Diagnostic and prognostic correlates of preoperative FDG PET for breast cancer

Abstract

Purpose To explore the preoperative utility of FDG PET for the diagnosis and prognosis in a retrospective breast cancer case series. Methods In this retrospective study, 104 patients who had undergone a preoperative FDG PET scan for primary breast cancer at the UZ Brussel during the period 2002-2008 were identified. Selection criteria were: histological confirmation, FDG PET performed prior to therapy, and breast surgery integrated into the primary therapy plan. Patterns of increased metabolism were recorded according to the involved locations: breast, ipsilateral axillary region, internal mammary chain, or distant organs. The end-point for the survival analysis using Cox proportional hazards was disease-free survival.The contribution of prognostic factors was evaluated using the Akaike information criterion and the Nagelkerke index. Results PET positivity was associated with age, gender, tumour location, tumour size >2 cm, lymphovascular invasion, oestrogen and progesterone receptor status. Among 63 patients with a negative axillary PET status, 56 (88.9 %) had three or fewer involved nodes, whereas among 41 patients with a positive axillary PET status, 25 (61.0 %) had more than three positive nodes (P<0.0001). In the survival analysis of preoperative characteristics, PET axillary node positivity was the foremost statistically significant factor associated with decreased disease-free survival (hazard ratio 2.81, 95% CI 1.17-6.74). Conclusion Preoperative PET axillary node positivity identified patients with a higher burden of nodal involvement, Electronic supplementary material The online version of this article

Staging the axilla in breast cancer patients with 18F-FDG PET: how small are the metastases that we can detect with new generation clinical PET systems?

“…Therefore, accurate staging at the time of initial diagnosis is crucial. PET using 18 F-FDG has been used for staging, restaging and therapy monitoring in a variety of cancer types, including breast cancer [1–5]. In newly diagnosed breast cancer, 18 F-FDG PET is not recommended for routine staging of axillary lymph nodes because its sensitivity is too low [1].…”

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

“…Some studies included the more advanced stages, stage III and IV, and a few studies included post-operative patients. Many issues of importance are relevant for breast cancer, notably the emerging role of PET/MRI and its comparison with PET/CT[47], the use of PET in the monitoring of neoadjuvant therapy[48], the use for staging and restaging[49], the standardized uptake values (commonly known as SUVs) and how they relate to lymph node status[50], the prognostic role of FDG-PET[51] and the suitability for treatment planning[52]; all these represent immensely exciting domains of breast cancer research, but would have confused the scope of the present study, namely the rates of DM.…”

Pretreatment PET in breast cancer: is there a role?

“…Although most of these earlier studies employed stand-alone PET scanners, and therefore did not reflect the improved diagnostic performance of PET/CT, more recent studies using PET/CT still achieved only a relatively poor sensitivity of 58-70 %, although specificity was good at 92 %-100 % [5,11]. Given that PET positivity has a high positive predictive value for nodal involvement, it has been suggested by Aukema et al [12] and corroborated by Vinh-Hung et al [8], that preoperative PET may represent a useful stratification tool, obviating the need for SLNB in PET-positive patients, so that ALND can be proceeded to immediately. Although at present PET does not normally form part of breast cancer staging, it is sometimes performed as a baseline study for monitoring of response to neoadjuvant therapy, and this could be taken advantage of to reduce the need for SLNB [12].…”

“…An increasing body of data is, however, accumulating to support the suggestion that PET may provide valuable predictive prognostic information, and could usefully contribute to the preoperative decision-making process. The study by Vinh-Hung et al in a recent issue of European Journal of Nuclear Medicine and Molecular Imaging examines this potential role for PET, and suggests that the identification by PET of positive axillary nodes is predictive of nodal involvement and represents a useful tool for treatment decision making which can reduce the need for sentinel lymph node biopsy (SLNB) [8].…”

“…An increasing body of data is, however, accumulating to support the suggestion that PET may provide valuable predictive prognostic information, and could usefully contribute to the preoperative decision-making process. The study by Vinh-Hung et al in a recent issue of European Journal of Nuclear Medicine and Molecular Imaging examines this potential role for PET, and suggests that the identification by PET of positive axillary nodes is predictive of nodal involvement and represents a useful tool for treatment decision making which can reduce the need for sentinel lymph node biopsy (SLNB) [8].The potential role of PET in preoperative staging in breast carcinoma has been considered in detail by two large systematic reviews which analysed a total of 10 studies of between 18 and 167 patients [9,10]. These reviews were examined by a multidisciplinary expert panel under the auspices of the SNM to develop recommendations on the role of PET in oncology [3].…”