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

Abstract

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...

Predictive Value of 18F-FDG PET/CT for Axillary Lymph Node Metastasis in Invasive Ductal Breast Cancer

“…25,26 Although 18 F-FDG PET/CT can inform the decision to omit SLNB for patients who show FDG-avid ALN because of its high specificity, it cannot be used as a substitute for SLNB even if 18 F-FDG PET/CT is negative in the axilla because its reliability is very low. 7 However, 18 F-FDG uptake by primary tumor reflects not only metabolic information but also tumor aggressiveness.…”

Preoperative [18]fluorodeoxyglucose-positron emission tomography/computed tomography in early stage breast cancer: Rates of distant metastases

“…Some studies included the more advanced stages, stage III and IV, and a few studies included post-operative patients. Many issues of importance are relevant for breast cancer, notably the emerging role of PET/MRI and its comparison with PET/CT[47], the use of PET in the monitoring of neoadjuvant therapy[48], the use for staging and restaging[49], the standardized uptake values (commonly known as SUVs) and how they relate to lymph node status[50], the prognostic role of FDG-PET[51] and the suitability for treatment planning[52]; all these represent immensely exciting domains of breast cancer research, but would have confused the scope of the present study, namely the rates of DM.…”

FDG-PET/CT for systemic staging of patients with newly diagnosed breast cancer

“…PET/CT has shown a high accuracy to detect extra-axillary lymph nodes and distant metastases [2]. Given the high incidence of BC and known inconvenience of FDG imaging (such as high cost, radiation exposure, potential false positive findings and risk for delaying care), PET should be used in specific sub-groups only, especially in patients with high risk of distant metastases.…”

“…The larger evaluations have been performed in locally advanced and inflammatory BC [6][7][8] which are usually regarded as equivalent to stage III cancer of the AJCC classification [9]. More recent studies have suggested that PET/CT could also be valuable in stage II patients, especially in stage IIB [2,10,11]. In 254 patients with BC of mixed phenotypes, we detected distant metastases with PET/CT in 2.3% (1/44) of clinical stage IIA, 10.7% (6/56) of stage IIB, 17.5% (11/63) of stage IIIA, 36.5% (27/ 74) of stage IIIB and 47.1% (8/17) of stage IIIC patients [11].…”