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Whole-body FDG PET/CT is more accurate than conventional imaging for staging primary breast cancer patients

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

This retrospective study aimed (1) to compare the diagnostic accuracy of whole-body FDG PET/CT for initial breast cancer staging with the accuracy of a conventional, multimodal imaging algorithm, and (2) to assess potential alteration in patient management based on the FDG PET/CT findings.

Methods

Patients with primary breast cancer (106 women, mean age 57 ± 13 years) underwent whole-body FDG PET/CT and conventional imaging (X-ray mammography, MR mammography, chest plain radiography, bone scintigraphy and breast, axillary and liver ultrasonography). The diagnostic accuracies of FDG PET/CT and a conventional algorithm were compared. Diagnostic accuracy was assessed in terms of primary tumour detection rate, correct assessment of primary lesion focality, T stage and the detection rates for lymph node and distant metastases. Histopathology, imaging or clinical follow-up served as the standards of reference.

Results

FDG PET/CT was significantly more accurate for detecting axillary lymph node and distant metastases (p = 0.0125 and p < 0.005, respectively). No significant differences were detected for other parameters. Synchronous tumours or locoregional extraaxillary lymph node or distant metastases were detected in 14 patients (13%) solely by FDG PET/CT. Management of 15 patients (14%) was altered based on the FDG PET/CT findings, including 3 patients with axillary lymph node metastases, 5 patients with extraaxillary lymph node metastases, 4 patients with distant metastases and 3 patients with synchronous malignancies.

Conclusion

Full-dose, intravenous contrast-enhanced FDG PET/CT was more accurate than conventional imaging for initial breast cancer staging due to the higher detection rate of metastases and synchronous tumours, although the study had several limitations including a retrospective design, a possible selection bias and a relevant false-positive rate for the detection of axillary lymph node metastases. FDG PET/CT resulted in a change of treatment in a substantial proportion of patients.

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Authors and Affiliations

  1. Medical Faculty, Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, 40225, Dusseldorf, Germany

    C. Riegger, G. Antoch & T. A. Heusner

  2. Medical Faculty, Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, 45147, Essen, Germany

    C. Riegger, J. Herrmann, S. Hahn, T. Lauenstein & T. A. Heusner

  3. Medical Faculty, Department of Nuclear Medicine, University of Duisburg-Essen, 45147, Essen, Germany

    J. Nagarajah & A. Bockisch

  4. Medical Faculty, Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147, Essen, Germany

    J. Hecktor & S. Kuemmel

  5. Institute of Pathology and Neuropathology, University of Duisburg-Essen, 45147, Essen, Germany

    F. Otterbach

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  1. C. Riegger
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Correspondence to T. A. Heusner.

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Riegger, C., Herrmann, J., Nagarajah, J. et al. Whole-body FDG PET/CT is more accurate than conventional imaging for staging primary breast cancer patients. Eur J Nucl Med Mol Imaging 39, 852–863 (2012). https://doi.org/10.1007/s00259-012-2077-0

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  • DOI: https://doi.org/10.1007/s00259-012-2077-0

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