FDG-PET/CT in high-risk primary breast cancer—a prospective study of stage migration and clinical impact

Vogsen, Marianne; Jensen, Jeanette Dupont; Christensen, Ivar Yannick; Gerke, Oke; Jylling, Anne Marie Bak; Larsen, Lisbeth Aagaard; Braad, Poul-Erik; Søe, Katrine Lydolph; Bille, Camilla; Ewertz, Marianne

doi:10.1007/s10549-020-05929-3

Cited by 29 publications

(58 citation statements)

References 18 publications

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“…In nine patients, the origin of the detected metastases was suggested to be breast cancer, and [ 18 F]FDG-PET/CT suggested synchronous cancer in the remaining 9 of 225 patients (4%). This number corresponds well with the 3.88% of incidental ndings in a population of high-risk primary breast cancer in the same institution and time [10]. Other studies on different cancers have also found between 1-8% of additional malignancies at [ 18 F]FDG-PET/CT [9,[15][16][17][18].…”

Section: Accuracysupporting

confidence: 79%

“…The study was registered at ClinicalTrials.gov with an enrolment of patients with high-risk primary breast cancer. This population has been described elsewhere as the clinical impact of [ 18 F]FDG-PET/CT differs between patients with high-risk primary breast cancer and patients suspected of recurrent breast cancer [10]. Another strength is that we managed to reproduce and validate the diagnostic accuracy of an earlier study [4].…”

Section: Accuracymentioning

confidence: 99%

“…Like in other cancers, incidental ndings suspicious for malignancy may be detected by [ 18 F]FDG-PET/CT when used to diagnose and to stage cancer [9,10]. Incidental malignant ndings may generate additional examinations, complications, and anxiety, leading to avoidance of using [ 18 F]FDG-PET/CT.…”

Section: Introductionmentioning

confidence: 99%

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Benefits And Harms Of Implementing [18F]FDG-PET/CT For Diagnosing Recurrent Breast Cancer: A Prospective Clinical Study

Vogsen

Jensen

Gerke

et al. 2021

Preprint

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Background [18F]-fluorodeoxyglucose-positron emission tomography / computed tomography ([18F]FDG-PET/CT) has been implemented sporadically in hospital settings as the standard of care examination for recurrent breast cancer. We aimed to explore the clinical impact of implementing [18F]FDG-PET/CT for patients with clinically suspected recurrent breast cancer and validate the diagnostic accuracy. Methods Women with suspected distant recurrent breast cancer were prospectively enrolled in the study between September 2017 and August 2019. [18F]FDG-PET/CT was performed, and the appearance of incidental benign and malignant findings was registered. Additional examinations, complications, and the final diagnosis were registered to reflect the clinical consequence of such findings. The diagnostic accuracy of [18F]FDG-PET/CT as a stand-alone examination was analyzed. Biopsy and follow-up were used as a reference standard. Results [18F]FDG-PET/CT reported breast cancer metastases in 72 of 225 women (32.0%), and metastases were verified by biopsy in 52 (52/225, 23.1%). Prior probability and posterior probability of a positive test for suspected metastatic cancer and incidental malignancies were 27%/85% and 4%/20%, respectively. Suspected malignant incidental findings were reported in 46 patients (46/225, 20.4%), leading to further examinations and final detection of nine synchronous cancers (9/225, 4.0%). These cancers originated from the lung, thyroid, skin, pancreas, peritoneum, breast, kidney, one was malignant melanoma, and one was hematological cancer. False-positive incidental malignant findings were examined in 37/225 patients (16.4%), mainly in the colon (n = 12) and thyroid gland (n = 12). Ten incidental findings suspicious for benign disease were suggested by [18F]FDG-PET/CT, and further examinations resulted in the detection of three benign conditions requiring treatment. Sensitivity, specificity, and AUC-ROC for diagnosing distant metastases were 1.00 (0.93-1.0), 0.88 (0.82-0.92), and 0.98 (95% CI 0.97-0.99), respectively.Conclusion [18F]FDG-PET/CT provided a high posterior probability of positive test, and a negative test was able to rule out distant metastases in women with clinically suspected recurrent breast cancer. One-fifth of patients examined for incidental findings detected on [18F]FDG-PET/CT were diagnosed with clinically relevant conditions. Further examinations of false-positive incidental findings in one of six women should be weighed against the high accuracy for diagnosing metastatic breast cancer.Trial registration: Clinical.Trials.gov. NCT03358589. Registered 30 November 2017 - Retrospectively registered, http://www.ClinicalTrials.gov

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Section: Accuracysupporting

confidence: 79%

Section: Accuracymentioning

confidence: 99%

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Benefits And Harms Of Implementing [18F]FDG-PET/CT For Diagnosing Recurrent Breast Cancer: A Prospective Clinical Study

Vogsen

Jensen

Gerke

et al. 2021

Preprint

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“…In another recent study, of 103 women, 24 (23%) were diagnosed with distant metastases by FDG-PET/CT [60]. Based on these findings, breast surgery was omitted in 18.…”

Section: Contribution Of Pet/ct In the Assessment Of Extension Of Breast Cancermentioning

confidence: 99%

“…Twentynine incidental findings were detected in 24 women (23%), leading to further examinations in 22 and diagnosis of eight (8/22, 36%) synchronous diseases: cancer (n = 4), thyroiditis (n = 2), aorta aneurysm (n = 1), and meningioma (n = 1). The authors concluded that FDG-PET/CT should be considered for primary staging in high-risk primary breast cancer to improve treatment planning [60].…”

Section: Contribution Of Pet/ct In the Assessment Of Extension Of Breast Cancermentioning

confidence: 99%

Breast cancer: initial workup and staging with FDG PET/CT

Groheux

Hindié

2021

Clin Transl Imaging

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Purpose Precise staging is needed to plan optimal management in breast cancer. 18F-fluorodeoxyglucose positron emission tomography coupled with computed tomography (FDG-PET/CT) offers high sensitivity in detecting extra axillary lymph nodes and distant metastases. This review aims to clarify in which groups of patients staging with FDG-PET/CT would be beneficial and should be offered. We also discuss how tumor biology and breast cancer subtypes should be taken into account when interpreting FDG-PET/CT scans. Methods We performed a comprehensive literature review and rigorous appraisal of research studies assessing indications for FDG-PET/CT in breast cancer. This assessment regarding breast cancer served as a basis for the recommendations set by a working group of the French Society of Nuclear Medicine, in collaboration with oncological societies, for developing good clinical practice recommendations on the use of FDG-PET/CT in oncology. Results FDG-PET/CT is useful for initial staging of breast cancer, independently of tumor phenotype (triple negative, luminal or HER2 +) and regardless of tumor grade. Considering histological subtype, FDG-PET/CT performs better for staging invasive ductal carcinoma, although it is also helpful for staging invasive lobular carcinomas. Based on the available data, FDG-PET/CT becomes useful for staging starting from clinical stage IIB. FDG-PET/CT is possibly useful in patients with clinical stage IIA (T1N1 or T2N0), but there is not enough strong data to recommend routine use in this subgroup. For clinical stage I (T1N0) patients, staging with FDG-PET/CT offers no added value. Conclusion FDG-PET/CT is useful for staging patients with breast cancer, starting from clinical stage IIB.

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Joint EANM-SNMMI guideline on the role of 2-[18F]FDG PET/CT in no special type breast cancer

Vaz,

Woll,

Cardoso

et al. 2024

Eur J Nucl Med Mol Imaging

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Introduction There is much literature about the role of 2-[18F]FDG PET/CT in patients with breast cancer (BC). However, there exists no international guideline with involvement of the nuclear medicine societies about this subject. Purpose To provide an organized, international, state-of-the-art, and multidisciplinary guideline, led by experts of two nuclear medicine societies (EANM and SNMMI) and representation of important societies in the field of BC (ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA). Methods Literature review and expert discussion were performed with the aim of collecting updated information regarding the role of 2-[18F]FDG PET/CT in patients with no special type (NST) BC and summarizing its indications according to scientific evidence. Recommendations were scored according to the National Institute for Health and Care Excellence (NICE) criteria. Results Quantitative PET features (SUV, MTV, TLG) are valuable prognostic parameters. In baseline staging, 2-[18F]FDG PET/CT plays a role from stage IIB through stage IV. When assessing response to therapy, 2-[18F]FDG PET/CT should be performed on certified scanners, and reported either according to PERCIST, EORTC PET, or EANM immunotherapy response criteria, as appropriate. 2-[18F]FDG PET/CT may be useful to assess early metabolic response, particularly in non-metastatic triple-negative and HER2+ tumours. 2-[18F]FDG PET/CT is useful to detect the site and extent of recurrence when conventional imaging methods are equivocal and when there is clinical and/or laboratorial suspicion of relapse. Recent developments are promising. Conclusion 2-[18F]FDG PET/CT is extremely useful in BC management, as supported by extensive evidence of its utility compared to other imaging modalities in several clinical scenarios.

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FDG-PET/CT in high-risk primary breast cancer—a prospective study of stage migration and clinical impact

Abstract: Purpose To investigate the clinical impact of FDG-PET/CT for staging and treatment planning in high-risk primary breast cancer.Methods Women with high-risk primary breast cancer were enrolled between

Cited by 29 publications

References 18 publications

Benefits And Harms Of Implementing [18F]FDG-PET/CT For Diagnosing Recurrent Breast Cancer: A Prospective Clinical Study

Benefits And Harms Of Implementing [18F]FDG-PET/CT For Diagnosing Recurrent Breast Cancer: A Prospective Clinical Study

Breast cancer: initial workup and staging with FDG PET/CT

Joint EANM-SNMMI guideline on the role of 2-[18F]FDG PET/CT in no special type breast cancer

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