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Objective <p>Subcutaneous/cutaneous uptake (SCU) is occasionally observed in the cancer-affected breast, apart from the primary tumor. This study aimed to explore the prognostic value of SCU on preoperative Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (<sup>18</sup>F-FDG PET/CT) in patients with stage I–III non-inflammatory breast cancer. Additional objectives were to assess the association between SCU and subcutaneous edema (SE) on magnetic resonance imaging (MRI), as well as between SCU and lymphovascular invasion (LVI) on pathology.</p> Methods <p>This retrospective single-center study included patients with newly diagnosed unilateral stage I-III non-inflammatory breast cancer who underwent preoperative <sup>18</sup>F-FDG PET/CT followed by surgery between January 2012 and March 2021. SCU was visually assessed by independent board-certified nuclear medicine physicians and quantified using the subareolar standardized uptake value ratio (sSUVr), calculated as the maximum standardized uptake value (SUVmax) ratio of the nipple–areolar–subareolar region in the affected breast to that in the contralateral breast. Inter-reader agreement for SCU and agreement between SCU and SE were evaluated using the kappa coefficient. Associations between SCU and LVI were assessed using Fisher’s exact test. Cox regression and long-rank tests were used to evaluate associations between clinicopathological and imaging variables—including tumor size, nodal metastasis, histology, molecular subtype, primary tumor SUVmax, SCU, sSUVr, skin thickness on CT, and SE on MRI—and survival outcomes, including invasive disease-free survival (iDFS) and overall survival (OS).</p> Results <p>Among 168 women (mean age: 55&#xa0;years, range: 23–85), SCU was visually positive in 24 patients (14.3%), with high inter-reader agreement (<i>κ</i> = 0.76). SCU showed moderate concordance with SE (<i>κ</i> = 0.66). Dermal LVI was absent in all SCU-negative cases but detected in 2 of 7 SCU-positive cases (28.6%) (<i>p</i> = .005). Both visually positive SCU and sSUVr &gt; 1.3 were associated with worse iDFS and OS (<i>p</i> &lt; .05 for each). In multivariate analysis, sSUVr &gt; 1.3 was associated with worse iDFS and OS (hazard ratio [HR] 2.80, <i>p</i> = .04; HR 5.74, <i>p</i> = .02, respectively).</p> Conclusions <p>SCU on preoperative <sup>18</sup>F-FDG PET/CT was associated with poorer iDFS and OS in patients with stage I–III breast cancer and was moderately correlated with SE on MRI.</p>

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Subcutaneous/cutaneous uptake in the cancer-affected breast on 18F-FDG PET/CT: association with post-surgical prognosis in breast cancer patients

  • 期刊论文

  • 发表日期：

    2025年10月5日

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  • Yurika Kitano,
  • Kanae K. Miyake,
  • Tomomi W. Nobashi,
  • Takayoshi Ishimori,
  • Ryusuke Nakamoto,
  • Sho Koyasu,
  • Masako Kataoka,
  • Yasuhide Takeuchi,
  • Masakazu Toi,
  • Yuji Nakamoto

摘要

Objective

Subcutaneous/cutaneous uptake (SCU) is occasionally observed in the cancer-affected breast, apart from the primary tumor. This study aimed to explore the prognostic value of SCU on preoperative Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with stage I–III non-inflammatory breast cancer. Additional objectives were to assess the association between SCU and subcutaneous edema (SE) on magnetic resonance imaging (MRI), as well as between SCU and lymphovascular invasion (LVI) on pathology.

Methods

This retrospective single-center study included patients with newly diagnosed unilateral stage I-III non-inflammatory breast cancer who underwent preoperative 18F-FDG PET/CT followed by surgery between January 2012 and March 2021. SCU was visually assessed by independent board-certified nuclear medicine physicians and quantified using the subareolar standardized uptake value ratio (sSUVr), calculated as the maximum standardized uptake value (SUVmax) ratio of the nipple–areolar–subareolar region in the affected breast to that in the contralateral breast. Inter-reader agreement for SCU and agreement between SCU and SE were evaluated using the kappa coefficient. Associations between SCU and LVI were assessed using Fisher’s exact test. Cox regression and long-rank tests were used to evaluate associations between clinicopathological and imaging variables—including tumor size, nodal metastasis, histology, molecular subtype, primary tumor SUVmax, SCU, sSUVr, skin thickness on CT, and SE on MRI—and survival outcomes, including invasive disease-free survival (iDFS) and overall survival (OS).

Results

Among 168 women (mean age: 55 years, range: 23–85), SCU was visually positive in 24 patients (14.3%), with high inter-reader agreement (κ = 0.76). SCU showed moderate concordance with SE (κ = 0.66). Dermal LVI was absent in all SCU-negative cases but detected in 2 of 7 SCU-positive cases (28.6%) (p = .005). Both visually positive SCU and sSUVr > 1.3 were associated with worse iDFS and OS (p < .05 for each). In multivariate analysis, sSUVr > 1.3 was associated with worse iDFS and OS (hazard ratio [HR] 2.80, p = .04; HR 5.74, p = .02, respectively).

Conclusions

SCU on preoperative 18F-FDG PET/CT was associated with poorer iDFS and OS in patients with stage I–III breast cancer and was moderately correlated with SE on MRI.