Whole-body 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) for staging locally advanced breast cancer

Abstract

Background & objectives:Locally advanced breast cancer (LABC) is associated with substantial risk of occult metastases. The patients with LABC have high rate of systemic relapse, suggesting inadequacy of the current conventional staging in detecting the occult metastatic spread. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) is a new modality in the staging of breast cancer patients. Hence, this study was conducted to evaluate the role of 18F-FDG PET/CT in initial staging of LABC and to compare it with conventional methods.Methods:This prospective study included biopsy-confirmed female patients diagnosed with LABC meeting the selection criteria and attending surgical, medical and radiation oncology departments of a tertiary care centre in south India, from April 2013 to December 2014. Conventional workup included serum chemistry, mammogram, bone scan, contrast-enhanced CT (CECT) chest and upper abdomen and ultrasound abdomen and pelvis. All patients following conventional workup underwent 18F-FDG PET/CT.Results:In this study, 61 women with LABC underwent both conventional workup and 18F-FGD PET/CT. The 18F-FDG PET/CT, in comparison to conventional workup, revealed unsuspected N3 nodal disease in 11 more patients, revealed distant metastasis in seven more patients and also detected extra sites of metastasis in five patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT to detect distant metastasis were 95, 98, 95, 98 and 97 per cent, respectively, whereas the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional imaging to detect distant metastasis were 65, 93, 81, 84 and 84 per cent, respectively.Interpretation & conclusions:The 18F-FDG PET/CT was found to be more accurate than conventional imaging for staging and modified stage and treatment in 30 and 38 per cent of patients, respectively. It was particularly useful in detecting occult distant metastasis and N3 nodal disease with an added advantage of examining whole body in single session. However, CECT chest was superior over 18F-FDG PET/CT for detecting pulmonary metastasis.

Role of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in evaluation of newly diagnosed breast cancer patients

“…Hildebrandt et al [13] compared diagnostic value of conventional CT , 18 F-FDG PET/CT, and bone scan in 100 breast cancer women and found a greater superiority of PET/CT than contrast enhanced CT and bone scintigraphy. Our results are also in line with a study of Gajjala et al [19] that examined 61 locally advanced breast cancer patients and declared that 18 F-FDG PET/CT staging had a higher accuracy than the conventional imaging staging. In the study of kamal et al [20], 50 women with newly diagnosed breast cancer showed higher diagnostic performance of 18 F-FDG PET/CT with % 100 sensitivity in comparison to 96 % sensitivity of contrast-enhanced CT. 18 Additionally, according to the NCCN guidelines, performing PET/CT examination may be more effective in detecting suspected nodal and distant metastatic involvement in locally advanced breast cancer stage III, but not advised for stage I, II, or operable III (T3 N1) breast cancer because of the high probability of false-negative results of the tiny lesions.…”

FDG-PET/CT in high-risk primary breast cancer—a prospective study of stage migration and clinical impact

“…FDG-PET/CT was highly accurate in diagnosing distant metastases in our cohort, which is in line with previous studies. [4,5,16]. Our data illustrate daily clinical practice and patients were enrolled consecutively before initial treatment.…”

Impact of 18F-FDG PET, PET/CT, and PET/MRI on Staging and Management as an Initial Staging Modality in Breast Cancer

“… 12 , 14 , 16 – 27 , 29 – 32 , 34 – 40 For the measurement of exposure domain, 6 studies had a high risk of bias because a single reader interpreted PET images, 13 , 15 , 29 , 34 , 37 , 38 and 6 studies had an unclear risk of bias because they did not report the number of readers or their experience. 18 , 20 , 27 , 28 , 30 , 39 Regarding the blinding of outcome assessments domain, 13 studies had an unclear risk of bias as it was unclear whether PET interpretation was performed in a blinded manner, 15 , 16 , 18 , 22 – 24 , 28 – 30 , 32 , 35 , 36 , 40 and 1 study had a high risk of bias because PET interpretation was not blinded to the findings of other tests. 19 For outcome evaluation, 10 studies showed an unclear risk of bias as the method for classifying stage was not explicitly mentioned, 12 , 14 , 17 , 25 , 27 , 28 , 30 – 32 , 36 and 2 studies had a high risk of bias as the method for confirmation of additional lesions on PET scan was reported.…”