The Evolving Role of FDG-PET/CT in the Diagnosis, Staging, and Treatment of Breast Cancer

Abstract

The applications of 2-deoxy-2-[F]fluoro-D-glucose positron emission tomography/X-ray computed tomography (PET/CT) in the management of patients with breast cancer have been extensively studied. According to these studies, PET/CT is not routinely performed for the diagnosis of primary breast cancer, although PET/CT in specific subtypes of breast cancer correlates with histopathologic features of the primary tumor. PET/CT can detect metastases to mediastinal, axial, and internal mammary nodes, but it cannot replace the sentinel node biopsy. In detection of distant metastases, this imaging tool may have a better accuracy in detecting lytic bone metastases compared to bone scintigraphy. Thus, PET/CT is recommended when advanced-stage disease is suspected, and conventional modalities are inconclusive. Also, PET/CT has a high sensitivity and specificity to detect loco-regional recurrence and is recommended in asymptomatic patients with rising tumor markers. Numerous studies support the future role of PET/CT in prediction of response to neoadjuvant chemotherapy (NAC). PET/CT has a higher diagnostic value for prognostic risk stratification in comparison with conventional modalities. With the continuing research on the treatment planning and evaluation of patients with breast cancer, the role of PET/CT can be further extended.

The Value of F-18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for the Detection of Residual Breast Tumor or Axillary Metastasis after Neoadjuvant Chemotherapy in Invasive Ductal Carcinoma of the Breast

“…On the other hand, MRI had better performance when either of the two methods was used after the completion of neoadjuvant treatment, with significantly higher sensitivity (88% vs 57%) (19). There is a wide range of sensitivity and specificity across studies, which may be attributed to the heterogeneity between studies (17).…”

“…On the other hand, FDG-PET has been shown to have low sensitivity for small lesions (13). To date, several studies examined the role of PET/CT in predicting response to neoadjuvant chemotherapy when performed after the completion of neoadjuvant chemotherapy and before surgery, with inconsistent findings, most of them comparing the findings with that of MRI (6,(14)(15)(16)(17)(18)(19).…”

Positron emission tomography/computed tomography using 2‑deoxy‑2‑fluoro‑18‑fluoro‑D‑glucose peri‑tumoral halo uptake layer method outperforms magnetic resonance imaging and ultrasound methods in tumor size measurement of breast cancer

“…Sonography is more widely used in clinical practice, albeit as a method of cancer screening rather than tumor size estimation (17). Positron emission tomography (PET)/computed tomography (CT) using 2-deoxy-2 fluoro-18-fluoro-D-glucose (18F-FDG) is a useful modality in the diagnosis of patients with breast cancer (18). By evaluating glucose metabolism, it can also be used in staging, restaging and post-therapeutic response evaluation (16,19).…”

“…By evaluating glucose metabolism, it can also be used in staging, restaging and post-therapeutic response evaluation (16,19). In a previous study, 18 F-FDG PET/CT was considered inappropriate for evaluation of tumor size and not recommended as a priority option in clinical practice due to its poor spatial resolution, which limits clear delineation of the tumor boundary (20). However, other studies have demonstrated the advantage of 18 F-FDG PET/CT in tumor size estimation (21).…”

<p>⁶⁸Ga-radiolabeled bombesin-conjugated to trimethyl chitosan-coated superparamagnetic nanoparticles for molecular imaging: preparation, characterization and biological evaluation</p>

“…Molecular imaging modalities including whole-body 2-deoxy-2-18 F-fluoro-d-glucose ( 18 F-FDG) PET/computed tomography (CT) and positron emission mammography (PEM) have been evaluated for primary BC diagnosis, staging, and monitoring the response to therapy. 15 For years, the combination of PET and CT has offered concurrent anatomic and functional information in oncological imaging. In recent years, the integration of PET and MRI into a hybrid system has merged high sensitivity and metabolic characterization of PET with superior soft tissue characterization of MRI.…”