On the contrary, for the local evaluation of primary breast lesion, 18F-FDG PET/CT has so far been outperformed by echography and MRI mainly because of its lack of sensitivity ( 10, 11). When it comes to breast cancer staging, 2-deoxy-2-fluoro-D-glucose ( 18F-FDG) PET/CT is a well-established examination for the initial staging of locally advanced breast cancer ( 6– 9), as it displays excellent capabilities for extra-axillary nodal and distance metastases detection. An attempt to replicate molecular classification using conventional IHC characteristics of the tumor, including ER, PR, HER-2, and Ki67 showed low concordance with gene expressions profile ( 4, 5). However, its clinical use is limited, since these techniques are currently expensive as compared to conventional immunohistochemistry (IHC). More recently, with the development of DNA microarray gene expression analysis, a molecular classification has been proposed and validated ( 1– 3). Breast cancer treatment recommendations are based on histological subtype (ER-positive, HER-2 positive, or triple negative tumors), tumor grade, and stage of the disease. Its incidence is rising as a result of longer life expectancy and changes in risk factors. Indeed, skewness_ ER was significantly higher in youngest patients (ρ = −0.351, p = 0.031) and in clinical stage III tumors (p = 0.023).īreast cancer is the most frequently diagnosed cancer in women (16% of all women’s cancers) in all world regions. On multivariable analysis including age, clinical stage and skewness_ ER, none of the parameters were independent predictors. Univariable Kaplan-Meier survival analyses showed that skewness_ ER was a predictor of 8y-EFS (66.7 ± 27.2 versus 19.1 ± 15.2, p = 0.018 with a cut-off value set to 0.163) whereas other IHC and PET parameters were not. Random forest classification found age, clinical stage, SUV max, skewness_ ER, kurtosis_ ER, entropy_ HISTO, and uniformity_ HISTO to be variables of importance to predict the 8y-EFS. The median follow-up was 6.5 years and the 8y-EFS was 71.0%. The strongest correlations were observed between skewness_ ER and uniformity_ HISTO (ρ = −0.386, p = 0.017) and correlation_ PR and entropy_ GLCM (ρ = 0.540, p = 0.001), respectively. ![]() For ER expression, correlations were mainly observed with 18F-FDG histogram parameters, whereas for PR expression correlations were mainly observed with gray-level co-occurrence matrix (GLCM) parameters.
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