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

Alberini, Jean-Louis; Lerebours, Florence; Fourme, Emmanuelle; Stanc, Elise Le; Gontier, Éric; Madar, Olivier; Chérel, P.; Pecking, A.

doi:10.1002/cncr.24534

Cited by 106 publications

(71 citation statements)

References 53 publications

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“…Reporting of the CT part of the PET/CT examination obviously improved the sensitivity of PET/CT in comparison to stand-alone PET. However, free-breathing CT remains less efficient than standard diagnostic thoracic CT. Lymphangitis in 1 patient was detected only by enhanced diagnostic CT. 18 F-FDG-avid mediastinal lymph node metastases are not rare in cases of LABC or inflammatory carcinoma (8,10,14,15). In 2 studies (14,15), PET/CT depicted mediastinal lymph nodes in about 20% of women with inflammatory carcinoma.…”

Section: Discussionmentioning

confidence: 99%

¹⁸F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging

et al. 2012

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The prognosis of patients with locally advanced breast cancer (LABC) remains poor. We prospectively investigated the impact of 18 F-FDG PET/CT at initial staging in this clinical setting and compared PET/CT performance with that of conventional distant work-up. Methods: During 60 mo, consecutive patients with LABC (clinical T4 or N2-N3 disease) underwent 18 F-FDG PET/ CT. The yield was assessed in the whole group and separately for noninflammatory and inflammatory cancer. The performance of PET/CT was compared with that of a conventional staging approach including bone scanning, chest radiography, or dedicated CT and abdominopelvic sonography or contrast-enhanced CT. Results: 117 patients with inflammatory (n 5 35) or noninflammatory (n 5 82) LABC were included. 18 F-FDG PET/CT confirmed N3 nodal involvement in stage IIIC patients and revealed unsuspected N3 nodes (infraclavicular, supraclavicular, or internal mammary) in 32 additional patients. Distant metastases were visualized on PET/CT in 43 patients (46% of patients with inflammatory carcinoma and 33% of those with noninflammatory LABC). Overall, 18 F-FDG PET/CT changed the clinical stage in 61 patients (52%). Unguided conventional imaging detected metastases in only 28 of the 43 patients classified M1 with PET/CT (65%). 18 F-FDG PET/CT outperformed conventional imaging for bone metastases, distant lymph nodes, and liver metastases, whereas CT was more sensitive for lung metastases. The accuracy in diagnosing bone lesions was 89.7% for planar bone scanning versus 98.3% for 18 F-FDG PET/CT. The accuracy in diagnosing lung metastases was 98.3% for dedicated CT versus 97.4% for 18 F-FDG PET/CT. Conclusion: 18 F-FDG PET/CT had the advantage of allowing chest, abdomen and bone to be examined in a single session. Almost all distant lesions detected by conventional imaging were depicted with PET/CT, which also showed additional lesions.

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Section: Discussionmentioning

confidence: 99%

¹⁸F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging

et al. 2012

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“…High 18 F-FDG uptake has been associated with a poorer outcome (10,46,47). Recently, high baseline tumor SUV max and total lesion glycolysis were associated with shorter event-free survival in patients with estrogen receptorpositive/HER2-negative breast cancer (47).…”

Section: Prognostic Value Of Baseline 18 F-fdg Pet/ctmentioning

confidence: 99%

¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer

et al. 2016

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Many studies have pointed out the role of 18 F-FDG PET/CT (or 18 F-FDG PET) in patients with clinical stage III or II breast cancer. 18 F-FDG PET/CT might advantageously replace other staging procedures, such as bone scanning and possibly contrast-enhanced CT of the thorax or abdomen-pelvis. We discuss the findings, locoregional or distant, that can be expected in different categories of breast cancer and their impact on prognosis and management. We also discuss the role of 18 F-FDG PET/CT in restaging and how 18 F-FDG PET/CT compares with conventional techniques in restaging for patients with suspected disease recurrence. We conclude with some recommendations for clinical practice and future research. Accur ate staging is important for management decisions in patients with newly diagnosed breast cancer. Several studies have pointed out the lack of utility of PET/CT with 18 F-FDG in staging for patients with cancer detected early, that is, tumors of less than or equal to 2-3 cm and no palpable nodes-findings that represent most breast cancer cases (1-5). The lower sensitivity of 18 F-FDG imaging than of the sentinel node technique in assessing axillary lymph node involvement is well known (1-3), and the risk of distant metastases in early-stage cases is low (4,5). These factors, combined with the good but finite specificity of 18 F-FDG PET/CT, result in a relative abundance of false-positive findings and a paucity of truepositive findings; such findings lead to unwarranted patient anxiety and delay of care with the routine use of 18 F-FDG PET/CT for breast cancer detected early.In contrast, in such high-risk patients as those with inflammatory (T4d) or locally advanced breast cancer (LABC) (6,7), the role of 18 F-FDG imaging in detecting distant lesions has been highlighted (8-12). Recently, several studies pointed out that staging with 18 F-FDG PET/CT might be of value not only in patients with locally advanced disease but also in "intermediate-risk" patients (13-21)-that is, patients with clinical stage IIB disease (T2N1/T3N0) or higher-with significant diagnostic yield and prognostic information (18,19). PET/CT has also shown good performance in restaging for breast cancer patients (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).This review assesses the advantages and limits of 18 F-FDG PET/CT in initial staging and restaging for breast cancer patients. REGIONAL AND DISTANT STAGING IN LOCALLY ADVANCED AND INFLAMMATORY BREAST CANCERLABC is variably defined but usually refers to clinical N2, N3, or T4 disease and typically includes American Joint Committee on Cancer (AJCC) clinical stage IIIA (excluding T3N1), IIIB, and IIIC breast cancer (Table 1) (6,7). Within this entity, distinction is made between inflammatory carcinoma (T4d) and noninflammatory LABC. Patients without identified distant metastases usually receive neoadjuvant chemotherapy followed by surgery and radiation therapy as standard treatment. Detection of Regional Node Involvement Outside Axillary Levels I and IIAxillary node clearance by...

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“…For the initial staging work-up, many conventional imaging modalities, such as X-ray mammography, MR mammography, chest plain radiography, bone scintigraphy, and breast, axillary and liver ultrasonography, have been widely utilized. In recent years, several groups have evaluated the clinical role of FDG-PET/CT for pretreatment evaluation of breast cancer in comparison with conventional imaging tools [18,39,[43][44][45][46][47][48][49][50][51][52][53][54] (Table 2). These studies revealed that FDG-PET/CT is generally helpful, but particularly valuable for detection of extra-axillary (infraclavicular, supraclavicular and internal mammary) nodal metastasis and occult distant metastasis relative to conventional modalities, especially in patients with inflammatory breast cancer [43,46,47] and stage II-III disease [18, Fig.…”

Section: Initial Stagingmentioning

confidence: 99%

Present and future role of FDG-PET/CT imaging in the management of breast cancer

Kitajima

Miyoshi

2016

Jpn J Radiol

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by malignant cells, opened a new field in clinical oncologic imaging. Recently, integrated positron emission tomography/computed tomography (PET/CT), in which a full-ringdetector clinical PET scanner and multidetector-row helical CT scanner are combined, has made it possible to acquire both metabolic and anatomic imaging data using a single device in a single diagnostic session, and provides precise anatomic localization of suspicious areas of increased FDG uptake. When used in a clinical setting, FDG-PET/CT leads to a significant improvement in diagnostic accuracy and has had a considerable impact on patient management, including diagnosis, initial staging, optimization of treatment, restaging, monitoring of the response to therapy, and prognostication of various malignant tumors. We herein review the current and future roles of FDG-PET/CT in the management of breast cancer, discussing its usefulness and limitations for imaging in these patients. DiagnosisFDG-PET imaging has poor sensitivity (<50 %) for subcentimeter breast cancers [9,10]. This is due to the limited spatial resolution of PET and, in some cases, by tumor characteristics (e.g., low FDG avidity in grade 1 cancer, ductal carcinoma in situ, or lobular carcinoma) [1,2]. Specificity can also be altered by variations of FDG uptake in certain benign conditions, such as infection, fibroadenoma, ductal adenoma, inflammatory granulomatous mastitis, and fibrocystic changes [3].In order to improve specificity, some authors would obtain a second series of PET images centered on the breast approximately 2 h after FDG injection (dual-time imaging) [4]. Indeed, FDG uptake seems to increase with time in the case of malignancy, while some inflammatory lesions show stable or decreasing uptake [4]. However, dual-time Abstract Integrated positron emission tomography/computed tomography (PET/CT) with 2-[18F]fluoro-2-deoxyd-glucose (FDG) is a useful tool for acquisition of both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session, and has opened a new field in clinical oncologic imaging. FDG-PET/CT has been used successfully for the diagnosis, initial staging, restaging, early treatment response assessment, evaluation of metastatic disease response, and prognostication of breast cancer as well as various malignant tumors. We herein review the current place and role of FDG-PET/CT in the management of breast cancer, focusing on its usefulness and limitations in the imaging of these patients.

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

Abstract: BACKGROUND:To prospectively assess fluorodeoxyglucose positron emission tomography/computed

Cited by 106 publications

References 53 publications

¹⁸F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging

¹⁸F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging

¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer

Present and future role of FDG-PET/CT imaging in the management of breast cancer

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

Abstract: BACKGROUND:To prospectively assess fluorodeoxyglucose positron emission tomography/computed

Cited by 106 publications

References 53 publications

18F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging

18F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging

18F-FDG PET/CT for Staging and Restaging of Breast Cancer

Present and future role of FDG-PET/CT imaging in the management of breast cancer

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Product

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¹⁸F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging

¹⁸F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging

¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer