Clinical impact of 18F-FDG PET/CT on initial staging and therapy planning for breast cancer

Abstract

The purpose of this study was to determine the clinical significance of 18F-FDG PET/CT on initial staging and therapy planning in patients with invasive breast cancer. One hundred and forty-one consecutive, biopsy proven preoperative and 195 postoperative high-risk breast cancer patients who were referred for PET/CT for initial staging were included in this retrospective study. The clinical stage had been determined by conventional imaging modalities prior to the PET/CT scan. Of the 141 examined preoperative patients, 19 had clinical stage I (T1N0), 51 had stage IIA (12 T2N0 and 39 T1N1), 49 had stage IIB (2 T3N0 and 47 T2N1), 12 had stage IIIA (11 T3N1, 1 T2N2), 2 had stage IIIB (2 T4N1) and 8 had stage IV. PET/CT modified the staging for 26% of stage I patients, 29% of stage IIA patients, 46% of stage IIB patients, 58% of stage IIIA patients and 100% of stage IIIB patients. PET/CT scans detected extra-axillary regional lymph nodes in 14 (9.9%) patients and distant metastasis in 41 (29%) patients. PET/CT scans detected multifocal lesions in 30 (21%) patients, multicentric lesions in 21 (14%) patients and malign foci in the contralateral breast (bilateral breast cancer) confirmed by biopsy in 5 (3.5%) patients. Of the examined 195 postoperative patients PET/CT detected axillary lymph nodes in 22 (11%) patients, extra-axillary regional lymph nodes in 21 (10%) patients and distant metastasis in 24 (12%) patients. PET/CT findings altered plans for radiotherapy in 22 (11%) patients and chemotherapy was adapted to the meta-static diseases in 24 (12%) patients. PET/CT was revealed to be superior to conventional imaging modalities for the detection of extra-axillary regional metastatic lymph nodes and distant metastases. These features make PET/CT an essential imaging modality for the primary staging of invasive breast cancer, particularly in patients with clinical stages II and III.

Preoperative [18]fluorodeoxyglucose-positron emission tomography/computed tomography in early stage breast cancer: Rates of distant metastases

“…Clinical stage: The rates of DM ranged from 0% to 30%[ 17 - 34 ] for the entire group of reported patients. However, only 9 of the studies correlated DM rates detected by 18 FDG-PET/CT with the clinical stage[ 17 , 22 - 24 , 27 , 29 , 31 , 32 , 34 ]. The rate of DM was lowest among studies of patients with invasive lobular cancer compared to studies that had included a mixture of other histologies, such as invasive ductal carcinoma[ 18 ] (Tables 1 and 2 ).…”

“…Overall, the rate of DM for presumed stage I was low for all cancer types but non-negligible, ranging from 0% to 8.3%[ 22 , 27 , 29 , 31 , 32 , 34 ]. Among the 9 studies that reported the rate of DM in patients with stage II breast cancer separately, the prevalence ranged from 0% to 12.4%[ 17 , 22 , 24 , 27 , 29 , 31 , 32 , 34 ].…”

“…Overall, the rate of DM for presumed stage I was low for all cancer types but non-negligible, ranging from 0% to 8.3%[ 22 , 27 , 29 , 31 , 32 , 34 ]. Among the 9 studies that reported the rate of DM in patients with stage II breast cancer separately, the prevalence ranged from 0% to 12.4%[ 17 , 22 , 24 , 27 , 29 , 31 , 32 , 34 ]. Patients with large tumors and/or axillary lymph node metastases appeared to be at increased risk of DM; specifically, the rate of DM was 7.2% (range, 0%-19.6%) and 15.8% (range, 0%-40.8%) for stage IIA and stage IIB, respectively[ 17 , 22 , 24 , 27 , 31 , 32 , 34 ].…”

Molecular Imaging and Its Role in the Management of Breast Cancer

“…3 In breast cancer, PET-CT has been shown to upstage as many as 58% of preoperative and 32% of postoperative patients, whereas downstaging 2%. 4 Although beyond the scope of this discussion,otherimaginghybridshaveemergedas a result of PET-CT including SPECT-CT and PET-MR.…”

Present and future role of FDG-PET/CT imaging in the management of breast cancer

“…For the initial staging work-up, many conventional imaging modalities, such as X-ray mammography, MR mammography, chest plain radiography, bone scintigraphy, and breast, axillary and liver ultrasonography, have been widely utilized. In recent years, several groups have evaluated the clinical role of FDG-PET/CT for pretreatment evaluation of breast cancer in comparison with conventional imaging tools [18,39,[43][44][45][46][47][48][49][50][51][52][53][54] (Table 2). These studies revealed that FDG-PET/CT is generally helpful, but particularly valuable for detection of extra-axillary (infraclavicular, supraclavicular and internal mammary) nodal metastasis and occult distant metastasis relative to conventional modalities, especially in patients with inflammatory breast cancer [43,46,47] and stage II-III disease [18, Fig.…”