Prognostic value of FDG PET/CT in special types of breast cancer with non-favorable histology

Purpose Prognostic factors for special types of breast cancer remain poorly understood owing to limited clinical research. Therefore, we evaluated the prognostic significance of the maximum standardized uptake value (SUVmax) derived from fluorodeoxyglucose positron emission tomography/computed tomography in patients with special types. Methods This retrospective cohort study included patients who underwent curative surgery for special types of breast cancer at Hiroshima University Hospital between 2006 and 2021. Pretreatment SUVmax values, with a cutoff of > 3.0, were evaluated. Results Among the 226 identified cases, 105 with favorable histology according to the NCCN guideline were excluded, leaving 121 cases for analysis. The patients had a median follow-up period of 77.8 months (IQR 37.2–114.3). SUVmax > 3.0 was significantly associated with advanced T and N stages, higher nuclear grade, and receipt of adjuvant chemotherapy ( P = 0.012, P = 0.006, P < 0.005, P < 0.005, respectively). The 5-year relapse-free survival (RFS) and overall survival (OS) rates were 82.8% and 89.2% for SUVmax > 3.0 and 94.6% and 96.7% for SUVmax ≤ 3.0 ( P = 0.005; P = 0.167, respectively). Multivariate analysis identified N stage (Hazard Ratio (HR) 4.20, 95% CI 1.18–14.9, P = 0.026) and SUVmax (HR 3.55, 95% CI 1.12–11.2, P = 0.026) as significant independent prognostic factors for RFS, while no factors were prognostic for OS. Conclusions Our results underscore the utility of SUVmax > 3.0, which is a potential prognostic indicator of poor outcomes in patients with special types of breast cancer, in guiding personalized treatment strategies.