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

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Abstract

Purpose

To investigate the clinical impact of FDG-PET/CT for staging and treatment planning in high-risk primary breast cancer.

Methods

Women with high-risk primary breast cancer were enrolled between September 2017 and August 2019 at Odense University Hospital, Denmark. Conventional mammography with/without MRI was performed before staging by FDG-PET/CT. We studied the accuracy of FDG-PET/CT for the detection of distant metastases, the effect on the change of treatment, and the prevalence of incidental findings. Biopsy and follow-up were used as a reference standard for the accuracy analysis.

Results

Of 103 women, 24 (23%) were diagnosed with distant metastases by FDG-PET/CT. Among these, breast surgery was omitted in 18 and could have been spared in six. Another sixteen (16%) patients were upstaged to more advanced loco-regional disease, leading to more extensive radiotherapy. Sensitivity and specificity for diagnosing distant metastases were 1.00 (95% confidence interval: 0.86–1.00) and 0.95 (0.88–0.99), respectively. Twenty-nine incidental findings were detected in 24 women (23%), leading to further examinations in 22 and diagnosis of eight (8/22, 36%) synchronous diseases: cancer (n = 4), thyroiditis (n = 2), aorta aneurysm (n = 1), and meningioma (n = 1).

Conclusions

FDG-PET/CT had a substantial impact on staging and change of treatment in women with high-risk primary breast cancer, and further examination of incidental findings was considered clinically relevant. Our findings suggest that FDG-PET/CT should be considered for primary staging in high-risk primary breast cancer to improve treatment planning.

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Acknowledgements

Two patient representatives, Marie Lykke Rasmussen and Susanne Geneser have served as co-researchers in this study. We want to share our deepest acknowledgments for a highly valuable impact on the design and conduct of the study.

Funding

The work has been financially supported by Mrs. Astrid Thaysens grant, Qvesehls grant, The Independent Research Fund Denmark (DFF – 7016–00359), by University of Southern Denmark (Ph.D. grant), Odense University Hospital (Ph.D. grant) and by Centre for Personalized Response Monitoring in Oncology (PREMIO), Odense University Hospital, Odense, Denmark.

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Authors and Affiliations

  1. Department of Oncology, Odense University Hospital, Odense, Denmark

    Marianne Vogsen & Jeanette Dupont Jensen

  2. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

    Marianne Vogsen, Oke Gerke, Poul-Erik Braad & Malene Grubbe Hildebrandt

  3. Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Marianne Vogsen, Oke Gerke, Poul-Erik Braad, Marianne Ewertz & Malene Grubbe Hildebrandt

  4. Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark

    Marianne Vogsen

  5. Centre for Personalized Response Monitoring in Oncology (PREMIO), Odense University Hospital, Odense, Denmark

    Marianne Vogsen & Malene Grubbe Hildebrandt

  6. Department of Radiology, Odense University Hospital, Odense, Denmark

    Ivar Yannick Christensen & Lisbet Brønsro Larsen

  7. Department of Pathology, Odense University Hospital, Odense, Denmark

    Anne Marie Bak Jylling

  8. Department of Breast Surgery, Odense University Hospital, Odense, Denmark

    Katrine Lydolph Søe

  9. Department of Plastic Surgery, Odense University Hospital, Odense, Denmark

    Camilla Bille

  10. Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark

    Malene Grubbe Hildebrandt

  11. Department of Oncology and Department of Nuclear Medicine, Odense University Hospital, Kloevervaenget 47, 5000, Odense C, Denmark

    Marianne Vogsen

Authors
  1. Marianne Vogsen
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  8. Katrine Lydolph Søe
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  11. Malene Grubbe Hildebrandt
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Contributions

All authors contributed to the study concept and design. Material preparation, data collection, and analysis were performed by Marianne Vogsen, Jeanette Dupont Jensen, Ivar Yannick Christensen, Oke Gerke, Anne Marie Bak Jylling, Lisbet Brønsro Larsen, Katrine Lydolph Søe, Camilla Bille, Marianne Ewertz, and Malene Grubbe Hildebrandt. The first draft of the manuscript was written by Marianne Vogsen and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marianne Vogsen.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Danish Ethics Regional committee (S-20170019) and conducted following the Helsinki declaration. The study was registered at ClinicalTrials.gov (NCT03358589).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

Patients consented to publish their data and photographs.

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Vogsen, M., Jensen, J.D., Christensen, I.Y. et al. FDG-PET/CT in high-risk primary breast cancer—a prospective study of stage migration and clinical impact. Breast Cancer Res Treat 185, 145–153 (2021). https://doi.org/10.1007/s10549-020-05929-3

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  • DOI: https://doi.org/10.1007/s10549-020-05929-3

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