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Peer-reviewedCC BY 4.0European Journal of Nuclear Medicine and Molecular Imaging

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

  • Luca Urso1,2
  • Stefano Panareo3
  • Domenico Albano4
  • Antonella Iudicello2,3
  • Luca Filippi5
  • Francesca Borgia1,2
  • Mirco Bartolomei2
  • Priscilla Guglielmo6,7
  • Francesco Bertagna4
  • Silvia Taralli8
  • Maria Lucia Calcagni8,9
  • Angelica Mazzoletti10
23 more authors
  • Mattia Bonacina10
  • Lorenzo Fantini11
  • Andrea Paccagnella12
  • Carlotta Benedetta Colombo13
  • Massimo Castellani13
  • Alessio Annovazzi14
  • Rosa Sciuto14
  • Matteo Bauckneht15,16
  • Federico Garrou17
  • Demetrio Aricò18
  • Guido Rovera19
  • Cristina Ferrari20
  • Alberto Miceli21
  • Pasquale Reccia22
  • Gianluca Cassarino23
  • Elisa Rizza24
  • Andrea Marongiu25
  • Annachiara Arnone26
  • Anna Margherita Maffione27
  • Salvatore Ialuna28
  • Nicola Frega29
  • Laura Evangelista6,30
  • All the TRINE-PET Investigators
30 affiliations
  1. 1Department of Translational Medicine, University of Ferrara, Via Aldo Moro N.8, Ferrara, Italy
  2. 2Nuclear Medicine Unit, Onco-Hematology Department, University Hospital of Ferrara, Ferrara, Italy
  3. 3Nuclear Medicine Unit, Oncology and Hematology Department, University Hospital of Modena, Modena, Italy
  4. 4Nuclear Medicine, University of Brescia, Brescia, Italy
  5. 5Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
  6. 6Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
  7. 7Nuclear Medicine Unit, Humanitas Gavazzeni, Bergamo, Italy
  8. 8Nuclear Medicine Unit, Diagnostic Imaging and Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  9. 9Section of Nuclear Medicine, Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy
  10. 10Nuclear Medicine “Alessandra Bono”, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
  11. 11Nuclear Medicine Department, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori “Dino Amadori” (IRST), Meldola, Italy
  12. 12Nuclear Medicine Service, ‘M. Bufalini’ Hospital, ‘Azienda Unità Sanitaria Locale’ Romagna, Cesena, Italy
  13. 13Nuclear Medicine Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
  14. 14Nuclear Medicine Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
  15. 15IRCCS Azienda Ospedaliera Metropolitana, Genova, Italy
  16. 16Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
  17. 17Nuclear Medicine, AOU Maggiore Della Carità, Novara, Italy
  18. 18Nuclear Medicine Unit, Humanitas Istituto Clinico Catanese, Catania, Italy
  19. 19Nuclear Medicine Division, Department of Medical Sciences, AOU Città Della Salute E Della Scienza Di Torino, University of Turin, Turin, Italy
  20. 20Department of Nuclear Medicine, University Aldo Moro, Bari, Italy
  21. 21Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
  22. 22Unit of Nuclear Medicine and Molecular Imaging, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
  23. 23Nuclear Medicine Unit, Giovanni Paolo II Hospital, Ragusa, Italy
  24. 24Nuclear Medicine Unit, Vito Fazzi Hospital, Lecce, Italy
  25. 25Unit of Nuclear Medicine. Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
  26. 26Department of Nuclear Medicine, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
  27. 27Department of Nuclear Medicine, S.M. Della Misericordia Hospital, Rovigo, Italy
  28. 28Nuclear Medicine Unit, Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, Italy
  29. 29Nuclear Medicine Unit, Department of Health Service, AORN Ospedali Dei Colli, Naples, Italy
  30. 30Nuclear Medicine Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
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Abstract

Purpose: Triple negative breast cancer (TNBC) is an aggressive subtype, still with limited therapeutic options. [18F]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 [18F]FDG PET/CT in a large real world TNBC cohort.

Methods: This retrospective multicenter study included 389 TNBC patients who underwent 707 [18F]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 [18F]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 [18F]FDG PET/CT was strongly associated with worse PFS and OS (all p < 0.001). In multivariate analysis, distant metastases at [18F]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 [18F]FDG uptake at primary tumor did not. [18F]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, [18F]FDG PET/CT demonstrated robust prognostic value across all disease settings. PET detected metastatic involvement emerged as the most powerful predictor of survival; moreover, [18F]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 [18F]FDG PET/CT into the diagnostic pathways of TNBC.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08056-1.

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Cite

BibTeXRIS
BibTeX
@article{urso2026prognostic,
  title = {{Prognostic relevance of [18F]FDG PET/CT in triple-negative breast cancer: Results from the triple negative (TRINE)-PET trial}},
  author = {Luca Urso and Stefano Panareo and Domenico Albano and Antonella Iudicello and Luca Filippi and Francesca Borgia and Mirco Bartolomei and Priscilla Guglielmo and Francesco Bertagna and Silvia Taralli and Maria Lucia Calcagni and Angelica Mazzoletti and Mattia Bonacina and Lorenzo Fantini and Andrea Paccagnella and Carlotta Benedetta Colombo and Massimo Castellani and Alessio Annovazzi and Rosa Sciuto and Matteo Bauckneht and Federico Garrou and Demetrio Aricò and Guido Rovera and Cristina Ferrari and Alberto Miceli and Pasquale Reccia and Gianluca Cassarino and Elisa Rizza and Andrea Marongiu and Annachiara Arnone and Anna Margherita Maffione and Salvatore Ialuna and Nicola Frega and Laura Evangelista and All the TRINE-PET Investigators},
  journal = {European Journal of Nuclear Medicine and Molecular Imaging},
  year = {2026},
  month = aug,
  doi = {10.1007/s00259-026-08056-1},
  url = {https://doi.org/10.1007/s00259-026-08056-1},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Prognostic relevance of [18F]FDG PET/CT in triple-negative breast cancer: Results from the triple negative (TRINE)-PET trial
AU  - Luca Urso
AU  - Stefano Panareo
AU  - Domenico Albano
AU  - Antonella Iudicello
AU  - Luca Filippi
AU  - Francesca Borgia
AU  - Mirco Bartolomei
AU  - Priscilla Guglielmo
AU  - Francesco Bertagna
AU  - Silvia Taralli
AU  - Maria Lucia Calcagni
AU  - Angelica Mazzoletti
AU  - Mattia Bonacina
AU  - Lorenzo Fantini
AU  - Andrea Paccagnella
AU  - Carlotta Benedetta Colombo
AU  - Massimo Castellani
AU  - Alessio Annovazzi
AU  - Rosa Sciuto
AU  - Matteo Bauckneht
AU  - Federico Garrou
AU  - Demetrio Aricò
AU  - Guido Rovera
AU  - Cristina Ferrari
AU  - Alberto Miceli
AU  - Pasquale Reccia
AU  - Gianluca Cassarino
AU  - Elisa Rizza
AU  - Andrea Marongiu
AU  - Annachiara Arnone
AU  - Anna Margherita Maffione
AU  - Salvatore Ialuna
AU  - Nicola Frega
AU  - Laura Evangelista
AU  - All the TRINE-PET Investigators
PY  - 2026
DA  - 2026/08/17
JO  - European Journal of Nuclear Medicine and Molecular Imaging
DO  - 10.1007/s00259-026-08056-1
UR  - https://doi.org/10.1007/s00259-026-08056-1
AB  - Purpose: Triple negative breast cancer (TNBC) is an aggressive subtype, still with limited therapeutic options. [18F]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 [18F]FDG PET/CT in a large real world TNBC cohort.  Methods: This retrospective multicenter study included 389 TNBC patients who underwent 707 [18F]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 [18F]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 [18F]FDG PET/CT was strongly associated with worse PFS and OS (all p < 0.001). In multivariate analysis, distant metastases at [18F]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 [18F]FDG uptake at primary tumor did not. [18F]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, [18F]FDG PET/CT demonstrated robust prognostic value across all disease settings. PET detected metastatic involvement emerged as the most powerful predictor of survival; moreover, [18F]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 [18F]FDG PET/CT into the diagnostic pathways of TNBC.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08056-1.
SN  - 1619-7070
SN  - 1619-7089
ER  -