The value of 18-FDG PET/CT in early-stage breast cancer compared to traditional diagnostic modalities with an emphasis on changes in disease stage designation and treatment plan

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Abstract

Background

Proper preoperative staging is vital in the treatment of breast cancer patients. The aim of our study was to assess the value of the diagnostic information provided by PET/CT in surgical practice in breast cancer cases considered early-stage by conventional diagnostic modalities.

Methods

Whole-body 18-FDG PET/CT was performed on 115 breast cancer patients in whom traditional diagnostic modalities showed no signs of distant metastases or extensive axillary and/or extra-axillary lymphatic spreading, and the size of the primary tumor was <4 cm.

Results

The sensitivity of PET/CT in the detection of the primary tumor was 93%. The sensitivity of the traditional diagnostic modalities in the detection of multifocality was 43.8% while that of PET/CT was 100% (p < 0.001). In the assessment of axillary lymph nodes, ultrasound had a sensitivity of 30% and a specificity of 95%. The corresponding estimates for PET/CT were 72% and 96%, respectively. PET/CT detected distant metastases in 8 patients. TNM classification was modified after PET/CT scanning in 54 patients (47%). PET/CT data changed the treatment plan established upon the results of traditional imaging modalities in 18 patients (15.6%).

Conclusions

PET/CT is able to assess primary tumor size and axillary lymphatic status more accurately than traditional diagnostic methods. It can detect distant metastases in 7–8% of those patients who were declared free of metastasis by clinical investigations. PET/CT scan modifies the disease stage determined by traditional diagnostic modalities in almost half of the patients and leads to a change in the treatment plan in every 6th patient.

Introduction

Like in most European Union countries and the United States, breast cancer is among the most common cancers in women in Hungary. The improved survival rates may be attributed to increased efficiency of screening programs and better utilization of available treatment modalities. However, choosing the best therapeutic plan requires exact staging information. The course of action in a breast cancer case reported to be early-stage by traditional diagnostic methods – and thus referred to primary surgery – may be completely altered by the presumed or confirmed presence of distant metastases and extensive axillary or extra-axillary lymphatic spreading. 18-FDG PET/CT – incorporating the metabolic data provided by PET and the structural imaging of a CT scan into one modality, thus improving the specificity of the evaluation – can be a valuable tool in the preoperative staging process.1, 2

The aim of our study was to assess the value of the extra diagnostic information provided by 18-FDG PET/CT in routine surgical practice in breast cancer cases considered early-stage and thus candidates for primary surgery by conventional diagnostic modalities. We also examined whether PET/CT data have resulted in changes to clinical disease stage designation or to the originally outlined therapeutic plan.

Section snippets

Patients

Between February 2008 and February 2010, whole-body 18-FDG PET/CT was performed on 115 patients who had breast cancer as confirmed by fine needle aspiration or core biopsy, for whom traditional diagnostic modalities showed no signs of distant metastases or extensive axillary and/or extra-axillary lymphatic spreading (N0–N1), and the size of whose primary tumors was <4 cm. Bilateral mammography, breast and abdominal ultrasound (US), chest X-ray and bone scintigraphy were performed on all the

Results

The clinical staging of breast cancer is based on the TNM classification which requires detailed information on the size of the primary tumor, axillary and extra-axillary lymphatic status, and the presence or absence of any distant metastases.

Between February 2008 and February 2010, all those 115 of author ZG’s patients who fulfilled the above-mentioned criteria were enrolled into the study. Relevant characteristics of the patients are listed in Table 1. No surgery was performed in two

Discussion

The clinical role of PET and PET/CT in the complex diagnosis and staging of breast cancer was evaluated in numerous studies, the first published by Minn and Soini.3 Several authors confirmed that PET/CT facilitates more precise diagnostic assessments than a PET or CT scan alone.1, 2

Conclusion

PET/CT is able to assess primary tumor size and axillary lymphatic status significantly more accurately than traditional diagnostic methods. It can detect distant metastases in 7–8% of those patients who were declared free of metastasis by clinical investigations. As a result, a PET/CT scan modifies the disease stage determined by traditional diagnostic modalities in almost half of the patients and leads to a major change in the treatment plan in every 6th patient. There is no significant

Conflict of interest statement

There is no conflict of interest for any of the authors of the manuscript.

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