and 2 Seattle Radiologists, Seattle, Washington Breast cancer is the most common non-skin type of cancer and the second leading cause of cancer mortality in women. Advances in diagnosis and treatment have led to declines in mortality, despite an increase in breast cancer incidence. An advancing array of both local and systemic therapy options has led to increasingly individualized treatment. Imaging plays a key role in detecting breast cancer and directing its therapy. This continuing education article provides a comprehensive review of current and future radiotracer imaging methods applied to breast cancer, in the context of breast cancer management strategies and other nonnuclear imaging methods. Part 1 of the review provided an overview of clinical and biologic considerations in breast cancer and covered radionuclide imaging for detection and staging. Part 2 covers radionuclide imaging of breast cancer response to therapy, other clinical indications for radionuclide breast cancer imaging, and future directions, including molecular imaging.Key Words: breast cancer; response to therapy; continuing education; molecular imaging; radionuclide imaging J Nucl Med 2009; 50:738-748 DOI: 10.2967/jnumed.108.061416 Breastcanceri s the most common non-skin type of cancer and the second leading cause of cancer mortality in women (1). Although its incidence continues to rise, mortality has declined over the past several years (1,2). The decline has been attributed to both early diagnosis and more effective treatment (2). Advances in molecular cancer biology have led to an increased understanding of the biologic factors that contribute to breast cancer pathogenesis and progression. This understanding has already led to new and effective treatments (3), and new targeted therapies continue to be developed and tested (4). Advances in breast cancer molecular biology have also yielded improvements in diagnosis through molecular pathology and molecular imaging (5,6).Part 1 of this review provided an overview of breast cancer clinical features and biology and reviewed radionuclide imaging for breast cancer detection and staging. Part 2 reviews applications to therapeutic monitoring and other indications such as toxicity monitoring, followed by highlights of future directions, including that of molecular imaging.
RESPONSE TO THERAPY
OverviewA wide range of systemic therapy options for breast cancer exists, and breast cancer is one of the more responsive solid tumors (7). Therefore, the evaluation of response to therapy is an important diagnostic need for breast cancer. Systemic therapy is given in 1 of the 3 following clinical settings: adjuvant (after completion of definitive locoregional surgery to treat residual or metastatic microscopic disease), neoadjuvant (primary systemic therapy given before definitive local surgery), or metastatic (systemic therapy of stage IV disease).For adjuvant therapy, there should be no residual macroscopic disease after surgery and, therefore, imaging is not helpful for response monitoring, exce...