Additional Value of PET–CT in Staging of Clinical Stage IIB and III Breast Cancer

Abstract:  To evaluate retrospectively the accuracy of integrated PET/CT, against PET, CT, or conventional staging in breast cancer. Seventy consecutive biopsy proven clinical stage IIB and III breast cancer patients were included. Descriptive statistics of integrated PET/CT for the primary tumor, nodal status and metastasis detection were compared to PET, CT with contrast, and conventional staging (biochemistry, chest X‐ray, liver ultrasound, and bone scintigraphy). Sensitivity of PET/CT for primary tumor and nodal status was 97.1% and 62.5%, respectively. Specificity and negative predictive value for nodal status were 100% and 66.6%, respectively. The values for conventional staging for nodal involvement were 100% and 85.7% with a sensitivity of 87.5%. PET/CT showed metastatic disease in seven women despite normal conventional staging. PET/CT is able to visualize most clinical stage IIB and III primary breast cancers. PET/CT is superior to conventional staging for detecting internal mammary chain nodes and metastatic disease, but not for axillary staging. Future studies will have to test whether therapy adjustment based on PET/CT has the potential to improve survival.

[1]  R. Wahl,et al.  Initial experience with FDG-PET/CT in the evaluation of breast cancer , 2006, European Journal of Nuclear Medicine and Molecular Imaging.

[2]  H. Nabi,et al.  18F-FDG imaging: pitfalls and artifacts. , 2005, Journal of nuclear medicine technology.

[3]  R. Wahl,et al.  Detection of unexpected additional primary malignancies with PET/CT. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[4]  M. Endo,et al.  Comparison of FDG PET and SPECT for detection of bone metastases in breast cancer. , 2005, AJR. American journal of roentgenology.

[5]  David A Mankoff,et al.  Evolving role of positron emission tomography in breast cancer imaging. , 2005, Seminars in nuclear medicine.

[6]  Y. Nishiwaki,et al.  Pitfalls in lymph node staging with positron emission tomography in non-small cell lung cancer patients. , 2005, Lung cancer.

[7]  G. V. von Schulthess,et al.  PET and Functional Anatomic Fusion Imaging in Lung and Breast Cancers , 2004, Cancer journal.

[8]  K. Scheidhauer,et al.  FDG PET and other imaging modalities in the primary diagnosis of suspicious breast lesions , 2004, European Journal of Nuclear Medicine and Molecular Imaging.

[9]  Claudio Landoni,et al.  PET/CT and breast cancer , 2004, European Journal of Nuclear Medicine and Molecular Imaging.

[10]  Thomas Beyer,et al.  Advantages and limitations of FDG PET in the follow-up of breast cancer , 2004, European Journal of Nuclear Medicine and Molecular Imaging.

[11]  Barry A. Siegel,et al.  Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  S. Giordano,et al.  Update on locally advanced breast cancer. , 2003, The oncologist.

[13]  Kelly K Hunt,et al.  Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stage-specific survival. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  A. Kuten,et al.  Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[15]  Thomas Beyer,et al.  PET/CT scanners: a hardware approach to image fusion. , 2003, Seminars in nuclear medicine.

[16]  Hans-Jürgen Gallowitsch,et al.  F-18 Fluorodeoxyglucose Positron-Emission Tomography in the Diagnosis of Tumor Recurrence and Metastases in the Follow-Up of Patients With Breast Carcinoma: A Comparison to Conventional Imaging , 2003, Investigative radiology.

[17]  J. Carreras,et al.  Early diagnosis of recurrent breast cancer with FDG-PET in patients with progressive elevation of serum tumor markers. , 2002, The quarterly journal of nuclear medicine : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology.

[18]  S S Gambhir,et al.  Impact of whole-body 18F-FDG PET on staging and managing patients with breast cancer: the referring physician's perspective. , 2001, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[19]  D. Mankoff,et al.  18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  R L Wahl,et al.  Current status of PET in breast cancer imaging, staging, and therapy. , 2001, Seminars in roentgenology.

[21]  M. Greco,et al.  Association between [18F]fluorodeoxyglucose uptake and postoperative histopathology, hormone receptor status, thymidine labelling index and p53 in primary breast cancer: a preliminary observation , 1998, European Journal of Nuclear Medicine.

[22]  I. Datseris,et al.  PET imaging in breast cancer , 2007 .

[23]  W. De Wever,et al.  Additional value of PET-CT in the staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT , 2006, European Radiology.

[24]  Wolfgang A Weber,et al.  Monitoring response to treatment in patients utilizing PET. , 2005, Radiologic clinics of North America.

[25]  S. Faria,et al.  FDG PET in the evaluation of treatment for lymphoma: clinical usefulness and pitfalls. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.

[26]  A. Jemal,et al.  Cancer Statistics, 2005 , 2005, CA: a cancer journal for clinicians.

[27]  E. Deperi,et al.  The role of positron emission tomographic imaging in breast cancer , 2004, Current oncology reports.

[28]  C. Compton,et al.  AJCC Cancer Staging Manual , 2002, Springer New York.

[29]  C. Balch,et al.  AJCC Cancer Staging Manual. 6th ed , 2002 .

[30]  N. Dubrawsky.  Cancer statistics , 1989, CA: a cancer journal for clinicians.