Could Visceral Fat Metabolic Activity and Primary Tumor Metrics of 18 F-FDG PET/CT Predict the Clinical Staging of Breast Cancer at Initial Presentation?

PurposeTo explore the association between clinical staging and various factors, including body mass index (BMI), adipose tissue metabolic activity, and primary tumor metabolic parameters extracted from 18-F fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in breast cancer (BC).MethodsOne hundred thirty-eight newly diagnosed BC patients underwent 18-F FDG PET/CT (for initial staging). Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor were extracted. The average SUVmax for the subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and visceral/subcutaneous ratio (V/S ratio) were calculated. Univariate and multivariate analyses were utilized to determine the significant factors predicting clinical staging.ResultsNinety-two patients (67%) presented with advanced tumor stages (stage III, IV), while 46 patients (33%) were classified with low stages (stage I, II). In univariate analysis, the significant predictors associated with late-stage included a decrease in SAT (OR = 0.01, p < 0.001), as well as an elevation in V/S ratio (OR = 14.60, p < 0.001), TLG (OR = 1.01, p = 0.017), and MTV (OR = 1.05, p = 0.003). BMI was not associated with a significant predictive value for late-stage presentation (OR: 0.97, p=0.157). In multivariate analysis, a decrease in SUVmax SAT (OR=0.013, p=0.002), elevated V/S ratio (OR=10.48, p=0.002), and elevated TLG (OR=1.01, 95% CI: 1.01-1.013, p=0.012) were identified to be reliable advanced tumor staging predictors.ConclusionTumor TLG and V/S ratio are significant predictors for advanced tumor stage at initial presentation in BC patients.