Current guidelines do not systematically recommend 18F-FDG PET/CT for breast cancer staging; and the recommendations and level of evidence supporting its use in different groups of patients vary among guidelines. This review summarizes the evidence about the role of 18F-FDG PET/CT in breast cancer staging and the therapeutic and prognostic impact accumulated in the last decade. Other related aspects, such as the association of metabolic information with biology and prognosis are considered and evidence-based recommendations for the use of 18F-FDG PET/CT in breast cancer staging are offered. We systematically searched MEDLINE for articles reporting studies with at least 30 patients related to clinical questions following the Problem/Population, Intervention, Comparison, and Outcome framework. We critically reviewed the selected articles and elaborated evidence tables structuring the summarized information into methodology, results, and limitations. The level of evidence and the grades of recommendation for the use of 18F-FDG PET/CT in different contexts are summarized. Level III evidence supports the use of 18F-FDG PET/CT for initial staging in patients with recently diagnosed breast cancer; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a weak recommendation in this population. In patients with locally advanced breast cancer, level II evidence supports the use of 18F-FDG PET/CT for initial staging; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a strong recommendation in this population. In patients with recently diagnosed breast cancer, the metabolic information from baseline 18F-FDG PET/CT is associated with tumor biology and has prognostic implications, supported by level II evidence. In conclusion, 18F-FDG PET/CT is not recommended for staging all patients with early breast cancer, although evidence of improved regional and systemic staging supports its use in locally advanced breast cancer. Baseline tumor glycolytic activity is associated with tumor biology and prognosis.

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The results of our meta-analysis reveal high diagnostic performance of FDG PET in the detection of malignancy responsible for PNS, not affected by the presence of onconeural antibodies or clinical characteristics.

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P atient 1 was a 44-year-old woman, a journalist, who was attended to at the emergency unit of Hospital Universitario Miguel Servet for two pruriginous small lesions, each with a blackish center and a hyperkeratotic halo, on the heel of the right foot and a larger lesion adjacent to the distal edge of the nail of the fifth finger, approximately 1 cm in diameter. The previous month, she had traveled to Tanzania and Zanzibar Island, performing barefoot walks on sandy beaches and rocky areas. During the trip, she had presented an episode of generalized pruritus. The injuries were punctured with iodine antiseptic application, and the serous material was sent to the microbiology laboratory. The direct microscopic examination showed brownish structures of arthropod parts and ovoid structures (Fig. 1, left). Resolution was satisfactory.Patient 2 was a 66-year-old woman, a social worker, who was attended to at the dermatology unit for painless lesions in the pads of the toes of both feet. The onset had occurred after a 4-month stay with a nonprofit organization in Ethiopia. On examination, she had in the first and second left toes and in the second right toe periungual lesions, each with a black center surrounded by erythema and hyperkeratosis (Fig. 1, upper right). Material extracted was sent to the microbiological laboratory with visualization of ovoid structures (Fig. 1, lower right). The lesions were topically treated with 4% formaldehyde, with satisfactory resolution. Magnification, ϫ400.