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Discrepancy between FDG-PET/CT and contrast-enhanced CT in the staging of patients with inflammatory breast cancer: implications for treatment planning

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Abstract

Purpose

Optimizing treatment strategies for patients with inflammatory breast cancer (IBC) relies on accurate initial staging. This study compared contrast-enhanced computed tomography (ce-CT) and FDG-PET/CT for initial staging of IBC to determine the frequency of discordance between the two imaging modalities and potential impact on management.

Methods

81 patients with IBC underwent FDG-PET/CT and ce-CT prior to starting treatment. FDG-PET/CT and ce-CT scans were independently reviewed for locoregional and distant metastases and findings recorded by anatomic site as negative, equivocal, or positive for breast cancer involvement. Each paired ce-CT and FDG-PET/CT case was classified as concordant or discordant for findings. Discordant findings were subclassified as (a) related to the presence or absence of distant metastases; (b) affecting the locoregional radiation therapy plan; or (c) due to incidental findings not related to IBC.

Results

There were 47 discordant findings between ce-CT and FDG-PET/CT in 41 of 81 patients (50.6%). Thirty (63.8%) were related to the presence or absence of distant metastases; most commonly disease detection on FDG-PET/CT but not ce-CT (n = 12). FDG-PET/CT suggested alterations of the locoregional radiation therapy plan designed by CT alone in 15 patients. FDG-PET/CT correctly characterized 5 of 7 findings equivocal for metastatic IBC on ce-CT.

Conclusions

This study demonstrates differences between ce-CT and FDG-PET/CT for initial staging of IBC and how these differences potentially affect patient management. Preliminary data suggest that FDG-PET/CT may be the imaging modality of choice for initial staging of IBC. Prospective trials testing initial staging with FDG-PET/CT versus important clinical end-points in IBC are warranted.

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Funding

The authors received no funding for this work.

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Authors and Affiliations

  1. Department of Imaging and Radiology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA

    Heather A. Jacene, Pamela J. DiPiro & Eren Yeh

  2. Department of Radiation Oncology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Jennifer Bellon & Laura Warren

  3. Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Jiani Hu & Su-Chun Cheng

  4. Inflammatory Breast Cancer Program, Medical Oncology, Susan F. Smith Center for Women’s Cancers, Dana-Farber Cancer Institute, Boston, USA

    Emily Schlosnagle, Faina Nakhlis, Jennifer M. Rosenbluth & Beth Overmoyer

  5. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Faina Nakhlis

Authors
  1. Heather A. Jacene
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  2. Pamela J. DiPiro
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  3. Jennifer Bellon
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  4. Jiani Hu
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  5. Su-Chun Cheng
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  6. Laura Warren
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  7. Emily Schlosnagle
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  8. Faina Nakhlis
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  9. Jennifer M. Rosenbluth
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  10. Eren Yeh
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  11. Beth Overmoyer
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Corresponding author

Correspondence to Heather A. Jacene.

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Conflict of interest

Heather Jacene has received honoraria from Janssen Pharmaceuticals, Bayer Healthcare; research support from Siemens Healthcare, Inc, GTx, Inc; and consulting from Advanced Accelerator Applications. Beth Overmoyer has received clinical trial support from Genentech, Incyte, GTx, and Eisai. All other authors have no declarations of interest.

Statement of human rights

This was a retrospective study involving data from human participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Dana-Farber/Harvard Cancer Center Institutional Review Boards; DFCI 12-156) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This was a retrospective study and the requirement for informed consent was waived by the Dana-Farber/Harvard Cancer Center Institutional Review Board (DFCI clinical trial number 12-156).

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Jacene, H.A., DiPiro, P.J., Bellon, J. et al. Discrepancy between FDG-PET/CT and contrast-enhanced CT in the staging of patients with inflammatory breast cancer: implications for treatment planning. Breast Cancer Res Treat 181, 383–390 (2020). https://doi.org/10.1007/s10549-020-05631-4

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  • DOI: https://doi.org/10.1007/s10549-020-05631-4

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