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Objective <p>The primary role of <sup>18</sup>F-FDG PET/CT at the initial diagnosis of breast cancer is to detect distant metastases. This study aimed to investigate locoregional characteristics associated with distant metastasis, based on clinicopathological factors, standard-of-care (SOC) imaging, and <sup>18</sup>F-FDG PET/CT—including a novel PET parameter, subcutaneous/cutaneous uptake (SCU).</p> Methods <p>This retrospective study included patients with newly diagnosed, unilateral invasive breast cancer who underwent pretreatment <sup>18</sup>F-FDG PET/CT. Associations between distant metastasis and the following parameters—including age, SOC imaging-based clinical T and N stage, histology, histological grade, and subtype, as well as tumor SUVmax, subareolar SUV ratio (sSUVr), and subcutaneous/cutaneous uptake (SCU) on PET—were assessed using the Mann–Whitney U test, Fisher’s exact test, and logistic regression. Subgroup analyses were also performed after stratifying patients by locoregional clinical stage (I–IIIA vs. IIIB–C).</p> Results <p>Among 197 women (mean age, 56 ± 14 years), distant metastasis was identified in 23 (11.6%). The prevalence of distant metastasis at each locoregional stage in SCU-positive versus SCU-negative patients was as follows: 0% vs. 0% for stage I; 22% vs. 1% for stage IIA; 25% vs. 14% for stage IIB; 25% vs. 13% for stage IIIA; 25% vs. 33% for stage IIIB; and 50% vs. 50% for stage IIIC, with a statistically significant difference observed at stage IIA. In the total cohort, univariate analysis showed that clinical T stage (<i>p</i> = .005), clinical N stage (<i>p</i> &lt; .001), sSUVr (<i>p</i> = .002), and SCU (<i>p</i> &lt; .001) were significantly associated with distant metastasis. In multivariate analysis, only clinical N stages (Odd ratio [OR], 6.5–32.6; <i>p</i> &lt; .001-0.02) remained independent predictors. In the stage I–IIIA subgroup, SCU (OR, 4.86; <i>p</i> = .048) independently predicted distant metastasis, along with age (OR, 1.07; <i>p</i> = .01) and clinical N stages (OR, 8.40–30.26; <i>p</i> = .002–0.008). In the stage IIIB–C subgroup, none of the explanatory variables had significant associations with distant metastasis.</p> Conclusions <p>Age, clinical N stages, and SCU were associated with an elevated risk of distant metastasis in the stage I–IIIA disease. SCU may serve as a novel imaging marker of systemic disease and aid in the diagnosis of distant metastasis—particularly in patients with early-stage breast cancer, where such findings can critically influence treatment strategy.</p>

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Locoregional indicators of systemic spread in breast cancer: insights from standard-of-care imaging and ¹⁸F-FDG PET/CT

  • 期刊论文

  • 发表日期：

    2025年11月12日

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

摘要

Objective

The primary role of 18F-FDG PET/CT at the initial diagnosis of breast cancer is to detect distant metastases. This study aimed to investigate locoregional characteristics associated with distant metastasis, based on clinicopathological factors, standard-of-care (SOC) imaging, and 18F-FDG PET/CT—including a novel PET parameter, subcutaneous/cutaneous uptake (SCU).

Methods

This retrospective study included patients with newly diagnosed, unilateral invasive breast cancer who underwent pretreatment 18F-FDG PET/CT. Associations between distant metastasis and the following parameters—including age, SOC imaging-based clinical T and N stage, histology, histological grade, and subtype, as well as tumor SUVmax, subareolar SUV ratio (sSUVr), and subcutaneous/cutaneous uptake (SCU) on PET—were assessed using the Mann–Whitney U test, Fisher’s exact test, and logistic regression. Subgroup analyses were also performed after stratifying patients by locoregional clinical stage (I–IIIA vs. IIIB–C).

Results

Among 197 women (mean age, 56 ± 14 years), distant metastasis was identified in 23 (11.6%). The prevalence of distant metastasis at each locoregional stage in SCU-positive versus SCU-negative patients was as follows: 0% vs. 0% for stage I; 22% vs. 1% for stage IIA; 25% vs. 14% for stage IIB; 25% vs. 13% for stage IIIA; 25% vs. 33% for stage IIIB; and 50% vs. 50% for stage IIIC, with a statistically significant difference observed at stage IIA. In the total cohort, univariate analysis showed that clinical T stage (p = .005), clinical N stage (p < .001), sSUVr (p = .002), and SCU (p < .001) were significantly associated with distant metastasis. In multivariate analysis, only clinical N stages (Odd ratio [OR], 6.5–32.6; p < .001-0.02) remained independent predictors. In the stage I–IIIA subgroup, SCU (OR, 4.86; p = .048) independently predicted distant metastasis, along with age (OR, 1.07; p = .01) and clinical N stages (OR, 8.40–30.26; p = .002–0.008). In the stage IIIB–C subgroup, none of the explanatory variables had significant associations with distant metastasis.

Conclusions

Age, clinical N stages, and SCU were associated with an elevated risk of distant metastasis in the stage I–IIIA disease. SCU may serve as a novel imaging marker of systemic disease and aid in the diagnosis of distant metastasis—particularly in patients with early-stage breast cancer, where such findings can critically influence treatment strategy.