A Pilot Study for the Feasibility of F-18 FLT-PET in Locally Advanced Breast Cancer: Comparison with F-18 FDG-PET

Lee, Jai Hyuen; Kim, Euy Nyong; Hong, Il Ki; Ahn, Jin Hee; Kim, Sung Bae; Ahn, Sei Hyun; Gong, Gyung Yup; Kim, Jae Seung; Oh, Seung Jun; Moon, Dae Hyuk; Ryu, Jin Sook

Abstract

PURPOSE: The aim of this study was to investigate the feasibility of 3'-[F-18]fluoro-3'-deoxythymidine positron emission tomography(FLT-PET) for the detection of locally advanced breast cancer and to compare the degree of FLT and 2'-deoxy-2'-[F-18]fluoro-d-glucose(FDG) uptake in primary tumor, lymph nodes and other normal organs. MATERIAL AND METHODS: The study subjects consisted of 22 female patients (mean age; 42+/-6 years) with biopsy-confirmed infiltrating ductal carcinoma between Aug 2005 and Nov 2006. We perfomed conventional imaging workup, FDG-PET and FLT PET/CT. Average tumor size measured by MRI was 7.2+/-3.4 cm. With visual analysis, Tumor and Lymph node uptakes of FLT and FDG were determined by calculation of standardized uptake value (SUV) and tumor to background (TB) ratio. We compared FLT tumor uptake with FDG tumor uptake. We also investigated the correlation between FLT tumor uptake and FDG tumor uptake and the concordant rate with lymph node uptakes of FLT and FDG. FLT and FDG uptakes of bone marrow and liver were measured to compare the biodistribution of each other.
RESULTS
All tumor lesions were visually detected in both FLT-PET and FDG-PET. There was no significant correlation between maximal tumor size by MRI and SUVmax of FLT-PET or FDG-PET (p>0.05). SUVmax and SUV75 (average SUV within volume of interest using 75% isocontour) of FLT-PET were significantly lower than those of FDG-PET in primary tumor (SUVmax; 6.3+/-5.2 vs 8.3+/-4.9, p=0.02 / SUV75; 5.3+/-4.3 vs 6.9+/-4.2, p=0.02). There is significant moderate correlation between uptake of FLT and FDG in primary tumor (SUVmax; rho=0.450, p=0.04 / SUV75; rho=0.472, p=0.03). But, TB ratio of FLT-PET was higher than that of FDG-PET(11.7+/-7.7 vs 6.3+/-3.8, p=0.001). The concordant rate between FLT and FDG uptake of lymph node was reasonably good (33/34). The FLT SUVs of liver and bone marrow were 4.2+/-1.2 and 8.3+/-4.9. The FDG SUVs of liver and bone marrow were 1.8+/-0.4 and 1.6+/-0.4.
CONCLUSION
The uptakes of FLT were lower than those of FDG, but all patients of this study revealed good FLT uptakes of tumor and lymph node. Because FLT-PET revealed high TB ratio and concordant rate with lymph node uptakes of FDG-PET, FLT-PET could be a useful diagnostic tool in locally advanced breast cancer. But, physiological uptake and individual variation of FLT in bone marrow and liver will limit the diagnosis of bone and liver metastases.