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Comparison of Triple-negative and Estrogen Receptorpositive/Progesterone Receptor-positive/HER2-negative
Breast Carcinoma Using Quantitative Fluorine-18
Fluorodeoxyglucose/Positron Emission Tomography
Imaging Parameters
A Potentially Useful Method for Disease Characterization

Sandip Basu, MBBS(Hons) DNB1,2
Wengen Chen, MD1
Julia Tchou, MD, PhD3
Ayse Mavi, MD1,4
Tevfik Cermik,MD1
Brian Czerniecki, MD3
Mitchell Schnall, MD, PhD5
Abass Alavi, MD1
1

BACKGROUND. This study was designed to investigate the fluorine-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging characteristics of
triple-negative (estrogen receptor-negative [ER2]/progesterone receptor-negative
[PR2]/HER2-negative [HER22]) breast carcinoma and compare the results withcharacteristics of ER1/PR1/HER22 breast carcinomas, which usually carry a
favorable prognosis.

METHODS. Patients with newly diagnosed breast carcinoma who had undergone
dual-time-point FDG-PET before any therapeutic intervention and were identified as either ER2/PR2/HER22 or ER1/PR1/HER22 (the control group) on his-

Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Universityof Pennsylvania
School of Medicine, Philadelphia, Pennsylvania.

topathology of the surgical specimen, were considered candidates for inclusion

2

Radiation Medicine Center, Tata Memorial Hospital Annex, Parel, Mumbai, India.

spective study that evaluated the role of multimodality imaging for characterizing

3

imaged twice at approximately 63 minutes and 101 minutes after theadministra-

Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania
School of Medicine, Philadelphia, Pennsylvania.
4

Department of Nuclear Medicine, Yeditepe University Hospital, Istanbul, Turkey.
5

Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania
School of Medicine, Philadelphia, Pennsylvania.

inthis analysis. These patients underwent FDG-PET as a component of a proprimary breast lesions and locoregional staging. Breast cancer lesions were
tion of FDG. Maximum standardized uptake values (SUVmax) were measured at
both time points (SUVmax1 and SUVmax2) to analyze the data generated. After
FDG-PET imaging, the patients underwent either breast-conserving surgery or
mastectomy, andhistopathology reports were used to provide the definitive diagnosis against which the PET study results were compared.

RESULTS. In total, 88 patients with breast cancer (29 patients with ‘triple-negative’ breast cancer and 59 patients with ER1/PR1/HER22 breast malignancies)
were selected among 206 individuals who were enrolled in the study protocol.

Supported by U.S. Public Health Services
researchgrant M01-RR00040 from the National
Institutes of Health. This work also was supported in part by the International Union against
Cancer, Geneva, Switzerland, under the American
Cancer Society International Fellowship for the
Beginning Investigators.
Address for reprints: Abass Alavi, MD, Division of
Nuclear Medicine, Hospital of the University of
Pennsylvania, 110 Donner Building, 3400Spruce
Street, Philadelphia, PA 19104; Fax: (215) 3495843; E-mail: abass.alavi@uphs.upenn.edu
Received June 21, 2007; revision received
August 29, 2007; accepted September 4, 2007.

ª 2007 American Cancer Society

The ‘triple-negative’ group comprised 14.08% of the total study population. The
age of the patients with this subtype of tumor ranged from 33 years to 75 years
(mean ageÆstandarddeviation, 51.6 Æ 10.1 years), and tumors in this subgroup
ranged in size from 0.9 cm to 6 cm (mean size, 1.99 cm). Among the histopathologic subtypes, 25 tumors were infiltrating ductal carcinoma (86%), and 1 tumor
each (3.5% each subtype) was lobular, mixed ductal-lobular, medullary, and tubular. For the calculation of FDG-PET parameters in this group, only patients who
had undergone...