Performance of 2-Deoxy-2-[F-18]fluoro-d-glucose Positron Emission Tomography and Integrated PET/CT in Restaged Breast Cancer Patients

Fueger, Barbara J.; Weber, Wolfgang; Quon, Andrew; Crawford, Tyler L.; Allen-Auerbach, Martin; Halpern, Benjamin S.; Ratib, Osman; Phelps, Michael E.; Czernin, Johannes

doi:10.1007/s11307-005-0013-4

Cited by 94 publications

(54 citation statements)

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“…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).…”

Section: Pet/ct In Restaging Of Breast Carcinomamentioning

confidence: 99%

“…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. …”

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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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Section: Pet/ct In Restaging Of Breast Carcinomamentioning

confidence: 99%

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

et al. 2016

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“…The results of our study suggest that combined PET/CT may improve sensitivity compared with PET alone, as the CT portion of PET/CT makes the exact localisation of 18 F-FDG uptake possible. Past reports showed greater accuracy with PET/CT compared with PET alone in primary breast cancer [28,29]. With regard to the T stage, the sensitivity of PET/CT for ALN was lower in T1 breast carcinomas than in T2 or T3 18 F-FDG uptake in previous lesion becomes more discrete and intense (SUVmax2: 1.9).…”

Section: Dual-time 18 F-fdg Pet/ct In Axillary Stagingmentioning

confidence: 94%

The value of dual-time-point¹⁸F-FDG PET/CT for identifying axillary lymph node metastasis in breast cancer patients

Choi

Yoo²,

Kim³

et al. 2011

BJR

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Objective: The sensitivity of 18-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET) for detecting axillary lymph node (ALN) metastases in breast cancer is reported to be low. Several studies have shown, however, that dual-time-point 18 F-FDG PET imaging provides improved accuracy in the diagnosis of certain primary tumours when compared with single-scan imaging. The purpose of this study was to assess whether the use of dual-time-point 18 F-FDG PET/CT scans could improve the diagnostic accuracy of ALN metastasis in breast cancer. Method: The study included 171 breast cancer patients who underwent pre-operative 18 F-FDG PET/CT scans at 2 time-points, the first at 1 h after radiotracer injection and the second 3 h after injection. Where 18 F-FDG uptake was in the ALN perceptibly increased, the maximum standardised uptake values for both time-points (SUVmax1 and SUVmax2) and the retention index (RI) were calculated. Correlation between the PET/ CT results and post-operative histological results was assessed.Results: The performance of 1 h and 3 h PET/CT scans was equal, with sensitivity 60.3% and specificity 84.7%, in detecting ALN metastasis. Out of 171 patients, 60 had ALNs with increased 18 F-FDG uptake on 1 h or 3 h images. There was no significant difference in RI between the metastatic ALN-positive group and the node-negative group. The area under the receiver operating characteristic (ROC) curve for SUVmax1 was 0.90 (p,0.001) and 0.87 for SUVmax2 (p,0.001). Conclusion: Dual time-point imaging did not improve the overall performance of 18 F-FDG PET/CT in detecting ALN metastasis in breast cancer patients.

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“…FDG-PET/CT can evaluate the whole body (except the brain) in a single examination and is very useful for detecting recurrent or residual tumors because of its high sensitivity and specificity in comparison with conventional techniques. Table 3 shows the results of major studies that have evaluated the role of PET/CT [56][57][58][59][60][61][62][63][64][65][66][67][68][69]. We excluded studies in which staging and restaging populations were mixed.…”

Section: Restagingmentioning

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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Performance of 2-Deoxy-2-[F-18]fluoro-d-glucose Positron Emission Tomography and Integrated PET/CT in Restaged Breast Cancer Patients

Abstract: Integrated PET/CT only marginally improves the restaging accuracy over PET alone (p = 0.059) in breast cancer patients.

Cited by 94 publications

References 27 publications

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

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

The value of dual-time-point¹⁸F-FDG PET/CT for identifying axillary lymph node metastasis in breast cancer patients

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

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Performance of 2-Deoxy-2-[F-18]fluoro-d-glucose Positron Emission Tomography and Integrated PET/CT in Restaged Breast Cancer Patients

Abstract: Integrated PET/CT only marginally improves the restaging accuracy over PET alone (p = 0.059) in breast cancer patients.

Cited by 94 publications

References 27 publications

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

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

The value of dual-time-point18F-FDG PET/CT for identifying axillary lymph node metastasis in breast cancer patients

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

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

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

The value of dual-time-point¹⁸F-FDG PET/CT for identifying axillary lymph node metastasis in breast cancer patients