Wendie A. Berg MD, PhD, Presenter: Research grant, Naviscan, Inc Researcher, Naviscan, Inc Speaker, SuperSonic Imagine Researcher, SuperSonic Imagine Medical Advisory Board, Koninklijke Philips Electronics NV Author, Gamma Medica Ideas, License, Merge Healthcare

Kathleen S. Madsen PhD, Abstract Co-Author: Employee, Certus International, Inc Research funded, Naviscan, Inc

Kathy Turner, Abstract Co-Author: Employee, Certus International, Inc

Judith E. Kalinyak MD, PhD, Abstract Co-Author: Officer, Naviscan, Inc

To relate quantitative FDG uptake with histopathologic prognostic markers in breast cancer.

145 women at one site with newly diagnosed breast cancer anticipating breast-conserving surgery underwent PEM in an IRB-approved, HIPAA-compliant protocol and 137 participants were analyzable. Semi-quantitative maximum PEM uptake values (PUVmax) and lesion-to-background-ratios (LTB) were determined for the primary malignancy per breast and compared to histopathologic subtypes based on ER, PR, and Her-2/neu receptor status, Ki-67 proliferation index, lymphovascular invasion (LVI), tumor type, size, and axillary node status. 

138 index and 6 contralateral malignancies [34 DCIS, 110 invasive (14 ILC, 96 IDC) with median size 1.6 cm, range 0.3 to 8.5; axillary metastases in 24/144 (17%)] were analyzable in 137 women (median age 57 years, range 26-82). Median LTB for 14/15 (93%) visualized triple negative (invasive) cancers was 5.6 (mean 6.2, CI 4.6 to 7.9) [median PUVmax 2.6 (mean 2.7, 95% CI 1.9 to 3.6)]. LTB for triple negative cancers was lower than 3 Her-2 positive (ER-, PR-) cancers [LTB 12.8, mean 10.5, CI 6.9 to 14.1 (p=.03); PUVmax 4.0 (mean 3.5, CI 1.7 to 5.3)], but trended higher than ER+ cancers (p=.075) [86/92 (93%) seen on PEM: LTB 3.5 (mean 4.6, CI 4.0 to 5.3); PUVmax 1.7 (mean 2.4, CI 2.0 to 2.7)]. 29/34 (85%) DCIS were seen on PEM, with lower uptake than invasive cancer [median LTB 2.5 (mean 3.0, CI 1.8 to 4.2) vs 3.9 (mean 5.0, CI 4.4 to 5.7, p=.003); PUVmax 1.4 (mean 1.4, CI 0.9 to 2.0) vs 1.9 (mean 2.4 (CI 2.1 to 2.8)]. LTB and PUVmax trended higher for IDC than ILC (median 4.1 vs. 3.0, p=.15; median 1.9 vs. 1.5, p=.056). For IDC, LTB and PUVmax correlated with tumor grade (p<.001 for each): for grade I IDC medians 2.5, 1.5 respectively; grade II, 3.7, 1.8; and grade III, 7.1, 2.9. LTB and PUVmax correlated moderately with Ki-67 (Pearson’s ρ=.47 and .34 respectively) and invasive tumor size (ρ=.29 for each), but not with LVI (p-values=.21 and .66 respectively) or axillary node status (p=.46 and .72).

Increasing semi-quantitative FDG uptake on PEM correlates well with increasing Ki-67 proliferation index and higher invasive tumor grade. Triple negative cancers tended to show greater uptake than ER+ tumors. LVI and axillary node status could not be predicted. (Funded by NIH grant # 5 R44 CA103102-05 and Naviscan, Inc)

Quantitative FDG uptake relates to many biologically important prognostic markers for breast cancer.

Berg, W, Madsen, K, Turner, K, Kalinyak, J, Quantitative FDG Uptake on High-Resolution Breast PET [Positron Emission Mammography (PEM)]: Correlation with Histopathologic Markers in Breast Cancer.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11012018.html