Positron emission tomography/computed tomography in the management of recurrent/metastatic breast cancer: a large retrospective study from the Royal Marsden Hospital

Constantinidou, Anastasia; Martin, Axel; Sharma, Bhuey; Johnston, S.

doi:10.1093/annonc/mdq343

Cited by 44 publications

(37 citation statements)

References 24 publications

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“…In addition, our results agree with that of Constantinidou A et al [23] stating that PET/CT is equally specific and more sensitive than other imaging modalities in detecting small lesions (5-10 mm), particularly lymph nodes as well as visceral and bone disease. A significant proportion of their patients had PET/CT scans for staging in the recurrent and metastatic disease, especially in cases of rising tumor markers.…”

Section: Discussionsupporting

confidence: 92%

PET/CT Versus CT In Post-Operative Follow Up Of Breast Cancer Patients

Mohamed¹,

Ebied²,

Hussein³

2015

IJMI

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Abstract:Objectives: The aim of this work is to compare the sensitivity and specificity of CT alone versus PET/CT in postoperative follow up of breast cancer patients. Background: Positron emission tomography (PET), using 18F-fluorodeoxyglucose (FDG) is based on the principle of increased glucose metabolism in malignant tumors and has been frequently investigated in breast cancer. Materials & Methods: Thirty female patients with breast cancer have been investigated. All patients had positive operative history. PET/CT studies were performed for post-operative follow up. The inclusion criteria in this study are histologically proved breast cancer, positive operative history and normal blood urea and creatinine levels. Exclusion criteria is pregnancy and renal impairment. Patients were divided into three groups, first group FDG PET/CT was requested for non-conclusive CT findings, second group patients referred for FDG PET/CT for elevated tumor markers, while in third group FDG PET/CT was requested for follow up after chemotherapy and/or radiotherapy. Results: A comparison of the sensitivity and specificity for CT alone versus PET/CT in each group, in the first group CT alone had sensitivity and specificity of 90% and 12.5% respectively, while PET/CT had sensitivity and specificity 100%. In the second group CT alone had sensitivity and specificity of 57% and 100% respectively, while PET/CT had sensitivity and specificity of 100%. In group three, CT alone had sensitivity and specificity of 83.3% and 84.25%, respectively and PET/CT had sensitivity of 83.3% and specificity of 100%.Conclusions: PET/CT is more sensitive and specific than CT alone for post-operative follow up of breast cancer patients.

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Section: Discussionsupporting

confidence: 92%

PET/CT Versus CT In Post-Operative Follow Up Of Breast Cancer Patients

Mohamed¹,

Ebied²,

Hussein³

2015

IJMI

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“…PET/CT outperformed PET alone and conventional imaging but not MRI. Compared with conventional imaging, PET/CT provides better prognostic stratification by discriminating patients with locoregional recurrence only from those with distant recurrence (30,34,35) and is helpful for downstaging suspected lesions in some situations (34,50).…”

Section: Pet/ct In Restaging Of Breast Carcinomamentioning

confidence: 99%

¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer

et al. 2016

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Many studies have pointed out the role of 18 F-FDG PET/CT (or 18 F-FDG PET) in patients with clinical stage III or II breast cancer. 18 F-FDG PET/CT might advantageously replace other staging procedures, such as bone scanning and possibly contrast-enhanced CT of the thorax or abdomen-pelvis. We discuss the findings, locoregional or distant, that can be expected in different categories of breast cancer and their impact on prognosis and management. We also discuss the role of 18 F-FDG PET/CT in restaging and how 18 F-FDG PET/CT compares with conventional techniques in restaging for patients with suspected disease recurrence. We conclude with some recommendations for clinical practice and future research. Accur ate staging is important for management decisions in patients with newly diagnosed breast cancer. Several studies have pointed out the lack of utility of PET/CT with 18 F-FDG in staging for patients with cancer detected early, that is, tumors of less than or equal to 2-3 cm and no palpable nodes-findings that represent most breast cancer cases (1-5). The lower sensitivity of 18 F-FDG imaging than of the sentinel node technique in assessing axillary lymph node involvement is well known (1-3), and the risk of distant metastases in early-stage cases is low (4,5). These factors, combined with the good but finite specificity of 18 F-FDG PET/CT, result in a relative abundance of false-positive findings and a paucity of truepositive findings; such findings lead to unwarranted patient anxiety and delay of care with the routine use of 18 F-FDG PET/CT for breast cancer detected early.In contrast, in such high-risk patients as those with inflammatory (T4d) or locally advanced breast cancer (LABC) (6,7), the role of 18 F-FDG imaging in detecting distant lesions has been highlighted (8-12). Recently, several studies pointed out that staging with 18 F-FDG PET/CT might be of value not only in patients with locally advanced disease but also in "intermediate-risk" patients (13-21)-that is, patients with clinical stage IIB disease (T2N1/T3N0) or higher-with significant diagnostic yield and prognostic information (18,19). PET/CT has also shown good performance in restaging for breast cancer patients (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).This review assesses the advantages and limits of 18 F-FDG PET/CT in initial staging and restaging for breast cancer patients. REGIONAL AND DISTANT STAGING IN LOCALLY ADVANCED AND INFLAMMATORY BREAST CANCERLABC is variably defined but usually refers to clinical N2, N3, or T4 disease and typically includes American Joint Committee on Cancer (AJCC) clinical stage IIIA (excluding T3N1), IIIB, and IIIC breast cancer (Table 1) (6,7). Within this entity, distinction is made between inflammatory carcinoma (T4d) and noninflammatory LABC. Patients without identified distant metastases usually receive neoadjuvant chemotherapy followed by surgery and radiation therapy as standard treatment. Detection of Regional Node Involvement Outside Axillary Levels I and IIAxillary node clearance by...

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“…Conventional morphological imaging often yields equivocal or negative findings when trying to iden-tify sites of breast cancer recurrence. However, various studies originating from centres that perform serial CA15-3 measurements as part of routine surveillance in breast carcinoma patients have shown that FDG PET/CT imaging can complement information provided by morphological imaging techniques, increasing both sensitivity and specificity for recurrence detection of breast cancer [23][24][25][26][27][28][29][30][31]. These studies have been recently the subject of a metaanalysis.…”

Section: Breast Cancermentioning

confidence: 99%

“…Impor-tantly, for CA15-3 driven prescription of FDG/PET/CT imaging, a CA15-3 cut-off level, either of a single value or of a percentage increase over time, allowing identification of those patients likely to present with FDG PET/CT positive findings would be of great clinical interest. How-ever, while in breast cancer patients suspected to suffer from disease recurrence CA15-3 levels as well as increases of CA15-3 levels over time have proven systematically higher in PET positive patients when compared to PET negative patients, no single cut-off value yielding an acceptable sensitivity and specificity has been identified for either variable [23][24][25][26][27][28][29][30][31][32]. Rather the combination of increases in CA15-3 over time and the clinical suspicion of progression should prompt clinicians to perform PET/CT imaging.…”

Section: Breast Cancermentioning

confidence: 99%

Serum tumor markers and PET/CT imaging for tumor recurrence detection

et al. 2012

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When confronted with a suspicious rise in CA 15.3 in asymptomatic breast cancer patients following primary treatment and negative or equivocal conventional imaging findings, FDG PET/CT allows assessment of the site and extent of the recurring disease with an accuracy of 83 %. Both FDG PET and FDG PET/CT are superior when compared to CT alone for the purpose of recurrence detection in patients suffering from ovarian carcinoma who have completed primary therapy but demonstrate a rising serum CA-125 level. As the global accuracy of CT alone for detection of recurrence of ovarian cancer approximates 80 %, CT scan should be performed upfront to identify the site of recurrence. When confronted with negative or equivocal CT findings, FDG PET alone or FDG PET/CT should be added. In patients with rising erum CEA levels that have undergone primary treatment for a colorectal carcinoma, both FDG PET and FDG PET/ CTs allow detection of tumor recurrence with an accuracy of 95 %, well above that of CT and MRI. Available studies further suggest that FDG/PET findings will affect treatment management in 28-50 % of these patients. The detection rate of both 11C-choline and 18F-choline PET and PET/CT for local, regional, and distant recurrence in prostate carcinoma patients with a biochemical recurrence increases with rising PSA value at the time of imaging and reaches about 75 % in patients with PSA [3 ng/mL. Furthermore, PET and PET/CT with [11C]-and [18F]-choline derivates may be helpful in the clinical setting for optimization of individualized treatment.

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Positron emission tomography/computed tomography in the management of recurrent/metastatic breast cancer: a large retrospective study from the Royal Marsden Hospital

Abstract: PET/CT is useful in accurately staging metastatic disease, assessing response to systemic treatment and clarifying equivocation on other imaging. Incorporation of PET/CT in these areas contributes to breast cancer management optimisation.

Cited by 44 publications

References 24 publications

PET/CT Versus CT In Post-Operative Follow Up Of Breast Cancer Patients

PET/CT Versus CT In Post-Operative Follow Up Of Breast Cancer Patients

¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer

Serum tumor markers and PET/CT imaging for tumor recurrence detection

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Positron emission tomography/computed tomography in the management of recurrent/metastatic breast cancer: a large retrospective study from the Royal Marsden Hospital

Abstract: PET/CT is useful in accurately staging metastatic disease, assessing response to systemic treatment and clarifying equivocation on other imaging. Incorporation of PET/CT in these areas contributes to breast cancer management optimisation.

Cited by 44 publications

References 24 publications

PET/CT Versus CT In Post-Operative Follow Up Of Breast Cancer Patients

PET/CT Versus CT In Post-Operative Follow Up Of Breast Cancer Patients

18F-FDG PET/CT for Staging and Restaging of Breast Cancer

Serum tumor markers and PET/CT imaging for tumor recurrence detection

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Product

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¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer