Diagnostic and prognostic value of 18F-FDG PET/CT imaging in suspected recurrence of male breast cancer

Abstract

PurposeMale breast cancer (MBC) is a rare malignancy, with recurrence being one of the main adverse predictors for prognosis. The aim of the study was to evaluate the diagnostic and predictive value of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT in the setting of suspected recurrence of MBC.Patients and methodsRetrospective analysis of PET/CT findings was performed in 23 previously treated, histologically proven patients with MBC (mean age: 59.3±10.9 years; range: 36–79 years) with suspected recurrence. Kaplan–Meier disease-specific survival analysis was made with respect to histological, hormonal profile as well as PET/CT findings.ResultsOf the 23 patients, 19 (82.6%) showed recurrence. Recurrence at primary site with/without regional/distant site recurrence was seen in 12 (52.2%) patients. Only metastatic recurrence without primary site was seen in seven (30.4%) patients. Bone was the most common site of distant metastasis (14/23) followed by lungs (9/23), liver (4/23), brain (2/23), and adrenal (1/23). No recurrence (regional/distant) was noted in 4/23 (17.3%) patients; however, three of them had 18F-FDG-avid soft tissue lesions in esophagus, rectum and tongue, correspondingly, confirmed as second primaries with histopathology. Disease-specific survival analysis yielded nodal (P=0.01) as well as distant metastases (P=0.02) as the main survival predictors on PET/CT. Lung (P=0.001), followed by liver (P=0.009), and skeletal (P=0.01) metastases were the most adverse survival predictive factors.Conclusion18F-FDG PET/CT showed good diagnostic and prognostic utility in recurrent MBC. It was better than bone scan in evaluation of skeletal metastases. Most importantly, 18F-FDG PET/CT helped in early detection of second malignancy and their clinical management in studied patients.

18F-FDG PET/CT for the evaluation of male breast cancer: a systematic review

“…Many studies also underlined the ability of 18 F-FDG PET/CT to reveal synchronous malignancies both at stage or restage evaluation. In particular, incidental lymphoma, prostate cancer, colon cancer, tongue cancer, esophageal cancer and thyroid cancer are the most frequent findings reported in literature [16][17][18].…”

“…A total of 3178 articles were extrapolated with a computer literature search by reviewing the titles and abstracts; 3171 of them were excluded because the reported data were not within the field of interest of this review. Seven articles regarding MBC were selected and retrieved in the full-text version [16][17][18][19][20][21][22]; furthermore, all the studies were again screened to find articles regarding breast cancer in general (with both male and female patients) with at least 10 male participants and one additional article was found [23]. No additional studies were found on screening the references of the aforementioned articles (Fig.…”

“…Moreover, 18 F-FDG imaging demonstrated the potential role to reveal synchronous malignancies [16][17][18]. Lastly, the clinical significance of 18 F-FDG PET/CT for postoperative surveillance in breast cancer was also evaluated by a study with both male and female patients affected by BC.…”

“…The prognostic role of 18 F-FDG PET/CT for the evaluation of MBC has also been investigated, however, with heterogeneous results [17,18,21]. The presence of nodal or distant metastasis (liver, skeleton and lung) at restaging scan has an influence on patients' survival [17]. Moreover, a study reported that 100% of patients who died at the final follow-up had a positive PET/CT scan and, in contrast, only 44% of the patients alive had a positive scan; despite that, no statistically significant correlation between PET/CT and prognosis was underlined [21].…”

Diagnostic Performance of F18-FDG PET/CT in Male Breast Cancers Patients

“…Approximately 37% of patients with clinical stage IIA-IIIC breast cancer who underwent F18-FDG PET/CT before preoperative systemic therapy showed more extensive disease, including 23% with more extensive nodal metastasis and 14% with distant metastasis [ 5 ]. The male breast cancer represents only 1% of all breast cancers [ 3 , 6 ] and the literature is by far less consistent than in women, studies have limited number of subjects and many are case reports [ 6 , 7 , 8 , 9 , 10 , 11 ]. In a recent study published by Ulaner et al [ 7 ] it is underlined that the role of F18-FDG PET/CT is based on female guidelines and that an analysis of the value of F18-FDG PET/CT for systemic staging of male breast cancer is warranted.…”