Kanae Kawai Miyake MD, Presenter: Nothing to Disclose

Yuji Nakamoto MD, PhD, Abstract Co-Author: Nothing to Disclose

Shigehira Saji, Abstract Co-Author: Nothing to Disclose

Tomoharu Sugie, Abstract Co-Author: Nothing to Disclose

Kensuke Kurihara, Abstract Co-Author: Nothing to Disclose

Koya Nakatani MD, PhD, Abstract Co-Author: Research Grant, Nihon Medi-Physics Co, Ltd

Shotaro Kanao MD, Abstract Co-Author: Nothing to Disclose

Masakazu Toi, Abstract Co-Author: Nothing to Disclose

Kaori Togashi MD, PhD, Abstract Co-Author: Research Grant, Bayer AG Research Grant, DAIICHI SANKYO Group Research Grant, Eisai Co, Ltd Research Grant, FUJIFILM Holdings Corporation Research Grant, Nihon Medi-Physics Co, Ltd Research Grant, Shimadzu Corporation Research Grant, Toshiba Corporation Research Grant, Covidien AG

The physiological plasma estrogen concentration is consistently maintained in lower range such as 10 to 30 pM in postmenopausal women. However in premenopausal women, it changes more widely due to menstruation cycle and ranges around 0.01 nM to 10 nM. The purpose of this study was to evaluate whether the physiological fluctuation of estrogen level affects fluorodeoxyglucose (FDG) uptake in breast cancers of premenopausal patients.

Thirty-three premenopausal females (age 42±5 ys) with solid mass-type invasive breast cancer, who underwent positron emission tomography/computed tomography with FDG before therapy, were retrospectively analyzed. The maximal standardized uptake values (SUVmax) in primary breast cancer were compared among the patients, according to the menstruation cycle, in each clinicopathological subtype. In in vitro study, ER-positive T47D human breast cancer cells were previously incubated under different concentrations of 17β-estradiol (E2) level, and FDG uptake was evaluated after exposure to various doses of E2.  

In patients with ‘Luminal A’ breast cancer, FDG uptake was significantly higher during the late menstrual period (after day10: 6.2±2.2, n=8) than during the early menstrual period (day 1-9: 3.5±2.0, n=7) (p=0.026). There was no significant difference between the two periods in other subtypes, i.e. ‘Luminal B (HER2-negative)’ (n=10), ‘Luminal B (HER2-positive)’ (n=3), and ‘Triple-negative’ (n=5). In the in vitro study, E2 augmented FDG uptake in T47D cells in a dose- and time-dependent manner, which was inhibited by ER-agonists, such as tamoxifen and fulvestrant. With exposure with 0.01 nM, 0.1 nM, 1 nM and 10 nM E2 after incubation in E2-free medium, mean FDG uptake reached 114%, 121%, 150% and 147%, respectively, by 24 hr, and 153%, 173%, 174% and 178%, respectively, by 48hr. With the baseline E2 level of 0.01 nM, FDG uptake was significantly increased when E2 level was elevated to ≥1 nM. However, when the baseline E2 level was 0.1 nM, no significant elevation of uptake was observed when E2 level increased up to 1 to 10 nM.

Our preliminary data suggest that, in premenopausal patients with possibly lower baseline E2 level, FDG uptake in ‘Luminal’-type cancer could be elevated after E2 surges during the menstrual cycle.

Fluorodeoxyglucose uptake in breast cancer can be influenced by physiological estrogen fluctuations during the menstrual cycle.

Miyake, K, Nakamoto, Y, Saji, S, Sugie, T, Kurihara, K, Nakatani, K, Kanao, S, Toi, M, Togashi, K, Fluorodeoxyglucose Uptake in Breast Cancer Can Be Influenced by Physiological Estrogen Fluctuations during the Menstrual Cycle.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13017979.html