Search

Background: Stage II-III TNBC retains a poor outcome despite high chemosensitivity. Patients (pts) with pCR after neoadjuvant chemotherapy have a good prognosis whereas non-responding pts have a 25-40% risk of distant relapse at 5 years. pCR is thus a major goal in TNBC. We previously reported that TNLABC benefit the most of dose dense dose intense cyclophosphamide (C)-epirubicin (E) (S.Giacchetti; BJC, 2014) Aim: To confirm these results prospectively and analyze the predictive factors of response to high dose chemotherapy in TNBC. Patients and methods: From january 2009 to april 2015 non inflammatory TNLABC received high dose C (1200 mg/m2 d1 qw 2) with E (75 mg/m2/ d1 qw2) for 6 cycles. The pts had a breast biopsy with frozen tissue. We performed molecular studies: qRT-PCR for AR, FOXA1, PI3K and FASAY technic for p53 mutation.The percentage of stromal Tumor-infiltrating lymphocytes (TILs) was also evaluated by two independent pathologists and assessed as a continuous variable. A18F-FDG PET/CT was performed initially and after 2 courses of chemotherapy and the metabolic answer assessed as a variation of the tumor uptake (ΔSUVmax). We report here the pathological complete response (pCR) (absence of infiltrative carcinomas in the breast and in the lymph nodes) and the factors associated with pCR. Results: The characteristics of the 74 pts are listed in table 1. The median age is 48 years old, 48 pts (65.8%) are premenopausal and 79% did not have any family history of breast cancers. TIL was divided in 3 groups < 10 % (26 pts, 40 %); 10-50 % (30 pts, 46 %) > 50% (9 pts, 14 %). Pathological response was assessed in 66 pts, one pt progressed during chemotherapy and 6 pts did not undergo surgery yet. 28 pts were in pCR (42.4 %). With a median follow up of 25 months, 13 pts (17.8 %) progressed and 8 (11%) died. Table 1: Patients characteristics and pCR according to tumor features and metabolic responseCharacteristicsNumber of pts (%)N of pts evaluated for pCRpCR (%)OR [IC 95%]p-valueTumor size T2363519 (54)10.04T337319 (29)0.34 [0.12 ; 0.96]Nodal status N0363315 (46)10.62N1/N2/N3 24/11/33313 (39)0.78 [0.29 ; 2.07]Histological grade: 2660 (0) 0.04*3676028 (47)TILs Tumor size, tumor grade, percentage of TILs, the change in 18F-fluorodeoxyglucose tumor uptake (ΔSUVmax) were significantly associated with pCR at univariate analysis. Only one factor remained significant at multivariate analysis, the ΔSUVmax, OR: 0.04 [0.007- 0.27], p = 0.0008. Conclusion: In this prospective phase III trial we confirm the efficacy of a dose dense EC in TNBC. The metabolic response evaluated with 18 F-FDG PET/CT is a strong and reliable predictor of pCR and could allow an early change of treatment for the non responders. A clinical trial is planned to test this strategy. Citation Format: Giacchetti S, De Roquancourt A, Groheux D, Piron P, Lehmann-che J, Cuvier C, Resche-rigon M, Albiter M, Roche B, Frank S, Hamy A-S, Teixeira L, Marty M, Lalloum M, Espié M. Prediction of pathological response (pCR) to neoadjuvant dose dense and intense cyclophosphamide and anthracycline in a prospective series of triple negative locally advanced breast cancers (TNLABC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-08.

Resume Le travail de plusieurs equipes a permis au cours de ces dernieres annees d’asseoir le role de la TEP au 18FDG dans le bilan initial du cancer du sein chez des patientes risque eleve d’extension ganglionnaire extra-axillaire ou d’atteinte metastatique occulte. Dans cet article de revue, nous discuterons du stade clinique a partir duquel il est licite de demander cet examen. Dans le cadre d’essais cliniques, cet examen de stadification pourra egalement servir comme point de depart a l’evaluation de la reponse au traitement neoadjuvant avec pour objectif d’identifier precocement les patientes avec mauvaise reponse therapeutique. Apres l’ere de l’interim-PET dans les lymphomes, les annees futures pourraient etre celles de l’interim-PET dans le cancer du sein. La encore, le role pilote d’equipes francaises a ete determinant. Nous soulignerons comment l’evaluation precoce du cancer du sein doit considerer les trois grands sous-types (cancer triple-negatif, cancer ER+/HER2− et cancer HER2+) de maniere separee avec des criteres de reponse specifiques. Un premier essai multicentrique de changement therapeutique guide par la reponse precoce au traitement neoadjuvant, pilote par l’equipe de Dijon, vient d’etre publie, avec des resultats encourageants.

Background: Prospective evaluation of the role of 18FDG-PET/CT in patients with large primary operable breast cancer. Material and Methods: During 56 months, consecutive patients with large (>2cm) breast cancer and clinical stage IIA/IIB/IIIA (based on clinical examination, mammography, breast MRI and ultrasonography) underwent 18FDG-PET/CT. The nuclear physician was blind to the results of any other procedure (bone scan, chest X-ray, liver ultrasound, or thoraco-abdominal CT scan). Results: Out of the 131 examined patients, 36 had clinical stage IIA (34 T2 N0, 2 T1 N1), 48 stage IIB (20 T3 N0, 28 T2 N1), and 47 stage IIIA (29 T3 N1, 9 T2 N2, 9 T3 N2). 18FDG-PET/CT modified staging for 5.6% of stage IIA patients, for 14.6% of stage IIB patients, and for 27.6% of stage IIIA patients. However, within stage IIIA, the yield was specifically high among the 18 patients with N2 disease (56% stage modification). When considering stage IIB and primary operable IIIA (T3 N1) together, the yield of 18FDG-PET/CT was 13% (10/77); extra-axillary regional lymph nodes were detected in 5 and distant metastases in 7 patients. In this series, 18FDG-PET/CT outperformed bone scan with only 1 misclassification versus 8 for bone scan (p=0.036). Discussion: 18FDG-PET/CT provided useful information in 13% of patients with T3 N0 / T2 N1 / T3 N1 disease. The yield was more modest in patients with T2 N0 disease. The very high yield in the case of lymph nodes classified N2 demonstrates that stage IIIA comprises two quite distinct groups of patients. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-09-11.

Introduction La tomographie par emission de positons (TEP) au 18F-FDG a pris une place importante dans l’exploration des nodules pulmonaires solitaires (NPS). Etat des connaissances Les resultats des principales meta-analyses montrent que la sensibilite et la specificite de la TEP au 18F-FDG pour rechercher la malignite d’un NPS sont respectivement proches de 95 % et de 80 %. Les limites de la technique sont a present bien connues. Les faux negatifs sont essentiellement dus a certaines formes histologiques de faible activite metabolique (comme le carcinome bronchiolo-alveolaire et le carcinoide typique) et a la petite taille du nodule (inferieure a 8 mm). Les faux positifs sont surtout representes par les granulomatoses et les processus infectieux. Perspectives Un gain important en exactitude a ete apporte par la creation des machines hybrides qui associent les donnees fonctionnelles de la TEP et les donnees morphologiques de la tomodensitometrie (TDM). L’amelioration des protocoles d’imagerie (comme par exemple, l’injection de produit de contraste iode) pourrait encore permettre d’accroitre les performances de la TEP-TDM. D’autres voies d’amelioration comme la synchronisation respiratoire et l’avenement de nouveaux traceurs sont egalement attendues. Conclusion Tout nodule de plus de 8 mm pour lequel la probabilite pretest de malignite n’est pas negligeable devrait faire l’objet d’une exploration par un examen TEP-TDM au 18F-FDG.

Apres une presentation de la technique TEP-TDM, les auteurs montrent le role de cette imagerie aux differentes etapes de la prise en charge du cancer du sein. La place de nouveaux traceurs comme la 18F-fluorothymidine (FLT) (marqueur de la proliferation cellulaire), le 18F-fluoroestradiol (FES) (marqueur des recepteurs aux estrogenes) et le fluorure de sodium (FNA) (marqueur de la matrice osseuse) est egalement evoquee. En raison de la resolution spatiale limitee de la TEP (environ 5–6 mm) et de la faible prevalence des metastases pour un cancer du sein de petite taille, la TEP-TDM au 18F-FDG n’est pas indiquee pour effectuer le bilan d’extension des petites tumeurs (T ≤ T1). Elle ne peut notamment pas se substituer a la technique du ganglion sentinelle. En revanche, en cas de tumeur plus volumineuse et/ou de cancer inflammatoire, la TEP-TDM peut apporter des informations determinantes en detectant un envahissement ganglionnaire au niveau de l’etage III de Berg ou en sus-claviculaire ou au niveau de la chaine mammaire interne et en decelant des metastases a distance. Ainsi, pour ces tumeurs, le resultat de la TEP-TDM est susceptible d’entrainer une modification du plan de traitement initial. Cet examen est egalement tres performant devant une suspicion de recidive locale ou a distance et afin d’etablir le bilan corps entier d’une recidive confirmee. De nombreuses etudes montrent par ailleurs que la TEP 18F-FDG pourrait etre utilisee pour l’evaluation de la reponse a la chimiotherapie (en phase neoadjuvante et/ou metastatique). Ainsi, en repondant a un ensemble d’objectifs cliniques, la TEP-TDM devient progressivement un examen incontournable en senologie.

As compared to conventional axillary dissection, the sentinel node technique is accompanied by reduced morbidity and shorter hospital stay. Based on available data, the use of this technique does not seem to yield higher rates of axillary recurrence. A combination of both radioisotope detection and blue dye increases the identification rate, while also reducing false-negative rate. Surgical results are optimized when preoperative lymphoscintigraphy mapping is obtained in addition to peroperative probe detection. Considering the site of injection, the subareolar injection can be easy to apply even in case of non-palpable tumours, and gives higher count rates. However, the intraparenchymal, peritumoral, injection is necessary to evidence cases of extra-axillary drainage (internal mammary, infra- or supraclavicular) that is present in about 20% of patients. With the advent of hybrid cameras (SPECT-CT), the topography of these extra-axillary nodes can be given with high precision. Use of the sentinel node technique has been accompanied by an increase in the percent of patients with node involvement, due to an increased detection of micrometastases inferior or equal to 2 mm. Following an overview of basic principles, and of the main results with the sentinel node technique we focus the discussion on several points that are still open to debate, such as: 1) which group of patients can benefit from the sentinel node technique? 2) What is the optimal methodology? 3) What is the prognostic significance of micrometastases and of isolated tumour cells? 4) What attention should be given to extra-axillary drainage?

Resume Apres une courte introduction rappelant l’interet du ciblage de l’hypoxie tumorale, les progres sur la comprehension des mecanismes mis en jeu a l’echelon cellulaire sont decrits, en insistant sur le role cle du facteur induit par l’hypoxie-HIF-1α, ainsi que ses liens avec l’angiogenese, les differentes methodes d’exploration de l’hypoxie sont rapidement passees en revue. Les traceurs confirmes en tomographie par emission de positons (18F-fluoromisonidazole et 18F-fluoroerythronitroimidazole) sont brievement rappeles. Les recentes publications sur deux nouveaux traceurs prometteurs, le Cu(II)-diacetyl-bis(N(4)-methylthiosemicarbazone) et le AZA marque au 18F sont presentees et l’interet de ces traceurs est discute.

Positron emission tomography (PET) with 18F-FDG has become an important tool for the characterization of solitary pulmonary nodules (SPN).The results of the main meta-analyses show that the sensitivity and specificity of 18F-FDG PET for determining malignancy of SPN are close to 95% and 80% respectively. The limits of the technology are now well known. False negative results are mainly due to certain histological types with low metabolic activity (such as bronchiolo-alveolar carcinoma and typical carcinoid), or small size (nodules less than 8 mm). False positives are mainly represented by granulomatous and infectious processes.A gain in accuracy occurred with the advent of hybrid PET/CT machines that combine the functional data from 18FDG-PET and the morphological data of computed tomography. Improved imaging protocols (eg. injection of iodinated contrast media) could further enhance the performance of PET-CT. Further improvements will rely on respiratory synchronization protocols and on the advent of new PET tracers.18F-FDG PET-CT should be performed for any nodule over 8 mm in size when the pre-test probability of malignancy is not deemed negligible.

The authors discuss the various roles of 18F-FDG PET/CT in the management of breast cancer. Roles of new tracers such as F-18 fluoro-L-thymidine (a marker of cell proliferation), 18-fluoro-17-B-estradiol (marker of estrogen receptor) and sodium fluoride (marker of bone matrix) are also mentioned. There is little justification for the use of FDG-PET/CT in patient with clinically T1 (or = 2 cm) N0 tumours. Notably, it cannot be used as a substitute to SLNB "sentinel lymph node biopsy" for axillary staging due to limited sensitivity for the detection of small metastases. The case is different in higher risk patients, and especially so in patients with locally advanced disease. FDG-PET/CT in these patients might depict lymph node involvement in the level III of Berg or in supraclavicular or internal mammary basins. It might also uncover occult distant metastases, notably, early osteomedullary infiltration. Thus, for these tumors, initial PET/CT can enable better intramodality treatment planning or a change in treatment. PET/CT as a whole-body examination is also very efficient in case of suspicion of recurrence. On the other hand, many studies show that this functional imaging could be used to assess early response to neoadjuvant chemotherapy or to chemotherapy of metastatic disease. 18FDG-PET/CT could thus become an unavoidable modality to answer various clinical situations.

As compared to conventional axillary dissection, the sentinel node technique is accompanied by reduced morbidity and shorter hospital stay. Based on available data, the use of this technique does not seem to yield higher rates of axillary recurrence. A combination of both radioisotope detection and blue dye increases the identification rate, while also reducing false-negative rate. Surgical results are optimized when preoperative lymphoscintigraphy mapping is obtained in addition to peroperative probe detection. Considering the site of injection, the subareolar injection can be easy to apply even in case of non-palpable tumours, and gives higher count rates. However, the intraparenchymal, peritumoral, injection is necessary to evidence cases of extra-axillary drainage (internal mammary, infra- or supraclavicular) that is present in about 20% of patients. With the advent of hybrid cameras (SPECT-CT), the topography of these extra-axillary nodes can be given with high precision. Use of the sentinel node technique has been accompanied by an increase in the percent of patients with node involvement, due to an increased detection of micrometastases inferior or equal to 2 mm. Following an overview of basic principles, and of the main results with the sentinel node technique we focus the discussion on several points that are still open to debate, such as: 1) which group of patients can benefit from the sentinel node technique? 2) What is the optimal methodology? 3) What is the prognostic significance of micrometastases and of isolated tumour cells? 4) What attention should be given to extra-axillary drainage?

The present paper addresses the advantages and limits of PET-CT in the work-up of cervical cancer. PET-CT is not to be overlooked in initial staging. It is useful to assess involvement of pelvic and lumbar lymph nodes. It can improve staging accuracy and help guide initial treatment such as optimisation of radiation therapy fields. Given its limited spatial resolution however, PET does not seem so adequate to document tumours less than 5 mm in diameter. It is not warranted for staging carcinoma in situ (FIGO stage 0) or preclinical carcinoma (FIGO stage 1A1 and 1A2). Furthermore MRI performances are best as far as local extension and tumour volume measurement are concerned. PET brings prognostic information. High initial uptake in tumour tissue or persistent increased uptake at completion of treatment indicates rather poor prognosis. PET is useful to evaluate therapy, but its exact role in this issue remains to be further refined. Finally, PET-CT can document early recurrence of disease.

Objectifs Evaluer les associations entre des caracteristiques cliniques, histologiques et immuno-histochimiques et differents parametres quantitatifs extraits de l’examen TEP-FDG initial chez des patientes presentant un cancer du sein de stades II–III. Patientes et methodes Dans un effectif de 171 patientes, les differents parametres caracterisant la tumeur primitive etaient le SUVmax, le SUVmoy, le volume metabolique actif (VMA), le volume glycolyique total (VGT) et des parametres de texture quantifiant l’heterogeneite de la fixation du FDG. L’association entre les caracteristiques tumorales et les parametres TEP a ete evaluee avec l’analyse de variance et quantifiee a l’aide des aires sous la courbe ROC (AUC). Resultats Les tumeurs T3 (> 5 cm) etaient globalement plus heterogenes que les tumeurs T2 (AUC ∼ 0,73), alors que les SUVs n’etaient pas differents. Le SUVmax etait plus eleve pour les carcinomes canalaires infiltrants que pour les carcinomes lobulaires (p = 0,008), mais le VMA, le VGT et les parametres d’heterogeneite n’etaient pas differents. Les tumeurs de grade SBR 3 fixaient le FDG plus intensement que les tumeurs de grade 1 ou 2 (AUC = 0,78 pour le SUVmax et 0,69 pour le VGT) et leur heterogeneite etait legerement plus elevee (AUC = 0,62). Les tumeurs hormono-negatives avaient des SUVs et des VMAs plus eleves et une heterogeneite plus importante, le pouvoir discriminant des parametres TEP restant faible (AUC = 0,67 la plus elevee, pour SUVmax). Le SUVmax, le SUVmoy et le VGT differaient significativement entre les 3 sous-groupes phenotypiques (ER+/HER2−, HER2+, triple negatif), alors que le VMA et les parametres d’heterogeneite n’etaient pas discriminants. Conclusions Les parametres quantitatifs extraits d’images TEP presentent des associations differentes avec les caracteristiques cliniques et histopathologiques du cancer du sein. Leur pouvoir discriminant reste toutefois limite.

Objectifs Les images TEP au FDG peuvent fournir differents indices, tels que la valeur d’absorption maximale du radiotraceur (SUV max ), l’heterogeneite ou la forme du volume tumoral, qui se sont reveles utiles pour ameliorer la prise en charge des patients. La plupart des etudes se sont focalisees sur des cohortes provenant d’une seule institution. L’objectif de cette etude etait d’inclure des patients provenant de differents centres cliniques et d’etudier la valeur pronostique des images TEP et la complementarite de ces parametres par rapport aux criteres cliniques. Patients et methodes Cent soixante-dix-neuf patients provenant de 3 centres differents ont ete retrospectivement analyses. Tous les patients ont eu une image TEP au FDG dans le cadre du diagnostic clinique et disposent d’un suivi minimum de 3 ans. Les tumeurs ont ete segmentees avec l’algorithme FLAB demontre comme robuste et precis. Le volume tumoral metaboliquement actif (MATV), le SUV max , l’heterogeneite et la forme ont ete quantifies. La valeur pronostique de la survie globale a ete evaluee avec le modele de Cox et des courbes de Kaplan–Meier (avec une determination des valeurs de seuil a l’aide de courbes ROC). Ces resultats ont ete confrontes a ceux obtenus a partir des parametres cliniques. Resultats La survie mediane des patients etait de 16 mois (intervalle de 1 a 75 mois) avec une survie a 1, 2 et 3 ans de 68 %, 35 % et 26 %, respectivement. Le volume, l’heterogeneite, la forme, le traitement par chirurgie et le stade clinique se sont reveles etre des facteurs pronostiques de la survie. De plus, la majorite des parametres extraits des images TEP ont ete identifies comme independants des variables cliniques usuelles. Une combinaison des parametres a permis de definir 3 groupes de patients avec une survie significativement distincte ( hazard ratios de 1,7 et 2,1, p Conclusions Les parametres volumetriques, d’heterogeneite et de forme de la fixation tumorale en FDG TEP permettent une stratification des patients superieure a celle offerte par les parametres d’image et clinique usuels.

Objectifs La mortalite est elevee chez les patientes presentant un cancer du sein triple (TN). Nous avons evalue si la TEP/TDM au FDG pre-therapeutique et les resultats chirurgicaux en fin de chimiotherapie neoadjuvante (CNA) permettaient de stratifier les patientes en groupes pronostiques specifiques. Patientes et methodes Quatre-vingt-cinq patientes avec un cancer TN de stades II–III ont prospectivement beneficie d’une TEP/TDM initiale, d’une CNA, d’une chirurgie mammaire, d’une radiotherapie et d’une surveillance. La survie a ete mesuree selon la methode de Kaplan-Meier. Le type de recidive a ete evalue. Resultats La TEP/TDM initiale a revele des metastases a distance chez 11 des 85 patientes (12,9 %). Parmi les 74 femmes classees M0, 23 (31,1 %) ont presente une reponse histologique complete (pCR) a la chirurgie et 51 une maladie residuelle (mammaire et/ou axillaire). La survie specifique (SS) differait considerablement entre 3 groupes de patientes (log-rank p Conclusions En cas de cancer TN, la TEP/TDM pre-therapeutique et la reponse a la CNA permettent de definir 3 groupes pronostiques. Les recidives extra-osseuses predominent. Des strategies specifiques de suivi (incluant la TEP ?) meritent d’etre evaluees chez les patientes initialement M0 et sans pCR apres la CNA.

Objectifs Determiner les criteres TEP optimaux permettant d’evaluer precocement la reponse a la chimiotherapie neoadjuvante (CNA) du cancer du sein pour chacun des 3 principaux sous-groupes phenotypiques : ER+/HER2−, triple negatif (TN) et HER2+. Patientes et methodes Le SUVmax, le SUVpeak, le SUVmoy, le volume metaboliquement actif (VMA) et le volume glycolytique total (VGT) ont ete mesures dans la tumeur primitive et dans les ganglions axillaires, avant le debut de la CNA et apres 2 cures (TEP2). Le site le plus fixant, pouvant etre la tumeur du sein ou un ganglion axillaire, a ete denomme « cible ». Les parametres TEPs et leur variation (Δ) ont ete correles au resultat operatoire apres la CNA (test de Wilcoxon). Leur pouvoir predictif a ete evalue a partir de l’aire sous la courbe ROC (AUC). Resultats Parmi 169 patientes, la reponse histologique complete (pCR) etait plus frequente pour les tumeurs HER2+ (16/33 ; 48,5 %) et TN (20/54 ; 37 %) que pour les tumeurs ER+/HER2− (4/82 ; 4,9 %) (p Conclusions Les parametres TEP pour la prediction precoce de la reponse a la CNA varient en fonction du phenotype : le ΔSUVmax et le ΔTLG sont les plus pertinents pour les tumeurs TN et ER+/HER2− et la valeur absolue du SUVmax apres deux cycles est le parametre optimal pour les cancers HER2+.

Objectifs Rechercher des criteres permettant de predire precocement la survie sans recidive des patientes traitees par une chimiotherapie neoadjuvante (CNA) pour un cancer du sein de phenotype recepteur aux œstrogenes-positif/HER2-negatif (ER+/HER2−). Patientes et methodes Quatre-vingt-dix-huit patientes successives traitees pour un cancer du sein ER+/HER2− ont beneficie d’une TEP initiale (TEP1) et d’une TEP apres 2 cycles de CNA (TEP2). A l’issu de 8 cycles, une chirurgie mammaire avec curage ganglionnaire axillaire etait realisee. Nous avons evalue l’impact de deux parametres TEP, le SUVmax et le volume glycolytique total (VGT) et de plusieurs parametres histopathologiques sur la survie sans evenement (SSE). Resultats La TEP/TDM initiale a revele des metastases a distance chez 14 patientes. La survie globale etait significativement plus courte chez ces patientes (p 10 avaient une SSE a 3 ans de 49 % (vs 92 % pour les autres). Une faible variation (Δ) du SUVmax entre la TEP1 et la TEP2 etait egalement associee a une survie ecourtee (p = 0,033), de meme qu’un faible ΔTLG (p Conclusions Le SUVmax et le TLG mesures avant le debut de la CNA et leur variation a 2 cycles sont predictifs de la survie sans recidive chez les patientes traitees pour un cancer du sein ER+/HER2−.

Background: Previous studies showed a possible role of Fluorodeoxyglucose Positron Emission Tomography (FDG PET) in monitoring response to neoadjuvant chemotherapy (NACT) in breast cancer patients. Most studies, however, mixed various chemotherapy protocols. We assessed the ability of FDG PET to predict response after two cycles of epirubicin + cyclophosphamide (EC) and compared it with histopathological response as determined by the Sataloff scale after completion of chemotherapy.Material and Methods: From 07/2007 to 05/2009, 54 patients seen at Saint Louis hospital underwent FDG PET at baseline and after the second cycle of NACT. We present data for the first 22 consecutive patients for whom pathology data are available. Standard chemotherapy treatment was four cycles of epirubicin + cyclophosphamide followed by four cycles of docetaxel. The study was performed according to the guidelines of the institutional ethical committee. The standardized uptake value (SUVmax) of FDG was measured with a PET-CT instrument at baseline and after the second cycle of chemotherapy. The change in SUV was expressed as Δ SUVmax (%) = 100 X (2nd cycle SUVmax - baseline SUVmax)/baseline SUVmax. A Δ SUVmax cutoff value of -45% was used to differentiate metabolic responders and non-responders. Histopathological response was assessed on fresh surgical specimens (mastectomy or lumpectomy) by an experienced pathologist and graded according to the scale established by Sataloff: total or near-total therapeutic effect (grade A), more than 50% therapeutic effect but less than total or near-total effect (grade B), less than 50% therapeutic effect but visible effect (grade C), or no therapeutic effect (grade D). For the analysis, grades A and B were considered as histopathological responders and grades C and D were as non-responders.Results: Initial T-stage was T2 in 12 cases, T3 in 6 cases and T4 in 4 cases. There were 21 cases of invasive ductal carcinoma and 1 case of invasive lobular carcinoma. Mean SUVmax in initial PET was 7.22 (ranges from 2.7 to 18.5) and mean SUVmax after 2 cycles of chemotherapy was 4.77 (1.4-15.3). Breast-conserving surgery was performed in 12 patients and mastectomy in 10 patients. Nine (41%) of 22 patients were classified as histopathologic responders and 13 (59%) as non-responders. PET after two cycles of NACT revealed 9 patients (41%) as responders and 13 (59%) as non-responders. Among 9 metabolic responders, 7 were true positive, and 2 were false positive. Among 13 metabolic non-responders, 11 were true negative, and 2 were false negative. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FDG PET after two cycles of NACT were 78%, 85%, 78%, 85% and 82% respectively.Discussion: NACT has proved useful in stage II and III breast cancer, to reduce tumour volume, increasing the chance of breast-conserving surgery. In order to minimize adverse effects of NACT, non-responders must be identified as early as possible. Our preliminary results on a small series of patients show that FDG PET can differentiate responders from non-responders with good accuracy after two cycles of neoadjuvant chemotherapy with EC. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5009.

Background: This study analysed the correlation between [18F]fluorodeoxyglucose (FDG) uptake, assessed by positron emission tomography (PET), and prognostic factors in locally advanced breast cancersMaterial and Methods: All locally advanced breast cancers seen at Saint Louis hospital and treated with neo-adjuvant chemotherapy (NAC) have a FDG PET after core needle biopsy and before chemotherapy. We correlated the tumor characteristics: T-stage, histological grade, estrogen and progesterone receptors, c-erbB2 over-expression (immuno-histochemistry determination) and P53 (determinate on frozen biopsies by the FASAYmethod) to FDG standardized uptake value (SUV max). The statistics tests used are student test (comparison of 2 means) and kendall correlation.Results: From June 2006 to April 2009, 91 patients with locally advanced breast tumors have both PET scan and frozen tissue before NAC. Median age at diagnosis is 48 (26-81) and 45 % are post menopausal.Conclusion: This study indicates that FDG-PET uptake is correlated with the phenotype of breast tumours. Over-expression of c-erbB2 does not influence FDG uptake. Triple negative tumours and p53 mutated tumors have a high initial SUV which can reflect their aggressiveness and their chemotherapy sensitivity. The knowledge of SUV uptake according to tumor characteristics allows a better understanding of the role of FDG-PET in the prediction of neoadjuvant chemotherapy response.Patients characteristicsPtes characteristicsNumber of patients (%)Tumor size: T2/T3/T438 (41)/32 (35)/21(23)Lymph nodes N0/N1/N232 (35)/46 (50.5)/13 (14 )Invasive ductal carcinoma/invasive lobular carcinoma/miscellaneous82 (90 )/5 (5 )/3 (3)Histological grade/ 1/2/37 (7 )/49 (54)/35 (38)ER + / ER-58 (64 )/33 (36)PR+ /PR-35 (38) /56 (61)C-erbB2 +++15 (16 )Triple negative22 (24 )P53 ( 64 ptes) mutated/wild type32 (50)/32 (50) Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5010.