Bone Metastases in Patients with Metastatic Breast Cancer: Morphologic and Metabolic Monitoring of Response to Systemic Therapy with Integrated PET/CT

Tateishi, Ukihide; Gámez, Cristina; Dawood, Shaheenah; Yeung, Henry; Cristofanilli, Massimo; Macapinlac, Homer A.

doi:10.1148/radiol.2471070567

Cited by 183 publications

(89 citation statements)

References 22 publications

(24 reference statements)

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“…There is some evidence that FDG-PET/CT can provide additional and useful information for evaluating the response to systemic chemotherapy. Tateishi et al [93] demonstrated that an increase in attenuation in bone metastases (measured in Hounsfield units) and a decrease in SUV are overall potential predictors of response duration. Another important finding is that PET/CT allows evaluation of response in many different metastases.…”

Section: Evaluation Of the Response Of Metastatic Diseasementioning

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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Section: Evaluation Of the Response Of Metastatic Diseasementioning

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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“…Thus, many studies have demonstrated that FDG-PET/CT is more accurate than morphologic CI for early monitoring of response to therapy, with a good prognostic stratification [64,71]. FDG-PET/CT may emerge as a standard of care in bone metastatic breast cancer.…”

Section: Fdg-pet In the Metastatic Settingmentioning

confidence: 99%

Role of Positron Emission Tomography for the Monitoring of Response to Therapy in Breast Cancer

et al. 2015

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This review considers the potential utility of positron emission tomography (PET) tracers in the setting of response monitoring in breast cancer, with a special emphasis on glucose metabolic changes assessed with 18 F-fluorodeoxyglucose (FDG). In the neoadjuvant setting of breast cancer, the metabolic response can predict the final complete pathologic response after the first cycles of chemotherapy. Because tumor metabolic behavior highly depends on cancer subtype, studies are ongoing to define the optimal metabolic criteria of tumor response in each subtype.The recent multicentric randomized AVATAXHER trial has suggested, in the human epidermal growth factor 2-positive subtype, a clinical benefit of early tailoring the neoadjuvant treatment in women with poor metabolic response after the first course of treatment. In the bone-dominant metastatic setting, there is increasing clinical evidence that FDG-PET/computed tomography (CT) is the most accurate imaging modality for assessment of the tumor response to treatment when both metabolic information and morphologic information are considered. Nevertheless, there is a need to define standardized metabolic criteria of response, including the heterogeneity of response among metastases, and to evaluate the costs and health outcome of FDG-PET/CT compared with conventional imaging. New non-FDG radiotracers highlighting specific molecular hallmarks of breast cancer cells have recently emerged in preclinical and clinical studies. These biomarkers can take into account the heterogeneity of tumor biology in metastatic lesions. They may provide valuable clinical information for physicians to select and monitor the effectiveness of novel therapeutics targeting the same molecular pathways of breast tumor. The Oncologist 2015;20:94-104 Implications for Practice:18 F-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is a molecular imaging exam. It can monitor breast cancer response to therapy earlier than the tumor shrinking observed with conventional imaging. This review focuses on the advantages and limits of FDG-PET for early determination of response, both in the neoadjuvant and metastatic settings. It discusses the different PET timing and metabolic criteria to define response that have been evaluated in previous studies. The development of new radiotracers of specific molecular pathways of breast cancer cells is also a challenging and promising research area to monitor the effectiveness of the new target treatments emerging in breast cancer.

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“…In bone-dominant disease, in which morphological modalities do not allow assessment of tumour response [15] and in which hormonal therapy plays a major role, tumour FDG uptake can be used as a surrogate marker to monitor early response to therapy [15,16]. Du et al [15] considered 25 patients with bone metastatic breast cancer who underwent sequential FDG PET/CT studies for monitoring responses to treatment.…”

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confidence: 99%

“…The findings suggest that FDG uptake reflects the activity of bone metastases in breast cancer independently of morphological characteristics, whereas the radiographic changes which varied among individual patients could not be correlated with the presence of active tumour. Tateishi et al [16] retrospectively analysed 102 patients with bone metastatic breast cancer. Of these 102 patients, 76 had received chemotherapy plus hormonal therapy and the remainder had received chemotherapy alone.…”

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confidence: 99%

“…The authors found that a decrease in SUV after treatment was an independent predictor of response duration in patients with metastatic breast cancer with bone metastases. There were important differences among the three studies discussed in their approaches to testing the responses to treatment: FDG uptake in the first study [15], change in SUV and total lesion glycolysis between two consecutive PET scans in the second study [16], and EORTC criteria in the study by Mortazavi-Jehanno et al [9]. The assessment of metabolic response with FDG PET has not yet been standardized and a joint effort is needed to address this.…”

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confidence: 99%

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Can FDG PET/CT monitor the response to hormonal therapy in breast cancer patients?

Evangelista

Rubello

Saladini

2011

Eur J Nucl Med Mol Imaging

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Bone Metastases in Patients with Metastatic Breast Cancer: Morphologic and Metabolic Monitoring of Response to Systemic Therapy with Integrated PET/CT

Abstract: A decrease in SUV after treatment was an independent predictor of RD in patients with MBC who had bone metastases.

Cited by 183 publications

References 22 publications

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

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

Role of Positron Emission Tomography for the Monitoring of Response to Therapy in Breast Cancer

Can FDG PET/CT monitor the response to hormonal therapy in breast cancer patients?

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