Preoperative PET/CT in early-stage breast cancer

Bernsdorf, Mogens; Berthelsen, Anne Kiil; Wielenga, Vera Timmermans; Kroman, Niels; Teilum, D; Binderup, Tina; Tange, Ulla Brix; Andersson, Maria; Kjær, Andreas; Loft, Annika; Graff, Jesper

doi:10.1093/annonc/mds002

Cited by 70 publications

(53 citation statements)

References 21 publications

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“…Five studies were prospective, while three were retrospective. In these studies, PET/CT findings resulted in a treatment modification in 8-18 % of patients [6,[20][21][22][23][24][25][26]. Our study demonstrated an 11 % change in treatment, which is in the range.…”

Section: Discussionmentioning

confidence: 49%

“…Bernsdorf et al, did not perform abdominal imaging or bone scans on any patients. Although this might indicate a high number of undetected distant metastases on PET/CT, it only changed the treatment in 8 % of patients [24]. Overall, considering the various study designs, the range of findings that resulted in treatment changes remained relatively consistent in the literature.…”

Section: Discussionmentioning

confidence: 70%

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18 F-FDG PET/CT for initial staging in breast cancer patients – Is there a relevant impact on treatment planning compared to conventional staging modalities?

et al. 2015

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 70%

18 F-FDG PET/CT for initial staging in breast cancer patients – Is there a relevant impact on treatment planning compared to conventional staging modalities?

et al. 2015

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“…35 Evidence level IV, weak recommendation. 14,20,[36][37][38][39][40][41][42][43][44][45][46] For more detailed information, see Table 7. Question (d): Do 18F-FDG PET/CT findings result in a significant change in therapeutic management?…”

Section: Resultsmentioning

confidence: 99%

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

et al. 2017

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Current guidelines do not systematically recommend 18F-FDG PET/CT for breast cancer staging; and the recommendations and level of evidence supporting its use in different groups of patients vary among guidelines. This review summarizes the evidence about the role of 18F-FDG PET/CT in breast cancer staging and the therapeutic and prognostic impact accumulated in the last decade. Other related aspects, such as the association of metabolic information with biology and prognosis are considered and evidence-based recommendations for the use of 18F-FDG PET/CT in breast cancer staging are offered. We systematically searched MEDLINE for articles reporting studies with at least 30 patients related to clinical questions following the Problem/Population, Intervention, Comparison, and Outcome framework. We critically reviewed the selected articles and elaborated evidence tables structuring the summarized information into methodology, results, and limitations. The level of evidence and the grades of recommendation for the use of 18F-FDG PET/CT in different contexts are summarized. Level III evidence supports the use of 18F-FDG PET/CT for initial staging in patients with recently diagnosed breast cancer; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a weak recommendation in this population. In patients with locally advanced breast cancer, level II evidence supports the use of 18F-FDG PET/CT for initial staging; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a strong recommendation in this population. In patients with recently diagnosed breast cancer, the metabolic information from baseline 18F-FDG PET/CT is associated with tumor biology and has prognostic implications, supported by level II evidence. In conclusion, 18F-FDG PET/CT is not recommended for staging all patients with early breast cancer, although evidence of improved regional and systemic staging supports its use in locally advanced breast cancer. Baseline tumor glycolytic activity is associated with tumor biology and prognosis.

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“…PET/CT findings helped selecting patients for postoperative internal mammary chain radiotherapy. Bernsdorf et al [39] analyzed FDG PET/CT data of 103 consecutive patients with newly diagnosed operable breast cancer and tumors greater than 2 cm. Extra-axillary lymph node involvement was detected in the internal mammary chain by PET/CT in 10 patients, 5 of them had adjuvant treatment modifications.…”

Section: Fdg Pet/ct For Internal Mammary Lymph Nodesmentioning

confidence: 99%

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Liu¹

2014

WJCO

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Fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node (IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observations suggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast cancer; Fluorodeoxyglucose positron emission tomography/computed tomography; Locoregional nodal disease; Axillary lymph node; Internal mammary lymph node; Axillary lymph node dissection; Sentinel lymph node biopsy Core tip: The presence and extent of locoregional nodal metastasis at diagnosis is the single most important prognostic factor in breast cancer. The predominant lymphatic drainage pathway from the breast cancer is toward the axilla. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity secondary to the limitation of its spatial resolution. The internal mammary node (IMN) involvement is of prognostic significance in breast cancer, and IMN metastasis has been associated with higher rate of distant metastasis and lower overall survival rates. Limited preliminary data indicated that FDG PET/CT plays a role in identification of positive IMN, and it is superior to conventional imaging modalities.

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Preoperative PET/CT in early-stage breast cancer

Cited by 70 publications

References 21 publications

18 F-FDG PET/CT for initial staging in breast cancer patients – Is there a relevant impact on treatment planning compared to conventional staging modalities?

18 F-FDG PET/CT for initial staging in breast cancer patients – Is there a relevant impact on treatment planning compared to conventional staging modalities?

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

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