Early detection of metastatic disease in asymptomatic breast cancer patients with whole-body imaging and defined tumour marker increase

Abstract

Background:Follow-up care in breast cancer is still an issue of debate. Diagnostic methods are more sensitive, and more effective therapeutic options are now available. The risk of recurrence is not only influenced by tumour stage but also by the different molecular subtypes. This study was performed to evaluate the use of whole-body imaging combined with tumour marker monitoring for the early detection of asymptomatic metastatic breast cancer (MBC).Methods:This analysis was performed as part of a follow-up study evaluating 813 patients with a median follow-up of 63 months. After primary therapy, all patients underwent tumour marker monitoring for CEA, CA 15-3 and CA 125 at 6-week intervals within an intensified diagnostic aftercare algorithm. A reproducible previously defined increase was considered as a strong indicator of MBC. From 2007 to 2010, 44 patients with tumour marker increase underwent whole-body magnetic resonance imaging and/or an FDG-PET/CT scan. Histological clarification and/or imaging follow-up were done.Results:Metastases were detected in 65.9% (29/44) of patients, 13.6% (6/44) had secondary malignancies besides breast cancer and 20.5% (9/44) had no detectable malignancy. Limited disease was found in 24.1% (7/29) of patients. Median progression-free survival of MBC was 9.2 months and median overall survival was 41.1 months. The 3- and 5-year survival rates were 64.2% and 40.0%, respectively.Conclusions:A reproducible tumour marker increase followed by whole-body imaging is highly effective for early detection. By consequence, patients might benefit from earlier detection and improved therapeutic options with a prolonged survival.

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

“…PET/CT outperformed PET alone and conventional imaging but not MRI. Compared with conventional imaging, PET/CT provides better prognostic stratification by discriminating patients with locoregional recurrence only from those with distant recurrence (30,34,35) and is helpful for downstaging suspected lesions in some situations (34,50).…”

“…In the specific setting of asymptomatic patients with rising tumor marker levels and negative conventional imaging results, PET/CT has shown strength in detecting recurrence earlier than traditional imaging (29)(30)(31)35,51). In a metaanalysis of 13 studies, the sensitivity, specificity, and accuracy of PET were 87.8%, 69.3%, and 82.8%, respectively (51).…”

“…This impact could be even higher with the development of local control strategies for oligometastatic disease, such as surgery or stereotactic radiotherapy (53,54). Among patients with evidence of distant relapse, PET/CT may identify oligometastatic status in a significant proportion (35).…”

“…Although PET/CT offers the opportunity to provide an overview of disease in a single procedure (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), its use as a first-line method is not recommended in international guidelines. NCCN guidelines recommend that chest CT, abdominopelvic CT or MRI, and bone scanning be performed first; 18 F-FDG PET/CT is considered optional and "most helpful in situations where standard staging studies are equivocal or suspicious" (7).…”

“…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. …”