Role of pathologic prognostic factors in breast cancer patients with isolated bone metastasis and relationship between SUVmax and prognostic factors

Document Type : Original Article

Authors

1 Department of Nuclear Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey

2 Department of Oncology, Faculty of Medicine, Pamukkale University, Denizli, Turkey

3 Department of Pathology, Faculty of Medicine, Pamukkale University, Denizli, Turkey

Abstract

Introduction: 18F-FDG PET/CT provides very effective results in detecting metastases of breast cancer. In our study, we investigated the relationship between maximum standard uptake value (SUVmax) and prognostic pathologic factors in breast cancer cases with isolated bone metastasis and whether there was any difference in terms of prognostic pathologic factors between the group with and without bone metastasis.
Methods: Between 2013 and 2016, isolated bone metastases (55 female; 56±12 years; 32-87), and non-metastatic (46 female; 55±13 years; 30-81) patients who were referred to department of nuclear medicine and underwent 18F-FDG PET/CT for staging were included in the study. PET/CT images of patients and pathologic prognostic factors were evaluated retrospectively. SUVmax value of the most intense activity from metastatic bone lesions was calculated.
Results: In the metastatic group, there was no statistically significant relationship between measured SUVmax value of bone metastasis and pathologic prognostic factors. A statistically significant difference was found between the metastatic group and the non-metastatic group in terms of lymph node stage, lymphovascular/perineural invasion. The lymph node stage in the metastatic group was higher than the non-metastatic group. The presence of lymphovascular/perineural invasion in bone metastasis cases was more than in the non-metastatic group.
Conclusion: In our study, it was determined that there was a relationship between the lymph node stage, lymphovascular/ perineural invasion and formation of bone metastasis in breast cancer. Between SUVmax values and other factors in the metastatic group, no significant relationship was detected.

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Main Subjects


  1. Youlden DR, Cramb SM, Dunn NA, Muller JM, Pyke CM, Baade PD. The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer Epidemiol. 2012 Jun;36(3):237-48.
  2. Brewster AM, Hortobagyi GN, Broglio KR, Kau SW, Santa-Maria CA, Arun B, Buzdar AU, Booser DJ, Valero V, Bondy M, Esteva FJ. Residual risk of breast cancer recurrence 5 years after adjuvant therapy. J Natl Cancer Inst. 2008 Aug 20;100(16):1179-83.
  3. Perrone MA, Musolina A, Michiara M, Di Biasio B, Bella M, Franciosi V, Cocconi G, Camisa R, Todeschini R, Cascinu S. Early detection of recurrence in the follow-up of primary breast cancer in an asymptomatic or symptomatic phase. Tumori. 2004 May;90:276-279.
  4. Vogel CL, Azevedo S, Hilsenbeck S, East DR, Ayub J. Survival after first recurrence of breast cancer. The Miami experience. Cancer. 1992 July;70:129-135.
  5. Oka H, Kondoh T, Seichi A, Hozumi T, Nakamura T. Incidence and prognostic factors of Japanese breast cancer patients with bone metastasis. J Orthop Sci. 2006 Jan;11(1):13-19.
  6. Banin Hirata BK, Oda JM, Losi Guembarovski R, Ariza CB, de Oliveira CE, Watanabe MA. Molecular markers for breast cancer: prediction on tumor behavior. Dis Markers. 2014;2014:513158.
  7. Piccart-Gebhart MJ. New developments in hormone receptor-positive disease. Oncologist. 2010;15 Suppl 5:18-28.
  8. Solomayer EF, Diel IJ, Meyberg GC, Gollan C, Bastert G. Metastatic breast cancer: clinical course, prognosis, and therapy related to the first site of metastasis. Breast Cancer Res Treat. 2000 Feb;59(3):271-8.
  9. Neville AM, Bettelheim R, Gelber RD, Säve-Söderbergh J, Davis BW, Reed R, Torhorst J, Golouh R, Peterson HF, Price KN. Factor predicting treatment responsiveness and prognosis node-negative breast cancer. International [Ludwig] Breast Cancer Study Group. J Clin Oncol. 1992;10:696-705.
  10. Perez JE, Machiavelli M, Leone BA, Romero A, Rabinovich MG, Vallejo CT, Bianco A, Rodriguez R, Cuevas MA, Alvarez LA. Bone-only versus visceral-only metastatic pattern in breast cancer: analysis of 150 patients. A GOCS study. Am J Clin Oncol. 1990 Aug;13(4):294-8.
  11. Lacroix M. Significance, detection and markers of disseminated breast cancer cells. Endocr Relat Cancer. 2006 Dec;13(4):1033-67.
  12. Tanriverdi O, Menekse S, Teker F, Oktay E, Nur Pilanc K, Gunaldi M, Kocar M, Kacan T, Bahceci A, Avci N, Akman T, Cokmert S, Yesil-Cinkir H, Teoman Yanmaz M. The mean platelet volume may predict the development of isolated bone metastases in patients with breast cancer: a retrospective study of the Young Researchers Committee of the Turkish Oncology Group (TOG). J BUON. 2016 Jul-Aug;21(4):840-850.
  13. Buck AK, Schirrmeister H, Mattfeldt T, Reske SN. Biological characterisation of breast cancer by means of PET. Eur J Nucl Med Mol Imaging. 2004 Jun;31 Suppl 1:S80-7.
  14. Smith TA, Sharma RI, Thompson AM, Paulin FE. Tumor 18F-FDG incorporation is enhanced by attenuation of P53 function in breast cancer cells in vitro. J Nucl Med. 2006 Sep;47(9):1525-30.
  15. Buck A, Schirrmeister H, Kühn T, Shen C, Kalker T, Kotzerke J, Dankerl A, Glatting G, Reske S, Mattfeldt T. FDG uptake in breast cancer: correlation with biological and clinical prognostic parameters. Eur J Nucl Med Mol Imaging. 2002 Oct;29(10):1317-23.
  16. Zytoon AA, Murakami K, El-Kholy MR, El-Shorbagy E, Ebied O. Breast cancer with low FDG uptake: characterization by means of dual-time point FDG-PET/CT. Eur J Radiol. 2009 Jun;70(3):530-38.
  17. Gil-Rendo A, Martínez-Regueira F, Zornoza G, García-Velloso MJ, Beorlegui C, Rodriguez-Spiteri N. Association between [18F] fluorodeoxyglucose uptake and prognostic parameters in breast cancer. Br J Surg. 2009 Feb;96(2):166-70.
  18. Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thürlimann B, Senn HJ. Panel members. Strategies for subtypes–dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011 Jun;22:1736-47.
  19. Coleman RE, Smith P, Rubens RD. Clinical course and prognostic factors following bone recurrence from breast cancer. Br J Cancer. 1998;77(2):336-40.
  20. Wei S, Li Y, Siegal GP, Hameed O. Breast carcinomas with isolated bone metastases have different hormone receptor expression profiles than those with metastases to other sites or multiple organs. Ann Diagn Pathol. 2011 Apr;15(2):79-83.
  21. Coleman RE, Rubens RD. The clinical course of bone metastases from breast cancer. Br J Cancer.1987 Jan;55(1):61-6.
  22. Koenders PG, Beex LV, Langens R, Kloppenborg PW, Smals AG, Benraad TJ. Steroid hormone receptor activity of primary human breast cancer and pattern of first metastasis. The Breast Cancer Study Group. Breast Cancer Res Treat. 1991 Mar;18(1):27-32.
  23. Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006 Oct;12(Suppl 20):6243-49.
  24. Smid M, Wang Y, Zhang Y, Sieuwerts AM, Yu J,  Klijn JG, Foekens JA, Martens JW.  Subtypes of breast cancer show preferential site of relapse. Cancer Res. 2008;68(9):3108-14.
  25. Kennecke H, Yerushalmi R, Woods R, Cheang MC, Voduc D, Speers CH, Nielsen TO,  Gelmon K. Metastatic behavior of breast cancer subtypes. J Clin Oncol. 2010 Jul;28(20):3271-77.
  26. Goldhirsch A, Glick JH, Gelber RD, Coates AS, Thürlimann B, Senn HJ, Panel Members. Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol. 2005 Sep;16:1569-83.
  27. Groheux D, Giacchetti S, Moretti JL, Porcher R, Espie M, Lehmann-Che J, Roquancourt A, Hamy AS, Cuvier C, Vercellino L, Hindié E. Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer. Eur J Nucl Med Mol Imaging. 2011 Mar;38(3):426-35.
  28. Vicente AMG, Castrejón AS, Martín AL, López-Muñiz IC, Madero VM, Sánchez MM, Muñoz AP, Aunión RE, Ageitos AG. Molecular subtypes of breast cancer: metabolic correlation with 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging. 2013 Sep;40(9):1304-11.
  29. Ueda S, Tsuda H, Asakawa H, Shigekawa T, Fukatsu K, Kondo N, Yamamoto M, Hama Y, Tamura K, Ishida J, Abe Y, Mochizuki H. Clinicopathological and prognostic relevance of uptake level using 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in primary breast cancer. Jpn J Clin Oncol. 2008 Apr;38(4):250-58.
  30. Koo HR, Park JS, Kang KW, Cho N, Chang JM, Bae MS, Kim WS, Lee SH, Kim MY, Kim JY, Seo M, Moon WK. 18F-FDG uptake in breast cancer correlates with immunohistochemically defined subtypes. Eur Radiol. 2014 Mar;24(3):610-18.
  31. Tchou J, Sonnad SS, Bergey MR, Basu S, Tomaszewski J, Alavi A, Schnall M. Degree of tumor FDG uptake correlates with proliferation index in triple negative breast cancer. Mol Imaging Biol. 2010 Dec;12(6):657-62.
  32. Zhang J, Jia Z, Zhou M, Ragaz J, Zhang YP, Wang BY, Wang ZH, Hu XC, Zhang YJ. The SUVmax for 18F-FDG correlates with molecular subtype and survival of previously untreated metastatic breast cancer. Clin Nucl Med. 2013 Apr;38(4):256-62.
  33. Cokmert S, Tanriverdi O, Karapolat I, Demir L, Bayoglu V, Can A, Akyol M, Yilmaz Y, Oktay Tarhan M. The maximum standardized uptake value of metastatic site in 18F-FDG PET/CT predicts molecular subtypes and survival in metastatic breast cancer: An Izmir Oncology Group study. J BUON. 2016 Nov-Dec;21(6):1410-1418.
  34. Zhang J, Jia Z, Ragaz J, Zhang YJ, Zhou M, Zhang YP , Li G, Wang BY, Wang ZH, Hu XC. The maximum standardized uptake value of 18 F-FDG PET scan to determine prognosis of hormone-receptor positive metastatic breast cancer. BMC Cancer. 2013;13:42.