18‐Fluorodeoxyglucose‐Positron Emission Tomography in Inflammatory Breast Cancer

Abstract

Inflammatory breast cancer (IBC) is the most aggressive form of locally advanced breast cancer. It can be diagnosed based on a clinical or pathologic basis. We evaluated the usefulness of (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scans for diagnosing and staging IBC. We retrospectively reviewed the medical records of seven consecutive patients with IBC who underwent FDG-PET scanning for the initial staging. Four patients had follow-up PET scans after chemotherapy. All seven patients presented with diffuse breast enlargement, redness, and peau d'orange for 1 to 5 months' duration. In addition, four patients had a palpable breast mass, and three had axillary lymph node enlargement. Mammography showed diffuse, increased parenchymal density and skin thickening in 85% and parenchymal distortion in 43%. There was no evidence of distant metastasis on computed tomography of the chest or abdomen. Pathologic examination of breast biopsy specimens showed infiltrating ductal carcinoma in six patients, and one had lobular carcinoma. All patients had prechemotherapy whole-body PET scans that showed diffuse FDG uptake in the breast with superimposed intense foci in the primary tumor. Furthermore, there was skin enhancement in 100%, axillary lymph node in 85%, and skeletal metastases in 14% of the patients, confirmed by bone scintigraphy. Postchemotherapy FDG-PET scans performed in four patients showed response in the primary tumor, axillary lymph nodes, and skeletal metastases. The FDG-PET scan is thus useful for displaying the pattern of FDG breast uptake that reflects the extent of the pathologic involvement in IBC (i.e., diffuse breast involvement and dermal lymphatic spread). It can also detect the presence of lymph node and skeletal metastases, demarcating the extent of the disease locally as well as distally.

18F‐fluorodeoxyglucose positron emission tomography/computed tomography (FDG‐PET/CT) imaging in the staging and prognosis of inflammatory breast cancer

“…9 In another small retrospective series of IBC, distant metastases were revealed by FDG-PET in 4 of 7 cases. 18 So, our series confirms the high percentage of IBC presenting with distant lesions at diagnosis. FDG-PET imaging for initial staging of standard breast cancer has shown debatable results for locoregional disease, but has proved its value for detecting distant metastases in locally advanced breast carcinoma patients.…”

Retrospective Study of 18F-FDG PET/CT in the Diagnosis of Inflammatory Breast Cancer: Preliminary Data

“…PET/CT showed hypermetabolic uptake in the affected breast in all but 1 patient in this study. These findings are similar to the results of Baslaim et al and van der Hoeven et al (24,25) but differ from those results regarding the value of 18 F-FDG PET in early breast cancer (stages 1 and 2), for which PET has shown a lower accuracy (18,26,27), likely secondary to the low tumor volume. Diffuse hypermetabolic skin thickening was noted in all patients and is a unique feature of IBC that is infrequent in all other subgroups of breast cancer.…”

Inflammatory breast cancer: PET/CT, MRI, mammography, and sonography findings

“…A single PET study of seven patients with IBC demonstrated diffusely increased or intense foci of increased uptake in enlarged breasts with increased skin uptake [17].…”

“…To the best of our knowledge, findings of IBC on magnetic resonance imaging (MRI) and functional positron emission tomography/computed tomography (PET/CT) are scarce in the published literature [14][15][16][17]. In this retrospective study, we report the imaging findings using MRI, PET/CT, mammography, and sonography at the time of initial presentation in IBC patients.…”