article.
Highly Cited.
Comparisons of tumor-infiltrating lymphocyte levels and the 21-gene recurrence score in ER-positive/HER2-negative breast cancer.
Sung Gwe Ahn, Yoon Jin Cha, +3 authors, Joon Jeong.
BMC Cancer, 2018 Mar 27; 18(1). PMID: 29573739    Free PMC article.
Dual time point 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in primary breast cancer.
Yoji Yamagishi, Tomomi Koiwai, +8 authors, Hitoshi Tsuda.
BMC Cancer, 2019 Nov 30; 19(1). PMID: 31775675    Free PMC article.
Low PR in ER(+)/HER2(-) breast cancer: high rates of TP53 mutation and high SUV.
Sung Gwe Ahn, Chang Ik Yoon, +7 authors, Joon Jeong.
Endocr Relat Cancer, 2018 Nov 09; 26(2). PMID: 30407916    Free PMC article.
Genomic Signature of the Standardized Uptake Value in 18F-Fluorodeoxyglucose Positron Emission Tomography in Breast Cancer.
Seon-Kyu Kim, Sung Gwe Ahn, +6 authors, In-Sun Chu.
Cancers (Basel), 2020 Feb 26; 12(2). PMID: 32093417    Free PMC article.
Genetic features associated with 18F-FDG uptake in intrahepatic cholangiocarcinoma.
Keun Soo Ahn, Koo Jeong Kang, +7 authors, Kyoung Sook Won.
Ann Surg Treat Res, 2019 Apr 04; 96(4). PMID: 30941318    Free PMC article.