Total Lesion Glycolysis on 18F-FDG PET/CT of Women with Non-Locally Advanced Breast Cancer: Does it Correlate with CT Density of the Lesion?

Yıl 2019, , 46 - 49, 14.03.2019

Sevin Coşar Ayaz

https://doi.org/10.16948/zktipb.493796

Öz

Objective:
Breast cancer (BC) is the second most frequent malignancy in women. Fluorine-18-fluorodeoxyglucose
(¹⁸F-FDG) positron emission tomography
(PET)/computed tomography (CT)
has become a major diagnostic tool for staging of the disease and
predicting the prognosis. We aimed to
evaluate the correlation between main quantitative ¹⁸F-FDG
PET/CT parameters- primarily TLG
(total lesion glycolysis), and CT density measurements as Hounsfield Unit (HU) of the primary BC masses in non-locally advanced BC (non-LABC)
patients. And also we aimed to see whether there is a correlation between the
volume and HU measurements of BC masses in non-LABC patients.

Methods:
In this retrospective study, we included 17 women with unilateral non-LABC having
a mean age of 54.1±10.3 years who underwent ¹⁸F-FDG PET/CT before any treatment between
2016−2017.  The mean volume, HU, maximum standardized uptake value (SUVmax) and
TLG of the primary BC masses with their standard
deviations and 95% confidence intervals (CI)s were calculated. Of the BC masses, the
correlations between their mean TLG and mean HU, their mean SUVmax and mean HU,
their mean volume and mean HU were statistically calculated.

Results:
The
mean volume and HU of BC masses were 4.6±3.9 mL
(95% CI: 2.6−6.6) and 42.5±4.1 HU (95% CI: 40.3−44.6), respectively. The
mean SUVmax and TLG of BC masses were 6.4±5.6 g/mL (95%
CI: 3.5−9.3) and 22.1±14.2 g/mLxmL (95% CI:
14.7−29.4), respectively. Of the BC masses, the correlations between
their mean TLG and mean HU  (r=-0.443, P=0.075),
besides their  mean SUVmax and mean HU (r=-0.368, P=0.146) were not
statistically significant. The correlation between the mean
volume and the mean HU of BC masses was also statistically insignificant (r=-0.214, P=0.410).

Conclusion:
In women with non-LABC, ¹⁸F-FDG PET/CT is a useful and reliable tool
for obtaining the TLG of primary BC masses presenting with various CT densities. 

Anahtar Kelimeler

Fluorodeoxyglucose F18, Positron Emission Tomography Computed Tomography, Carcinoma, Ductal, Breast, Glycolysis

Lokal Olarak İlerlememiş Meme Kanserli Kadınların 18F-FDG PET/BT Tetkiklerinde Toplam Lezyon Glikolizi: Lezyonun BT Dansitesi ile Bağıntılı mı?

Öz

Amaç: Meme kanseri
kadınlardaki ikinci en sık malign tümördür.
Flor-18-florodeoksiglukoz
pozitron emisyon tomografisi/bilgisayarlı tomografi (18F-FDG PET/BT),
hastalığın evrelemesi ve prognozun belirlenmesi için başlıca tanı aracı haline
gelmiştir. Lokal olarak ilerlememiş meme kanseri olgularının primer
kitlelerinde, başta toplam lezyon glikolizi (TLG) olmak üzere ana nicel 18F-FDG
PET/BT değişkenleri ve Hounsfield ünitesi (HU) şeklinde BT dansite ölçümleri arasındaki bağıntıyı değerlendirmeyi ve ayrıca, bu kitlelerin
hacimleri ile  HU ölçümleri arasında bir bağıntı olup olmadığını görmeyi amaçladık.

Gereç ve Yöntem: Bu retrospektif
çalışmaya, 2016−2017 yıllarında tedavi öncesi 18F-FDG PET/BT tetkiki yapılan,
yaş ortalaması 54.1±10.3 yıl olan ve tek taraflı, lokal olarak ilerlememiş meme
kanseri bulunan 17 kadın olgu alınmıştır. Primer meme kanseri kitlelerinin
hacim,  HU, en yüksek standart tutulum
değeri (SUVmaks) ve TLG ortalamaları, standart sapmalar ve %95 güven aralığı
(GA) ile birlikte hesaplandı. Bu kitlelerin TLG ve HU, SUVmaks ve HU, hacim ve
HU değerleri arasındaki bağıntı istatistiksel olarak hesaplandı.

Bulgular: Meme
kanseri kitlelelerinin ortalama hacmi ve HU değeri sırasıyla 4.6±3.9 mL (%95
GA: 2.6−6.6) ve  42.5±4.1 HU (%95 GA:
40.3−44.6) bulundu. Bu kitlelerin ortalama SUVmaks ve TLG’si sırasıyla 6.4±5.6 g/mL (%95 GA: 3.5−9.3)
ve  22.1±14.2
g/mLxmL (%95 GA: 14.7−29.4) bulundu. Meme kanseri kitlelerinin ortalama TLG’si ile HU
değeri arasında (r=-0.443,
P=0.075) ve ortalama SUVmaks’ı ile HU değeri
arasında (r=-0.368,
P=0.146) istatistiksel olarak anlamlı bağıntı saptanmadı. Bu kitlelerin ortalama hacmi ve HU değeri arasındaki
bağıntı da istatistiksel olarak anlamlı bulunmadı (r=-0.214, P=0.410).

Sonuç: 18F-FDG PET/BT lokal olarak
ilerlememiş meme kanserli kadınlarda, değişik BT dansiteleri ile kendini
gösteren primer meme kanseri kitlelerinin TLG’lerini hesaplamada  yararlı ve güvenilir bir araçtır.  

Anahtar Kelimeler

Fluorodeoksiglukoz F18, Pozitron Emisyon Tomografi bilgisayarlı Tomografi, Karsinoma, Duktal, Meme, Glikoliz

Kaynakça

• 1. Breast cancer. Available at: https://www.cancer.gov/types/breast. Access date: 23.08.20182. Invasive breast cancer. Available at : https://www.cancerresearchuk.org/about-cancer/breast-cancer/stages-types-grades/types/invasive-breast-cancer. Access date: 23.08.20183. Özşahin H , Yetkin G , Sevim ZK , Çitgez B , Uludağ M ,Mihmanlı M. Ulcerated giant breast cancer. Med Bull Sisli Etfal Hosp 2016;50(2):155−8.4. Robertson IJ, Hand F, Kell MR. FDG-PET/CT in the staging of local/regional metastases in breast cancer. Breast 2011;20(6):491−4.5. Liu Y. Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer. World J Clin Oncol 2014;5(5):982−9. 6. Ayaz S, Gültekin SS, Ayaz ÜY, Dilli A. Initial fludeoxyglucose (18F) positron emission tomography-computed tomography (FDG-PET/CT) imaging of breast cancer - correlations with the primary tumour and locoregional metastases. Pol J Radiol 2017;82:9−16. 7. Kitajima K, Miyoshi Y, Yamano T, Odawara S, Higuchi T, Yamakado K. Prognostic value of FDG-PET and DWI in breast cancer. Ann Nucl Med 2018;32(1):44−53.8. Song BI, Hong CM, Lee HJ, Kang S, Jeong SY, Kim HW, et al. Prognostic value of primary tumor uptake on F-18 FDG PET/CT in patients with invasive ductal breast cancer. Nucl Med Mol Imaging 2011;45(2):117−24. 9. Ueda S, Tsuda H, Asakawa H, Shigekawa T, Fukatsu K, Kondo N, et al. 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;38(4):250−8. 10. Yoo J, Kim BS, Chung J, Yoon HJ. Percentage change of primary tumor on 18F-FDG PET/CT as a prognostic factor for invasive ductal breast cancer with axillary lymph node metastasis: Comparison with MRI. Medicine (Baltimore). 2017;96(31):e7657. 11. Jiménez-Ballvé A, García García-Esquinas M, Salsidua-Arroyo O, Serrano-Palacio A, García-Sáenz JA, Ortega Candil A, et al. Prognostic value of metabolic tumour volume and total lesion glycolysis in 18F-FDG PET/CT scans in locally advanced breast cancer staging. Rev Esp Med Nucl Imagen Mol 2016;35(6):365−72. 12. Breast cancer staging. Available at: https://cancerstaging.org/references-tools/quickreferences/Documents/BreastSmall.pdf. Access date: 22.08.201813. Singh D, Miles K. Multiparametric PET/CT in oncology. Cancer Imaging 2012;12:336−44. 14. Satoh Y, Nambu A, Ichikawa T, Onishi H. Whole-body total lesion glycolysis measured on fluorodeoxyglucose positron emission tomography/computed tomography as a prognostic variable in metastatic breast cancer. BMC Cancer 2014;14:525.15. Kumar R, Chauhan A, Zhuang H, Chandra P, Schnall M, Alavi A. Standardized uptake values of normal breast tissue with 2-deoxy-2-[F-18]fluoro-D: -glucose positron emission tomography: variations with age, breast density, and menopausal status. Mol Imaging Biol 2006;8(6):355−62.16. Lakhani P, Maidment AD, Weinstein SP, Kung JW, Alavi A. Correlation between quantified breast densities from digital mammography and 18F-FDG PET uptake. Breast J 2009;15(4):339−47. 17. Vranjesevic D, Schiepers C, Silverman DH, Quon A, Villalpando J, Dahlbom M, et al. Relationship between 18F-FDG uptake and breast density in women with normal breast tissue. J Nucl Med 2003;44(8):1238−42.18. Flechsig P, Walker C, Kratochwil C, König L, Iagura A, Moltz J, et al. Role of CT density in PET/CT-based assessment of lymphoma. Mol Imaging Biol 2018;20(4):641−9. 19. Goudarzi B, Jacene HA, Wahl RL. Diagnosis and differentiation of bronchioloalveolar carcinoma from adenocarcinoma with bronchioloalveolar components with metabolic and anatomic characteristics using PET/CT. J Nucl Med 2008;49(10):1585−92. 20. Bogowicz M, Riesterer O, Stark LS, Studer G, Unkelbach J, Guckenberger M, et al. Comparison of PET and CT radiomics for prediction of local tumor control in head and neck squamous cell carcinoma. Acta Oncol 2017;56(11):1531−36. 21. Giesel FL, Schneider F, Kratochwil C, Rath D, Moltz J, Holland-Letz T, et al. Correlation between SUVmax and CT radiomic analysis using lymph node density in PET/CT-based lymph node staging. J Nucl Med 2017;58(2):282−7. 22. Flechsig P, Frank P, Kratochwil C, Antoch G, Rath D, Moltz J, et al. Radiomic analysis using density threshold for FDG-PET/CT-based N-staging in lung cancer patients. Mol Imaging Biol 2017;19(2):315−22. 23. Nakadate M, Yoshida K, Ishii A, Koizumi M, Tochigi N, Suzuki Y, et al. Is 18F-FDG PET/CT useful for distinguishing between primary thyroid lymphoma and chronic thyroiditis? Clin Nucl Med 2013;38(9):709−14. 24. Weber WA, Figlin R. Monitoring cancer treatment with PET/CT: does it make a difference? J Nucl Med 2007; 48 Suppl 1:36S-4