18 F-FDG PET/CT for initial staging in breast cancer patients – Is there a relevant impact on treatment planning compared to conventional staging modalities?
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To evaluate the impact of whole-body 18 F-FDG PET/CT on initial staging of breast cancer in comparison to conventional staging modalities.
This study included 102 breast cancer patients, 101 patients were eligible for evaluation. Preoperative whole-body staging with PET/CT was performed in patients with clinical stage ≥ T2 tumours or positive local lymph nodes (n = 91). Postoperative PET/CT was performed in patients without these criteria but positive sentinel lymph node biopsy (n = 10). All patients underwent PET/CT and a conventional staging algorithm, which included bone scan, chest X-ray and abdominal ultrasound. PET/CT findings were compared to conventional staging and the impact on therapeutic management was evaluated.
PET/CT led to an upgrade of the N or M stage in overall 19 patients (19 %) and newly identified manifestation of breast cancer in two patients (2 %). PET/CT findings caused a change in treatment of 11 patients (11 %). This is within the range of recent studies, all applying conventional inclusion criteria based on the initial T and N status.
PET/CT has a relevant impact on initial staging and treatment of breast cancer when compared to conventional modalities. Further studies should assess inclusion criteria beyond the conventional T and N status, e.g. tumour grading and receptor status.
• PET/CT may be relevant in staging breast cancer patients at higher risk for metastases
• PET/CT may modify the N and M stage in multiple patients
• PET/CT may impact treatment planning in breast cancer patients
KeywordsPET/CT Breast Cancer Staging Treatment Conventional Imaging
We would like to thank Wolfgang A. Weber, Molecular Imaging and Therapy Service at the Memorial Sloan-Kettering Cancer Centre New York for critically reading and reviewing the manuscript. The scientific guarantor of this publication is Professor Dr. med. Stefan O. Schoenberg, Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Joachim Brade kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution
- 1.R. Kreienberg: Interdisciplinary S3 Guidelines for the Diagnosis, Treatment and Follow-up Care Breast Cancer, 3rd updated version., 3 edn. München: Zuckerschwerdt Verlag; 2012Google Scholar
- 3.Hillner BE, Siegel BA, Liu D, Shields AF, Gareen IF, Hanna L, Stine SH, Coleman RE (2008) Impact of positron emission tomography/computed tomography and positron emission tomography (PET) alone on expected management of patients with cancer: initial results from the National Oncologic PET Registry. J Clin Oncol 26:2155–2161PubMedCrossRefGoogle Scholar
- 5.Fuster D, Duch J, Paredes P, Velasco M, Munoz M, Santamaria G, Fontanillas M, Pons F (2008) Preoperative staging of large primary breast cancer with [18F]fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J Clin Oncol 26:4746–4751PubMedCrossRefGoogle Scholar
- 7.Aukema TS, Rutgers EJ, Vogel WV, Teertstra HJ, Oldenburg HS, Vrancken Peeters MT, Wesseling J, Russell NS, Valdes Olmos RA (2010) The role of FDG PET/CT in patients with locoregional breast cancer recurrence: a comparison to conventional imaging techniques. Eur J Surg Oncol 36:387–392PubMedCrossRefGoogle Scholar
- 8.Alberini JL, Lerebours F, Wartski M, Fourme E, Le Stanc E, Gontier E, Madar O, Cherel P, Pecking AP (2009) 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging in the staging and prognosis of inflammatory breast cancer. Cancer 115:5038–5047PubMedCrossRefGoogle Scholar
- 13.Ueda S, Tsuda H, Asakawa H, Omata J, Fukatsu K, Kondo N, Kondo T, Hama Y, Tamura K, Ishida J et al (2008) Utility of 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in combination with ultrasonography for axillary staging in primary breast cancer. BMC Cancer 8:165PubMedCentralPubMedCrossRefGoogle Scholar
- 16.Brito RA, Valero V, Buzdar AU, Booser DJ, Ames F, Strom E, Ross M, Theriault RL, Frye D, Kau SW et al (2001) Long-term results of combined-modality therapy for locally advanced breast cancer with ipsilateral supraclavicular metastases: The University of Texas M.D. Anderson Cancer Centre experience. J Clin Oncol 19:628–633PubMedGoogle Scholar
- 17.Early and locally advanced breast cancer: diagnosis and treatment National Institute for Health and Clinical Excellence guideline 2009Google Scholar
- 19.Pace L, Nicolai E, Luongo A, Aiello M, Catalano OA, Soricelli A, Salvatore M (2014) Comparison of whole-body PET/CT and PET/MRI in breast cancer patients: lesion detection and quantitation of 18F-deoxyglucose uptake in lesions and in normal organ tissues. Eur J Radiol 83:289–296PubMedCrossRefGoogle Scholar
- 20.Cochet A, Dygai-Cochet I, Riedinger JM, Humbert O, Berriolo-Riedinger A, Toubeau M, Guiu S, Coutant C, Coudert B, Fumoleau P et al (2014) (18)F-FDG PET/CT provides powerful prognostic stratification in the primary staging of large breast cancer when compared with conventional explorations. Eur J Nucl Med Mol Imaging 41:428–437PubMedCrossRefGoogle Scholar
- 22.Garami Z, Hascsi Z, Varga J, Dinya T, Tanyi M, Garai I, Damjanovich L, Galuska L (2012) The value of 18-FDG PET/CT in early-stage breast cancer compared to traditional diagnostic modalities with an emphasis on changes in disease stage designation and treatment plan. Eur J Surg Oncol 38:31–37PubMedCrossRefGoogle Scholar
- 23.Riegger C, Herrmann J, Nagarajah J, Hecktor J, Kuemmel S, Otterbach F, Hahn S, Bockisch A, Lauenstein T, Antoch G et al (2012) Whole-body FDG PET/CT is more accurate than conventional imaging for staging primary breast cancer patients. Eur J Nucl Med Mol Imaging 39:852–863PubMedCrossRefGoogle Scholar
- 26.Koolen BB, Vrancken Peeters MJ, Aukema TS, Vogel WV, Oldenburg HS, van der Hage JA, Hoefnagel CA, Stokkel MP, Loo CE, Rodenhuis S et al (2012) 18F-FDG PET/CT as a staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques. Breast Cancer Res Treat 131:117–126PubMedCrossRefGoogle Scholar
- 27.de Azambuja E, Cardoso F, De Jr. Castro G, Colozza M, Mano MS, Durbecq V, Sotiriou C, Larsimont D, Piccart-Gebhart MJ, Paesmans M (2007) Ki-67 as prognostic marker in early breast cancer: a meta-analysis of published studies involving 12,155 patients. Br J Cancer 96:1504–1513PubMedCentralPubMedCrossRefGoogle Scholar