Journal Article

Whole-body FDG PET/CT is more accurate than conventional imaging for staging primary breast cancer patients

Hecktor, J., Otterbach, F., Riegger, C., Hahn, S., Bockisch, A., Kuemmel, S., Herrmann, J., Nagarajah, J., Heusner, T. A., Lauenstein, T., Antoch, G.

2012

Overview

Purpose This retrospective study aimed (1) to compare the diagnostic accuracy of whole-body FDG PET/CT for initial breast cancer staging with the accuracy of a conventional, multimodal imaging algorithm, and (2) to assess potential alteration in patient management based on the FDG PET/CT findings. Methods Patients with primary breast cancer (106 women, mean age 57 ± 13 years) underwent whole-body FDG PET/CT and conventional imaging (X-ray mammography, MR mammography, chest plain radiography, bone scintigraphy and breast, axillary and liver ultrasonography). The diagnostic accuracies of FDG PET/CT and a conventional algorithm were compared. Diagnostic accuracy was assessed in terms of primary tumour detection rate, correct assessment of primary lesion focality, T stage and the detection rates for lymph node and distant metastases. Histopathology, imaging or clinical follow-up served as the standards of reference. Results FDG PET/CT was significantly more accurate for detecting axillary lymph node and distant metastases ( p  = 0.0125 and p  < 0.005, respectively). No significant differences were detected for other parameters. Synchronous tumours or locoregional extraaxillary lymph node or distant metastases were detected in 14 patients (13%) solely by FDG PET/CT. Management of 15 patients (14%) was altered based on the FDG PET/CT findings, including 3 patients with axillary lymph node metastases, 5 patients with extraaxillary lymph node metastases, 4 patients with distant metastases and 3 patients with synchronous malignancies. Conclusion Full-dose, intravenous contrast-enhanced FDG PET/CT was more accurate than conventional imaging for initial breast cancer staging due to the higher detection rate of metastases and synchronous tumours, although the study had several limitations including a retrospective design, a possible selection bias and a relevant false-positive rate for the detection of axillary lymph node metastases. FDG PET/CT resulted in a change of treatment in a substantial proportion of patients.

• Publisher: Springer-Verlag,Springer Nature B.V
• Subject: Adult / Age / Aged / Aged, 80 and over / Algorithms / Bone cancer / Bone imaging / Breast cancer / Breast Neoplasms - diagnostic imaging / Breast Neoplasms - pathology / Breast Neoplasms - therapy / Cardiology / Chest / Computed tomography / Female / Fluorodeoxyglucose F18 / Humans / Imaging / Intravenous administration / Ionizing radiation / Liver / Lymph nodes / Malignancy / Mammography / Medical imaging / Medicine / Medicine & Public Health / Metastases / Middle Aged / Multimodal Imaging / Neoplasm Metastasis / Neoplasm Staging / NMR / Nuclear magnetic resonance / Nuclear Medicine / Oncology / Original Article / Orthopedics / Patients / Positron-Emission Tomography / Radiography / Radiology / Retrospective Studies / Scintigraphy / Sensitivity and Specificity / Tomography, X-Ray Computed / Ultrasonography / Whole Body Imaging