Prognostic relevance of [18F]FDG PET/CT in triple-negative breast cancer: Results from the triple negative (TRINE)-PET trial

Abstract Purpose Triple negative breast cancer (TNBC) is an aggressive subtype, still with limited therapeutic options. [ 18 F]FDG PET/CT is widely used in TNBC, but evidence regarding its prognostic value remains limited. The TRINE PET study, promoted by the Italian Association of Nuclear Medicine, aimed to evaluate the prognostic relevance and clinical impact of [ 18 F]FDG PET/CT in a large real world TNBC cohort. Methods This retrospective multicenter study included 389 TNBC patients who underwent 707 [ 18 F]FDG PET/CT scans across 23 Italian Nuclear Medicine Units. Clinical settings were baseline staging ( n = 257 patients), post neoadjuvant chemotherapy ( n = 111 patients), suspected recurrence ( n = 144 patients), and advanced metastatic disease ( n = 195 patients). Progression free survival (PFS) and overall survival (OS) were assessed using Kaplan–Meier and Cox regression analyses. The influence of [ 18 F]FDG PET/CT on clinical management was evaluated across all settings. Results During a median follow up of 34 months (1–124), disease progression and death occurred in 39.3% and 28.4% of cases, respectively. Across all clinical settings, nodal and distant metastatic involvement at [ 18 F]FDG PET/CT was strongly associated with worse PFS and OS (all p < 0.001). In multivariate analysis, distant metastases at [ 18 F]FDG PET/CT resulted the strongest independent predictor of OS (HR 9.42, 95% CI 3.74–23.75) and PFS (HR 6.57, 95% CI 3.05–14.12), while Ki67 and [ 18 F]FDG uptake at primary tumor did not. [ 18 F]FDG PET/CT findings led to a change in clinical management in 20.8% of all scans, with the highest impact in the advanced metastatic setting (34.9%). Conclusion In the largest real world multicenter study dedicated to TNBC, [ 18 F]FDG PET/CT demonstrated robust prognostic value across all disease settings. PET detected metastatic involvement emerged as the most powerful predictor of survival; moreover, [ 18 F]FDG PET/CT influenced therapeutic decision in all settings of disease, reaching one in three scans in the advanced metastatic disease. These findings support the systematic integration of [ 18 F]FDG PET/CT into the diagnostic pathways of TNBC.

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Journal
European Journal of Nuclear Medicine and Molecular Imaging
Published
2026-08-17
DOI
https://doi.org/10.1007/s00259-026-08056-1
Primary Topic
Medical Imaging Techniques and Applications
Type
article
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article

Prognostic relevance of [18F]FDG PET/CT in triple-negative breast cancer: Results from the triple negative (TRINE)-PET trial

Silvia Taralli, Andrea Paccagnella, Luca Urso, Mirco Bartolomei et al.
European Journal of Nuclear Medicine and Molecular Imaging
Medical Imaging Techniques and Applications
article

Prognostic relevance of [18F]FDG PET/CT in triple-negative breast cancer: Results from the triple negative (TRINE)-PET trial

Silvia Taralli, Andrea Paccagnella, Luca Urso, Mirco Bartolomei, Luca Filippi, Massimo Castellani, Angelica Mazzoletti, Salvatore Ialuna, Demetrio Aricò, Pasquale Reccia, Rosa Sciuto, Andrea Marongiu, Carlotta Benedetta Colombo, Mattia Bonacina, Alberto Miceli, Anna Margherita Maffione, G Cassarino, Lorenzo Fantini, Guido Rovera, Francesca Borgia, Priscilla Guglielmo, Alessio Annovazzi, Antonella Iudicello, Annachiara Arnone, Federico Garrou, Maria Lucia Calcagni, Nicola Frega, Laura EVANGELISTA, Matteo Bauckneht, Cristina Ferrari, Domenico Albano, Elisa Rizza, Francesco Bertagna, Stefano Panareo, All the TRINE-PET Investigators
article en

Abstract

Abstract Purpose Triple negative breast cancer (TNBC) is an aggressive subtype, still with limited therapeutic options. [ 18 F]FDG PET/CT is widely used in TNBC, but evidence regarding its prognostic value remains limited. The TRINE PET study, promoted by the Italian Association of Nuclear Medicine, aimed to evaluate the prognostic relevance and clinical impact of [ 18 F]FDG PET/CT in a large real world TNBC cohort. Methods This retrospective multicenter study included 389 TNBC patients who underwent 707 [ 18 F]FDG PET/CT scans across 23 Italian Nuclear Medicine Units. Clinical settings were baseline staging ( n = 257 patients), post neoadjuvant chemotherapy ( n = 111 patients), suspected recurrence ( n = 144 patients), and advanced metastatic disease ( n = 195 patients). Progression free survival (PFS) and overall survival (OS) were assessed using Kaplan–Meier and Cox regression analyses. The influence of [ 18 F]FDG PET/CT on clinical management was evaluated across all settings. Results During a median follow up of 34 months (1–124), disease progression and death occurred in 39.3% and 28.4% of cases, respectively. Across all clinical settings, nodal and distant metastatic involvement at [ 18 F]FDG PET/CT was strongly associated with worse PFS and OS (all p < 0.001). In multivariate analysis, distant metastases at [ 18 F]FDG PET/CT resulted the strongest independent predictor of OS (HR 9.42, 95% CI 3.74–23.75) and PFS (HR 6.57, 95% CI 3.05–14.12), while Ki67 and [ 18 F]FDG uptake at primary tumor did not. [ 18 F]FDG PET/CT findings led to a change in clinical management in 20.8% of all scans, with the highest impact in the advanced metastatic setting (34.9%). Conclusion In the largest real world multicenter study dedicated to TNBC, [ 18 F]FDG PET/CT demonstrated robust prognostic value across all disease settings. PET detected metastatic involvement emerged as the most powerful predictor of survival; moreover, [ 18 F]FDG PET/CT influenced therapeutic decision in all settings of disease, reaching one in three scans in the advanced metastatic disease. These findings support the systematic integration of [ 18 F]FDG PET/CT into the diagnostic pathways of TNBC.

European Journal of Nuclear Medicine and Molecular Imaging
Università Cattolica del Sacro Cuore (IT), University of Rome Tor Vergata (IT), University of Modena and Reggio Emilia (IT), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), AOL (United States) (US), Humanitas University (IT), University of Sassari (IT), University of Ferrara (IT), Agostino Gemelli University Polyclinic (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Azienda Unita' Sanitaria Locale Di Modena (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IT), Ospedale Vincenzo Cervello (IT), Azienda Unità Sanitaria Locale Della Romagna (IT), Istituto Oncologico Veneto (IT), Ospedale “M. Bufalini” di Cesena (IT), Azienda Ospedaliero Universitaria Maggiore della Carita (IT), Azienda Ospedaliera S.Maria (IT), Humanitas Gavazzeni (IT), Ospedale Monaldi (IT), Azienda Ospedaliera Ospedale Maggiore (IT), Fondazione Poliambulanza Istituto Ospedaliero (IT), Ospedale Santa Maria della Misericordia di Rovigo (IT), Ospedale Vito Fazzi (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo (IT), IRCCS Humanitas Research Hospital (IT), University of Bari Aldo Moro (IT), University of Brescia (IT), University of Genoa (IT), Union des Industries Ferroviaires Européennes (BE)
Università degli Studi di Ferrara
Openalex Percentile: Top 10%
Medical Imaging Techniques and Applications
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