The influence of receptor expression and clinical subtypes on baseline [18F]FDG uptake in breast cancer: systematic review and meta-analysis

EJNMMI Res. 2023 Jan 23;13(1):5. doi: 10.1186/s13550-023-00953-y.

ABSTRACT

BACKGROUND: To quantify the relationship between [18F]FDG uptake of the primary tumour measured by PET-imaging with immunohistochemical (IHC) expression of ER, PR, HER2, Ki-67, and clinical subtypes based on these markers in breast cancer patients.

METHODS: PubMed and Embase were searched for studies that compared SUV_max between breast cancer patients negative and positive for IHC expression of ER, PR, HER2, Ki-67, and clinical subtypes based on these markers. Two reviewers independently screened the studies and extracted the data. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were estimated by using DerSimonian-Laird random-effects models. P values less than or equal to 5% indicated statistically significant results.

RESULTS: Fifty studies were included in the final analysis. SUV_max is significantly higher in ER-negative (31 studies, SMD 0.66, 0.56-0.77, P < 0.0001), PR-negative (30 studies, SMD 0.56; 0.40-0.71, P < 0.0001), HER2-positive (32 studies, SMD – 0.29, – 0.49 to – 0.10, P = 0.0043) or Ki-67-positive (19 studies, SMD – 0.77; – 0.93 to – 0.61, P < 0.0001) primary tumours compared to their counterparts. The majority of clinical subtypes were either luminal A (LA), luminal B (LB), HER2-positive or triple negative breast cancer (TNBC). LA is associated with significantly lower SUV_max compared to LB (11 studies, SMD – 0.49, – 0.68 to – 0.31, P = 0.0001), HER2-positive (15 studies, SMD – 0.91, – 1.21 to – 0.61, P < 0.0001) and TNBC (17 studies, SMD – 1.21, – 1.57 to – 0.85, P < 0.0001); and LB showed significantly lower uptake compared to TNBC (10 studies, SMD – 0.77, – 1.05 to – 0.49, P = 0.0002). Differences in SUV_max between LB and HER2-positive (9 studies, SMD – 0.32, – 0.88 to 0.24, P = 0.2244), and HER2-positive and TNBC (17 studies, SMD – 0.29, – 0.61 to 0.02, P = 0.0667) are not significant.

CONCLUSION: Primary tumour SUV_max is significantly higher in ER-negative, PR-negative, HER2-positive and Ki-67-positive breast cancer patients. Luminal tumours have the lowest and TNBC tumours the highest SUV_max. HER2 overexpression has an intermediate effect.

PMID:36689007 | DOI:10.1186/s13550-023-00953-y