The prognostic value of SUV max measuring on primary lesion and ALN by 18 F-FDG PET or PET/CT in patients with breast cancer.

PURPOSE: To evaluate the prognostic value of maximum standardized uptake values (SUVmax ) measured in the primary lesion and axillary lymph nodes (ALN) by pretreatment fluorine-18-fluorodeoxyglucose (18 F-FDG) positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) in patients with breast cancer.

METHODS: We systematically searched PubMed, Embase, and the Cochrane Library. The primary prognosis endpoint was event-free survival (EFS), and the secondary endpoint was overall survival (OS). The pooled hazard ratio (HR) was estimated by using random-effects model according to the results of heterogeneity.

RESULTS: Fifteen eligible studies with 3574 breast cancer patients were included. For EFS, patients with higher primary SUVmax showed a poorer survival prognosis with pooled HR of 1.96 (95% confidence interval (CI) 1.40-2.73). The combined HR of high SUVmax in ALN and ALN-to-primary SUVmax ratio (N/T ratio) were 1.89 (95% CI 0.70-5.07) and 2.06 (95% CI 0.59-7.21), respectively. In analyzing invasive ductal carcinoma (IDC) patients, the pooled HR was 1.91 (95% CI 1.40-2.64). For OS, the pooled HR of SUVmax in primary lesion and ALN were 0.64 (95% CI 0.23-1.84) and 1.09 (95% CI 0.07-16.53), respectively.

CONCLUSIONS: Our meta-analysis suggested that patients with high primary SUVmax may experience a higher risk for recurrence or a poor progression. Moreover, the SUVmax of 18 F-FDG showed a significant prognostic value in IDC patients.