Comparación del valor pronóstico de diferentes criterios de respuesta metabólica determinados por PET/TC en pacientes con cáncer de mama metastásico en tratamiento con inhibidores de CDK 4/6 / Comparison of prognostic value of different metabolic response criteria determined by PET/CT in patients with metastatic breast cancer under CDK 4/6 inhibitor treatment

Objetivo Este estudio evalúa el papel pronóstico de diferentes criterios de respuesta metabólica de la PET/TC con [18F]FDG en pacientes con cáncer de mama metastásico (CMM) tratadas con inhibidores de la cinasa dependiente de ciclina 4/6 (CDK 4/6). Materiales y métodos Evaluamos retrospectivamente los datos de pacientes con CMM tratados con inhibidores de CDK 4/6 a los que se les realizó una [18F]FDG PET/TC antes de iniciar y durante el tratamiento. La respuesta de [18F]FDG PET/CT se evaluó con la Organización Europea para la Investigación y el Tratamiento del Cáncer, los criterios de respuesta de PET en tumores sólidos (PERCIST) y los criterios de glucólisis de lesión total de cuerpo entero (WBTLG). Fleiss kappa se calculó para evaluar la concordancia entre los criterios de respuesta metabólica. El criterio de valoración del estudio fue la supervivencia libre de progresión (PFS). Los datos de SLP se analizaron mediante el método de Kaplan-Meier y se compararon mediante la prueba de rango logarítmico. Resultados El estudio incluyó a 16 pacientes con CMM que recibieron terapia con inhibidores de CDK 4/6. Según PERCIST, se encontró respuesta metabólica parcial (PMR) en siete pacientes, enfermedad metabólica estable (SMD) en siete pacientes y enfermedad metabólica progresiva (PMD) en dos pacientes. Según la Organización Europea para la Investigación y el Tratamiento del Cáncer, se detectó PMR en ocho pacientes, SMD en siete pacientes y PMD en un paciente. Según WBTLG, se encontró PMR en 10 pacientes, SMD en cuatro pacientes y PMD en dos pacientes. Hubo un acuerdo justo entre los tres criterios. Si bien se detectó progresión en siete de los pacientes durante el seguimiento, no se detectó progresión en nueve de ellos. El análisis de Kaplan-Meier reveló que los que respondieron según WBTLG mostraron una SLP significativamente más larga que los que no respondieron (AU)

Purpose This study evaluates the prognostic role of different [18F]FDG PET/CT metabolic response criteria in metastatic breast cancer (MBC) patients treated with cyclin-dependent kinase 4/6 inhibitors (CDK 4/6). Materials and methods We retrospectively evaluated the data of MBC patients treated with CDK 4/6 inhibitors who underwent an [18F]FDG PET/CT scan before starting and during treatment. [18F]FDG PET/CT response was assessed with the European Organization for Research and Treatment of Cancer, PET response criteria in solid tumors (PERCIST), and whole-body total lesion glycolysis (WBTLG) criteria. Fleiss kappa was computed to assess the agreement between metabolic response criteria. The endpoint of the study was progression-free survival (PFS). PFS data were analyzed by the Kaplan–Meier method and compared using the log-rank test. Results The study included 16 MBC patients who received CDK 4/6 inhibitors therapy. According to PERCIST, partial metabolic response (PMR) was found in seven patients, stable metabolic disease (SMD) in seven patients, and progressive metabolic disease (PMD) in two patients. According to the European Organization for Research and Treatment of Cancer, PMR was detected in eight patients, SMD in seven patients, and PMD in one patient. According to WBTLG, PMR was found in 10 patients, SMD in four patients, and PMD in two patients. There was a fair agreement between the three criteria. While progression was detected in seven of the patients during follow-up, no progression was detected in nine of them. Kaplan–Meier analysis revealed that the responders according to WBTLG showed significantly longer PFS than non-responders. Conclusion Treatment response according to WBTLG criteria during treatment appears to be associated with prolonged PFS in patients treated with CDK 4/6 inhibitors for MBC (AU)

Association of 18F-FDG PET/CT textural features with immunohistochemical characteristics in invasive ductal breast cancer. / Asociación de características de textura de la PET/TC con [18F]FDG con las características inmunohistoquímicas en el cáncer de mama ductal infiltrante.

OBJECTiVES: This study investigates whether textural features (TFs) extracted from F-18 FDG positron emission tomography/computed tomography (PET/CT) are associated with IHCs of invasive ductal breast carcinoma (IDBC). MATERIALS AND METHODS: The relationship of TFs with IHCs [estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), Ki-67 proliferation index, and histological grades] from solely excised primary tumors were evaluated for a more accurate assessment. Therefore patients with early-stage IDBC who underwent pre-operative F-18 FDG PET/CT scan for staging were included in this retrospective study. The clinical staging was performed according to the 8th edition of the American Joint Committee on Cancer. Maximum standardized uptake value (SUVmax) and 37 TFs of the primary tumor were extracted from F-18 FDG PET/CT. Spearman's rank correlation test was used to evaluate the correlation between TFs and SUVmax. Receiver operating characteristic curves were generated to define the diagnostic performance of each parameter. Among these parameters, those with the highest diagnostic performance were included in the multivariate logistic regression model to identify the independent predictors of histopathological characteristics. RESULTS: A total of 124 patients were included. Histogram-uniformity, GLCM-energy, and GLCM-homogeneity showed a strong negative correlation with SUVmax, while GLRLM-SRHGE, GLZLM-HGZE, GLRLM-HGRE, GLCM-entropy, GLCM-contrast, histogram-entropy, and GLCM-dissimilarity showed a strong positive correlation. Some of the TFs were independently associated with ER-negativity, PR-negativity, HER-2-positivity, and increased Ki-67 proliferation index (GLCM-contrast, GLZLM-GLNU, histogram-uniformity, and shape-sphericity respectively). While SUVmax had an independent association with high-grade and triple-negativity, GLZLM-SZLGE, a high-order TF that shows the distribution of the short homogeneous zones with low grey-levels, had an independent association with axillary lymph node metastasis. CONCLUSIONS: ER-negative, PR-negative, HER-2-positive, triple-negative, high-grade, highly proliferative, and high-stage tumors were found to be more glycolytic and metabolically heterogeneous. These findings suggest that the use of TFs in addition to SUVmax may improve the prognostic value of F-18 FDG PET/CT in IDBC, as certain TFs were independently associated with many IHCs and predicted axillary lymph node involvement.