Preoperative Staging of Large Primary Breast Cancer With [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Compared With Conventional Imaging Procedures

Abstract

PET/CT underestimates locoregional lymph node staging in large primary breast cancer patients. PET/CT is a valuable tool to discard unsuspected extra-axillary lymph nodes and distant metastases.

Should FDG PET/CT be used for the initial staging of breast cancer?

“…Also, falsepositives resulting from muscular and brown fat uptake are avoided. In a prospective study of 60 breast tumours larger than 3 cm, PET/CT revealed unsuspected infraclavicular node involvement (N3a) in two patients, supraclavicular node involvement (N3c) in one patient and contralateral axillary involvement (M1) in one patient [9]. Differentiating level III axillary lymph nodes (infraclavicular lymph nodes located superomedially to the pectoralis minor muscle) is important since axillary clearance usually addresses Berg level I and II nodes only.…”

“…Depicting lymph node involvement in levels or basins other than those addressed by routine ALND may have major impact on treatment strategies. Many studies suggest that FDG PET performs better than conventional imaging in depicting involvement in high-level axillary (Berg level III) as well as in supraclavicular and internal mammary lymph nodes [8,9,[13][14][15]. PET/CT is particularly appealing compared to PET alone as it provides the precise location of involved nodes [7][8][9].…”

“…FDG PET [14,18,19] and especially FDG PET/CT [7][8][9] perform better than classic modalities to demonstrate occult metastases. In a retrospective study on 41 patients with inflammatory breast cancer, PET/CT demonstrated distant metastases in 20.…”

“…Two prospective studies have evaluated PET/CT in the initial work-up of less advanced breast cancer [8,9]. Our study included 39 patients with stage II or III breast cancer after conventional work-up [8].…”

“…Several studies have documented the value of 18 F-FDG PET in locally advanced and inflammatory breast cancer [6,7], but also in populations comprising clinical stage II patients [8,9].…”