The Effects of Preoperative¹⁸F-FDG PET/CT in Breast Cancer Patients in Comparison to the Conventional Imaging Study

Abstract

PurposeThere have been recent studies of the 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) in the staging, detection, and follow-up of the breast cancer occurrence and recurrence. There was controversy concerning the use of 18F-FDG PET/CT for staging primary breast cancer. In this study, we investigated the potential effects of 18F-FDG PET/CT in the initial assessment of patients with primary breast cancer.MethodsFrom January 2008 to December 2009, 154 consecutive biopsy-proven invasive breast cancer patients were enrolled in this study. Patients underwent conventional imaging studies including mammography, breast ultrasonography (USG), and magnetic resonance imaging for local assessment, and plain chest X-ray, liver USG, and bone scan to rule out distant metastasis. All 154 patients underwent 18F-FDG PET/CT in the initial assessment.Results18F-FDG PET/CT did not detect primary breast lesions in 16 patients with a sensitivity of 89.6% and detected only 5 multiple lesions (12.5%) out of 40 cases. Histologically confirmed axillary lymph node (LN) metastases were in 51 patients, and the sensitivity and specificity of 18F-FDG PET/CT to detect metastatic axilla were 37.3% and 95.8%, respectively; whereas the corresponding estimates of USG were 41.2% and 93.7%, respectively. Eleven extra-axillary LN metastases were found in eight patients, and seven lesions were detected by 18F-FDG PET/CT only. The sensitivity and specificity of 18F-FDG PET/CT in detecting distant metastasis were 100% and 96.4%, respectively; whereas the sensitivity and specificity of the conventional imaging were 61.5% and 99.2%, respectively.Conclusion18F-FDG PET/CT cannot be recommended as a primary diagnostic procedure in breast cancer, but it has the potential to be used as an additional imaging tool for the detection of axillary metastasis, distant metastasis, and extra-axillary LN metastasis. 18F-FDG PET/CT cannot solely replace the conventional diagnostic procedure in primary breast cancer. The best approach may be the combination of different imaging modalities.

Dual-Time 18F-FDG PET/CT Imaging in Initial Locoregional Staging of Breast Carcinoma: Comparison with Conventional Imaging and Pathological Prognostic Factors

“…In contrast, we found good detection of primary lesions with 18 F-FDG PET/CT in patients with tumors larger than 1.0 cm. The sensitivity of 18 F-FDG PET/CT for detecting multiple lesions in the study performed by Choi et al [9] was the lowest of the tested methods, whereas specificity was highest. Garami et al [10] found similar results to our own in 115 breast cancer patients; in that study, the sensitivity of the traditional diagnostic modalities in the detection of multifocality was 43.8 %, while that of PET/CT was 100 % (p < 0.001).…”

“…There are many studies about detecting primary breast carcinoma [9,10]. The rate of primary tumor detection by 18 F-FDG PET/CT was higher than that of MRI, USG, and MMG.…”

“…False-negative results in our study were found for 1.5-cm invasive lobular carcinoma, 1.2-cm invasive ductal carcinoma, and the combination of Paget and DCIS. Choi et al [9] showed that 18 F-FDG PET/CT was more effective than MRI and USG in detecting primary lesion tumors sized above 2.0 cm and that the USG was more successful in detecting lesions less than 2.0 cm in diameter. In contrast, we found good detection of primary lesions with 18 F-FDG PET/CT in patients with tumors larger than 1.0 cm.…”

“…We thought that the N1 status might have more falsenegative results in determination of metastatic lymph nodes with PET/CT. In a retrospective study for ALN metastasis detection, Choi et al [9] reported that the presence of micrometastases could not be determined by 18 F-FDG PET/ CT. Furthermore, the researchers concluded that 18 F-FDG PET/CT returned comparable sensitivity to USG and MRI, but had relatively high specificity in detecting ALN metastases.…”

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

“…A study by Choi et al [13] suggested that FDG PET/CT has similar sensitivity and specificity to breast ultrasonography in detecting axillary nodal lesions. One hundred and fifty-four consecutive biopsy-proven invasive breast cancer patients were enrolled in this study.…”