Evaluation of diagnostic accuracy and impact of preoperative positron emission tomography/computed tomography in the management of early operable breast cancers

Abstract

Aim: Our aim of this study was to evaluate the diagnostic accuracy of staging positron emission tomography/computed tomography (PET/CT) in early breast cancers (EBCs) and to assess its impact on disease management. Patients and Methods: We retrospectively reviewed preoperative PET/CT scans of patients from January 2015 to December 2018 with Stage I/II, clinically T1-T2 N0-N1 breast cancers. The diagnostic performance of PET/CT for nodal (N) and distant metastases (M), its correlation with patient/tumor-specific factors, and its impact on disease management were analyzed using histopathology/clinical follow-up as standards of reference. Results: Of 158 patients evaluated, 14% of patients were Stage I (T1N0), 60% were Stage IIA (T1N1, T2N0), and 26% were Stage IIB (T2N1). Sensitivity, specificity, and the diagnostic accuracy of PET/CT for axillary staging were 76%, 97%, and 84% and for distant metastasis evaluation were 100%, 98%, and 99%, respectively. The diagnostic accuracy of PET/CT for axillary staging was lower for low-grade, T1 tumors, postmenopausal group, and luminal A pathological subtype (77%, 84%, 81%, and 73%, respectively) compared to high-grade, T2 tumors, premenopausal group, and nonluminal A subtype (88%, 88%, 94%, and 87%, respectively). Distant metastases were detected on PET/CT in overall 16% (n = 25) of the patients (9% in Stage IIA and 27% in Stage IIB). PET/CT also incidentally identified clinically occult internal mammary nodes in 5% (n = 8) and organ-confined synchronous second malignancies in 5% (n = 8) of the patients. Conclusion: Preoperative PET/CT should be considered in all EBCs> 2 cm as it upstages the disease and alters management in about 24% of these patients. Given its high specificity for axillary staging PET/CT, patients with PET-positive axilla can be subjected to axillary dissection and those with PET-negative axilla to sentinel lymph node biopsy. The yield and diagnostic accuracy of PET/CT is less for low-grade tumors <2 cm and with luminal A subtype.

Correlation of primary tumor metabolic parameters with clinical, histopathological and molecular characteristics in breast cancer patients at pre-operative staging FDG-PET/CT study

“…BC is the commonest cancer and the leading cause of cancer mortality among women worldwide [1].Classification can be done according to TNM stage, immunohistochemical features, grade, proliferation index and gene expression profiles, with histopathology remaining the cornerstone of characterization [2]. Immunohistochemistry (IHC) markers such as ER, PR and Her2neu, along with clinicopathological variables including; tumor size, grade and nodal involvement are commonly used for patient prognosis and management [3,4].…”

Impact of 18F-FDG PET, PET/CT, and PET/MRI on Staging and Management as an Initial Staging Modality in Breast Cancer

“… 23 , 30 – 32 , 35 – 38 , 40 Twenty-five studies were regarded as having an unclear risk of bias in confounding variables because the exact time interval between conventional staging procedures and PET scans was not reported. 12 , 14 , 16 – 27 , 29 – 32 , 34 – 40 For the measurement of exposure domain, 6 studies had a high risk of bias because a single reader interpreted PET images, 13 , 15 , 29 , 34 , 37 , 38 and 6 studies had an unclear risk of bias because they did not report the number of readers or their experience. 18 , 20 , 27 , 28 , 30 , 39 Regarding the blinding of outcome assessments domain, 13 studies had an unclear risk of bias as it was unclear whether PET interpretation was performed in a blinded manner, 15 , 16 , 18 , 22 – 24 , 28 – 30 , 32 , 35 , 36 , 40 and 1 study had a high risk of bias because PET interpretation was not blinded to the findings of other tests.…”

“… 18 , 20 , 27 , 28 , 30 , 39 Regarding the blinding of outcome assessments domain, 13 studies had an unclear risk of bias as it was unclear whether PET interpretation was performed in a blinded manner, 15 , 16 , 18 , 22 – 24 , 28 – 30 , 32 , 35 , 36 , 40 and 1 study had a high risk of bias because PET interpretation was not blinded to the findings of other tests. 19 For outcome evaluation, 10 studies showed an unclear risk of bias as the method for classifying stage was not explicitly mentioned, 12 , 14 , 17 , 25 , 27 , 28 , 30 – 32 , 36 and 2 studies had a high risk of bias as the method for confirmation of additional lesions on PET scan was reported. 24 , 39 …”

Sensitivity, Specificity and the Diagnostic Accuracy of PET/CT for Axillary Staging in Patients With Stage I-III Cancer: A Systematic Review of The Literature

“…18 FDG PET/CT could be used to determine whether patients require SNB or ALND (10,18), thereby avoiding a potentially unnecessary invasive procedure (10,14). Some authors suggest that when 18 FDG PET/CT is positive patients could be offered ALND immediately (8,28,32), whereas a negative finding on 18 FDG PET/CT indicates the continued need of SNB. This is due to the high FN rate observed (8).…”