Retrospective Analysis of ¹⁸F-FDG PET/CT for Staging Asymptomatic Breast Cancer Patients Younger Than 40 Years

Abstract

National Comprehensive Cancer Network guidelines consider 18F-FDG PET/CT for only clinical stage III breast cancer patients. However, there is debate whether TNM staging should be the only factor in considering if PET/CT is warranted. Patient age may be an additional consideration, because young breast cancer patients often have more aggressive tumors with potential for earlier metastases. This study assessed PET/CT for staging of asymptomatic breast cancer patients younger than 40 y. Methods In this Institutional Review Board–approved retrospective study, our hospital information system was screened for breast cancer patients younger than 40 y who underwent staging PET/CT before any treatment. Patients with symptoms or conventional imaging findings suggestive of distant metastases or with prior malignancy were excluded. Initial stage was based on physical examination, mammography, ultrasound, and breast MR imaging. PET/CT was then evaluated to identify unsuspected extraaxillary regional nodal and distant metastases. Results One hundred thirty-four patients with initial breast cancer stage I to IIIC met inclusion criteria. PET/CT findings led to upstaging to stage III or IV in 28 patients (21%). Unsuspected extra-axillary regional nodes were found in 15 of 134 patients (11%) and distant metastases in 20 of 134 (15%), with 7 of 134 (5%) demonstrating both. PET/CT revealed stage IV disease in 1 of 20 (5%) patients with initial clinical stage I, 2 of 44 (5%) stage IIA, 8 of 47 (17%) stage IIB, 4 of 13 (31%) stage IIIA, 4 of 8 (50%) stage IIIB, and 1 of 2 (50%) stage IIIC. All 20 patients upstaged to stage IV were histologically confirmed. Four synchronous thyroid and 1 rectal malignancies were identified. Conclusion PET/CT revealed distant metastases in 17% of asymptomatic stage IIB breast cancer patients younger than 40 y. Although guidelines of the National Comprehensive Cancer Network recommend against systemic staging in patients with stage II disease, our data suggest that PET/CT might be valuable in younger patients with stage IIB and III disease. Use of PET/CT in younger patients has the potential to reduce the morbidity and cost of unnecessary therapies in young breast cancer patients.

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

“…(18). Two other studies (1 including only breast cancer patients younger than 40 y) also showed that the yield from 18 F-FDG PET/CT was high starting in patients with clinical stage IIB disease (16,20). The results of these studies provide supportive evidence for a role of 18 F-FDG PET/CT in determining the stage of disease for high-and intermediate-risk patients (clinical stage IIB or higher).…”

The Relationship Between Estrogen Receptor, Progesterone Receptor and Human Epidermal Growth Factor Receptor 2 Expression of Breast Cancer and the Retention Index in Dual Phase 18F-FDG PET/CT

“…18 F-fluorodeoxyglucose positron emission tomographycomputed tomography (FDG PET/CT) has been important in the management of breast cancer patients [6]. It is used for screening for the extra-axillary lymph node metastasis [7] and distant metastasis [8,9], assessing for the treatment responses [10,11], and predicting prognosis [12], but the benefit of FDG PET/CT scanning for staging remains a matter of debate [13]. Several studies have suggested that the characteristics of FDG uptake in breast cancer are relevant to biological or histological attributes of primary tumor, including its biomarker status [14][15][16][17][18][19].…”

Present and future role of FDG-PET/CT imaging in the management of breast cancer

“…For the initial staging work-up, many conventional imaging modalities, such as X-ray mammography, MR mammography, chest plain radiography, bone scintigraphy, and breast, axillary and liver ultrasonography, have been widely utilized. In recent years, several groups have evaluated the clinical role of FDG-PET/CT for pretreatment evaluation of breast cancer in comparison with conventional imaging tools [18,39,[43][44][45][46][47][48][49][50][51][52][53][54] (Table 2). These studies revealed that FDG-PET/CT is generally helpful, but particularly valuable for detection of extra-axillary (infraclavicular, supraclavicular and internal mammary) nodal metastasis and occult distant metastasis relative to conventional modalities, especially in patients with inflammatory breast cancer [43,46,47] and stage II-III disease [18, Fig.…”