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Updated: Feb 15, 2026
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Visualization and Quantification of Brown and Beige Adipose Tissues in Mice using [18F]FDG Micro-PET/MR Imaging
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SUV calculation in breast cancer: which normalization should be applied when using 18F-FDG PET?
Olivier Humbert1,2, Jean-Marc Riedinger3,4, David Chardin5
1Department of Nuclear Medicine, Centre Antoine-Lacassagne, University of Côte d'Azur, Nice, France - ohumbert@unice.fr.
Summary
Standardized uptake value (SUV) normalization methods in 18F-FDG PET imaging do not significantly impact the prediction of breast cancer aggressiveness or treatment response. Body weight (SUV BW) and lean body mass (SUL) normalization are robust for clinical use.
Area of Science:
- Nuclear Medicine
- Oncology
- Medical Imaging
Background:
- 18F-FDG PET imaging for glucose metabolism quantification is influenced by various factors.
- Accurate prediction of breast cancer aggressiveness and treatment response requires reliable 18F-FDG uptake measurements.
Purpose of the Study:
- To evaluate the effectiveness of different standardized uptake value (SUV) normalization methods in improving 18F-FDG uptake accuracy.
- To assess the predictive value of these normalizations for breast cancer aggressiveness and response to neoadjuvant chemotherapy (NAC).
Main Methods:
- 252 women with locally advanced breast cancer undergoing NAC were studied.
- 18F-FDG PET scans were performed before and after the first NAC course.
- Four SUV normalization methods were analyzed: body weight (SUV BW), blood glucose (SUVG), lean body mass (SUL), and combined lean body mass/glucose (SULG).
Main Results:
- Baseline SUL was significantly lower than SUV BW, but SUVG and SUV BW showed no significant difference.
- Different normalization methods yielded comparable statistical results and predictive accuracy (AUC) for tumor aggressiveness and treatment response.
- High baseline SUV BW correlated with aggressive tumor characteristics, and ΔSUV BW predicted pathological complete response (pCR).
Conclusions:
- SUV normalized by body weight (SUV BW) and lean body mass (SUL) are robust measures for 18F-FDG PET in breast cancer.
- Normalization by glycemia (SUVG) requires stringent procedures and offers no statistical advantage.
- These findings support the use of SUV BW and SUL in multicenter trials for breast cancer assessment.
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