CA 15.3 measurements for separating FDG PET/CT positive from negative findings in breast carcinoma recurrence

Summary

In breast cancer CA 15.3 is considered the tumour marker of choice. CA 15.3 is directly related to the disease extent and to hormone status (estrogen receptor ER+/ ER-, progesterone receptor PR+/PR-). This study was designed to assess the impact of disease extent, hormone receptor and HER2-status, and circulating blood volume on the area-under the ROC-curve of CA 15.3 to separate FDG PET positive from negative findings. Patients, methods: We retrospectively evaluated 379 FDG PET/CT examinations performed in 80 patients with breast cancer. Blood volumes were derived using the formulas by Nadler and multiplied by their corresponding CA 15.3 measurement. Results: ROC-curve analysis revealed an AUC of 0.695 (p = 0.0001) for CA 15.3 to separate FDG PET positive from negative findings. AUC measurements to separate normal scan find-ings from loco-regional disease and meta- static disease were 0.527 (p = 0.587) and 0.732 (p = 0.0001), respectively. AUC measurements for CA 15.3 to separate positive from negative FDG PET findings, in ER+ and ER- patients, were respectively 0.772 (p = 0.0001) and 0.596 (p = 0.143). AUC measurements for CA 15.3 to separate positive from negative FDG PET findings, in PR+ and PR- patients, were respectively 0.675 (p = 0.0001) and 0.694 (p = 0.0001). In HER2-positive and -negative patients, the AUC measurements were respectively 0.594 (p = 0.178) and 0.701 (p = 0.0001) to separate positive from negative FDG PET findings. Conclusion: The AUC for CA 15.3 measurements to separate FDG PET positive from negative findings in breast cancer patients with suspected recurrence proved to be directly related to the extent of the recurrent disease and hormone receptor status and inversely related to HER2-status. Correcting CA 15.3 measurements for blood volumes did not impact the AUC.

Zusammenfassung

Beim Mammakarzinom gilt das Cancer Antigen (CA) 15-3 als Tumormarker der Wahl. CA 15-3 steht in direkter Beziehung zum Ausmaß der Krankheit und Hormonstatus (Östrogenrezeptor ER+/ ER-, Progesteronrezeptor PR+/PR-). Die vorliegende Studie wurde entwickelt, um den Einfluss von Krankheitsausmaß, Hormonrezeptor- und HER2-Status sowie zirkulierendem Blutvolumen auf die Fläche unterhalb der ROC-Kurve von CA 15-3 zu beurteilen und dadurch FDG-PET-positive von -negativen Befunden abzugrenzen. Patientinnen, Methoden: Retrospektiv ausgewertet wurden 379 FDG-PET/CT-Untersu- chungen von 80 Patientinnen mit Mammakarzinom. Die Blutvolumina wurden anhand der Nadler-Formel abgeleitet und mit den korrelierenden CA-15-3-Konzentrationen multipliziert. Ergebnisse: Die ROC-Analyse zeigte eine AUC von 0,695 (p = 0,0001) für CA 15-3, um FDG-PET-positive von -negativen Befunden abzugrenzen. Die Messungen ergaben eine AUC von 0,527 (p = 0,587) bei normalem Untersuchungsbefund und von 0,732 (p = 0,0001) bei örtlich begrenzter und metastasierender Krankheit. Für CA 15-3 ergaben die Messungen eine AUC von 0,772 (p = 0,0001) bei ER-positiven und 0,596 (p = 0,143) bei ER-negativen Patientinnen sowie von 0,675 (p = 0,0001) bei PR-positiven und 0,694 (p = 0,0001) bei PR-negativen Patientinnen. Die Messungen ergaben bei HER2-positiven und HER2-negativen Patientinnen eine AUC von 0,594 (p = 0,178) bzw. 0,701 (p = 0,0001). Schlussfolgerung: Die AUC für CA 15-3 zur Unterscheidung zwischen FDG-PET-positiven und FDG-PET-ne- gativen Befunden steht bei Patientinnen mit Mammakarzinom und Verdacht auf ein Rezidiv in direktem Verhältnis zum Ausmaß der erneut aufgetretenen Krankheit und zum Hormonrezeptorstatus, aber in umgekehrtem Verhältnis zum HER2-Status. Korrekturen der CA-15-3-Konzentrationen bzgl. Blutvolumen hatten keinen Einfluss auf die AUC.

Keywords

FDG PET - breast cancer - recurrence - CA 15.3 - ROC-curve

Schlüsselwörter

FDG PET - Brustkrebs - Rezidiv - CA 15-3 - ROCKurvenanalyse

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