The impact of PET imaging on triple negative breast cancer: an updated evidence-based perspective,European Journal of Nuclear Medicine and Molecular Imaging

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The impact of PET imaging on triple negative breast cancer: an updated evidence-based perspective
European Journal of Nuclear Medicine and Molecular Imaging ( IF 8.6 ) Pub Date : 2024-08-07 , DOI: 10.1007/s00259-024-06866-9
Luca Filippi ₁ , Luca Urso ₂ , Cristina Ferrari ₃ , Priscilla Guglielmo ₄ , Laura Evangelista _{5,

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Affiliation

Introduction

Triple-negative breast cancer (TNBC) is a subtype of breast cancer characterized by the absence of estrogen, progesterone, and HER2 receptors. It predominantly affects younger women and is associated with a poor prognosis. This systematic review aims to evaluate the current role of positron emission tomography (PET) in the management of TNBC patients and to identify future research directions.

Methods

We systematically searched the PubMed, Scopus, and Web of Science databases up to February 2024. A team of five researchers conducted data extraction and analysis. The quality of the selected studies was assessed using a specific evaluation form.

Results

Twenty-eight studies involving 2870 TNBC patients were included in the review. Key clinical applications of PET in TNBC included predicting pathological complete response (pCR) in patients undergoing neoadjuvant chemotherapy (NAC), assessing the prognostic value of baseline PET, and initial disease staging. Two studies utilized PSMA-ligand agents, while the majority used [¹⁸F]FDG-based PET. Significant associations were found between baseline [18F]FDG uptake and molecular biomarkers such as PDL-1, androgen receptor, and Ki67. Baseline [¹⁸F]FDG PET led to the upstaging of patients from stage IIB to stage IV, influencing treatment decisions and survival outcomes. In the NAC setting, serial PET scans measuring changes in [¹⁸F]FDG uptake, indicated by maximum standardized uptake value (SUVmax), predicted pCR with varying cut-off values correlated with different response rates. Semiquantitative parameters such as metabolic tumor volume (MTV) and PET lung index were prognostic for metastatic disease.

Conclusions

In TNBC patients, [¹⁸F]FDG PET is essential for initial disease staging in both localized and metastatic settings. It is also useful for assessing treatment response to NAC. The ability of PET to correlate metabolic activity with molecular markers and predict treatment outcomes highlights its potential in TNBC management. Further prospective studies are needed to refine these clinical indications and establish its definitive role.

中文翻译：

PET 成像对三阴性乳腺癌的影响：最新的循证观点

介绍

三阴性乳腺癌 (TNBC) 是乳腺癌的一种亚型，其特征是缺乏雌激素、孕激素和 HER2 受体。它主要影响年轻女性，并且与预后不良有关。本系统综述旨在评估目前正电子发射断层扫描 (PET) 在 TNBC 患者管理中的作用并确定未来的研究方向。

方法

我们系统地检索了截至 2024 年 2 月的 PubMed、Scopus 和 Web of Science 数据库。由五名研究人员组成的团队进行了数据提取和分析。使用特定的评估表评估所选研究的质量。

结果

该评价纳入了涉及 2870 名 TNBC 患者的 28 项研究。 PET 在 TNBC 中的关键临床应用包括预测接受新辅助化疗 (NAC) 的患者的病理完全缓解 (pCR)、评估基线 PET 的预后价值和初始疾病分期。两项研究使用了 PSMA 配体试剂，而大多数研究使用了基于 [ ¹⁸ F]FDG 的 PET。研究发现基线 [18F]FDG 摄取与 PDL-1、雄激素受体和 Ki67 等分子生物标志物之间存在显着相关性。基线[ ¹⁸ F]FDG PET导致患者从IIB期升级至IV期，影响治疗决策和生存结果。在 NAC 设置中，连续 PET 扫描测量 [ ¹⁸ F]FDG 摄取的变化，以最大标准化摄取值 (SUVmax) 表示，预测 pCR，其截止值与不同的响应率相关。代谢肿瘤体积 (MTV) 和 PET 肺指数等半定量参数可预测转移性疾病。