Abstract
Background
This study was designed to evaluate the role of a single 18-FDG positron emission tomography and computed tomography (PET–CT) scan in comparison to multiple organ-directed conventional investigations (CI) as a staging tool in locally advanced breast cancer (LABC) to detect regional and distant metastasis.
Methods
All eligible patients were subjected to CI (chest X-ray, abdominal sonography, and bone scintigraphy) followed by a single 18-FDG PET–CT scan. Standard imaging criteria were used for diagnosis of metastasis. Histopathological confirmation was undertaken for suspicious lesions. An exploratory analysis was done to assess the impact of PET–CT on the staging of LABC and how it resulted in a change in management.
Result
The study included 79 patients of LABC. PET–CT detected distant metastasis in 36 (45.5 %) patients while CI could identify distant metastasis in 20 (25.3 %) patients. Two of the 36 patients in whom PET–CT detected distant metastasis were false positive. Overall PET–CT upstaged the disease in 38 (48.1 %) patients as compared to CI: stage III to stage IV migration in 14 (17.7 %) patients due to identification of additional sites of distant metastasis, and within stage III upstaging in 24 (30.3 %) patients due to identification of additional regional lymphadenopathy. PET–CT led to a change in management plan in 14 (17.7 %) patients.
Conclusion
PET–CT has a role in identifying additional sites of regional lymphadenopathy and distant metastasis to upstage the disease in a significant number of LABC patients in comparison to CI; this would help in accurate staging, selecting optimal treatment, and better prognostication of disease.
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References
Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–386
Gogia A, Raina V, Deo SV et al (2014) Taxane and anthracycline based neoadjuvant chemotherapy for locally advanced breast cancer: institutional experience. Asian Pac J Cancer Prev 15:1989–1992
Cancer Staging [Internet]. National Cancer Institute. [cited 2015 Apr 12]. http://www.cancer.gov/cancertopics/diagnosis-staging/staging/staging-fact-sheet
Garg PK, Deo SVS, Kumar R (2015) Role of positron emission tomography–computed tomography in locally advanced breast cancer. Indian J Surg Oncol 6:420–426
NCCN clinical practice guidelines in oncology (NCCN guidelines®) Breast Cancer, Version 2.2015. [cited 2015 May 10]. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf
Manohar K, Mittal BR, Bhoil A et al (2013) Role of 18F-FDG PET/CT in identifying distant metastatic disease missed by conventional imaging in patients with locally advanced breast cancer. Nucl Med Commun 34:557–561
Mahner S, Schirrmacher S, Brenner W et al (2008) Comparison between positron emission tomography using 2-[fluorine-18]fluoro-2-deoxy-d-glucose, conventional imaging and computed tomography for staging of breast cancer. Ann Oncol 19:1249–1254
Groheux D, Giacchetti S, Delord M et al (2013) 18F-FDG PET/CT in staging patients with locally advanced or inflammatory breast cancer: comparison to conventional staging. J Nucl Med 54:5–11
Choi YJ, Shin YD, Kang YH et al (2012) The effects of preoperative (18)F-FDG PET/CT in breast cancer patients in comparison to the conventional imaging study. J Breast Cancer 15:441–448
Fuster D, Duch J, Paredes P et al (2008) Preoperative staging of large primary breast cancer with [18F]fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J Clin Oncol 26:4746–4751
Niikura N, Costelloe CM, Madewell JE et al (2011) FDG-PET/CT compared with conventional imaging in the detection of distant metastases of primary breast cancer. Oncologist 16:1111–1119
Long NM, Smith CS (2011) Causes and imaging features of false positives and false negatives on 18F-PET/CT in oncologic imaging. Insights Imaging 2:679–698
Rosen EL, Eubank WB, Mankoff DA (2007) FDG PET, PET/CT, and breast cancer imaging. RadioGraphics 27:S215–229
Fujimoto R, Higashi T, Nakamoto Y et al (2006) Diagnostic accuracy of bone metastases detection in cancer patients: comparison between bone scintigraphy and whole-body FDG-PET. Ann Nucl Med 20:399–408
Morris PG, Lynch C, Feeney JN et al (2010) Integrated positron emission tomography/computed tomography may render bone scintigraphy unnecessary to investigate suspected metastatic breast cancer. J Clin Oncol 28:3154–3159
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The present study was part of the poster presentation during World Congress of Surgery—2015 held in Bangkok.
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Garg, P.K., Deo, S.V.S., Kumar, R. et al. Staging PET–CT Scanning Provides Superior Detection of Lymph Nodes and Distant Metastases than Traditional Imaging in Locally Advanced Breast Cancer. World J Surg 40, 2036–2042 (2016). https://doi.org/10.1007/s00268-016-3570-6
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DOI: https://doi.org/10.1007/s00268-016-3570-6