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First published online July 16, 2008, 10.2967/jnumed.108.052050
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Journal of Nuclear Medicine Vol. 49 No. 8 1215-1222
© 2008 by Society of Nuclear Medicine
doi: 10.2967/jnumed.108.052050

Clinical Investigation

Breast Cancer Staging in a Single Session: Whole-Body PET/CT Mammography

Till A. Heusner1, Sherko Kuemmel2, Lale Umutlu1, Angela Koeninger2, Lutz S. Freudenberg3, Elke A.M. Hauth1, Klaus R. Kimmig2, Michael Forsting1, Andreas Bockisch3 and Gerald Antoch1

1 Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University at Duisburg-Essen, Essen, Germany; 2 Department of Gynecology and Obstetrics, University Hospital Essen, University at Duisburg-Essen, Essen, Germany; and 3 Department of Nuclear Medicine, University Hospital Essen, University at Duisburg-Essen, Essen, Germany

Correspondence: For correspondence or reprints contact: Gerald Antoch, Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University at Duisburg-Essen, Essen, Germany. E-mail: gerald.antoch{at}uni-duisburg-essen.de

Our objective was to compare the diagnostic accuracy of an all-in-one protocol of whole-body 18F-FDG PET/CT and integrated 18F-FDG PET/CT mammography with the diagnostic accuracy of a multimodality algorithm for initial breast cancer staging. Methods: Forty women (mean age, 58.3 y; range, 30.8–78.4 y; SD, 12 y) with suspected breast cancer were included. For the primary tumor, we compared 18F-FDG PET/CT mammography versus MRI mammography; for axillary lymph node status, 18F-FDG PET/CT versus clinical investigation and ultrasound; and for distant metastases, 18F-FDG PET/CT versus a multimodality staging algorithm. Histopathology and clinical follow-up served as the standard of reference. The Fisher exact test evaluated the significance of differences (P < 0.05). Alterations in patient management caused by 18F-FDG PET/CT were documented. Results: No significant differences were found in the detection rate of breast cancer lesions (18F-FDG PET/CT, 95%; MRI, 100%; P = 1). 18F-FDG PET/CT correctly classified lesion focality significantly more often than did MRI (18F-FDG PET/CT, 79%; MRI, 73%; P < 0.001). MRI correctly defined the T stage significantly more often than did 18F-FDG PET/CT (MRI, 77%; 18F-FDG PET/CT, 54%; P = 0.001). 18F-FDG PET/CT detected axillary lymph node metastases in 80% of cases; clinical investigation/ultrasound, in 70%. This difference was not statistically significant (P = 0.067). Distant metastases were detected with 18F-FDG PET/CT in 100% of cases, and the multimodality algorithm identified distant metastases in 70%. This difference was not statistically significant (P = 1). Three patients had extraaxillary lymph node metastases that were detected only by PET/CT (cervical, retroperitoneal, mediastinal/internal mammary group). 18F-FDG PET/CT changed patient management in 12.5% of cases. Conclusion: Our data suggest that a whole-body 18F-FDG PET/CT mammography protocol may be used for staging breast cancer in a single session. This initial assessment of the 18F-FDG PET/CT protocol indicates similar accuracy to MRI for the detection of breast cancer lesions. Although MRI seems to be more accurate when assessing the T stage of the tumor, 18F-FDG PET/CT seems able to more accurately define lesion focality. Although 18F-FDG PET/CT mammography was able to detect axillary lymph node metastases with a high sensitivity, this method cannot soon be expected to replace the combination of clinical examination, ultrasound, and sentinel lymph node biopsy for axillary assessment.

Key Words: breast cancer • oncology • PET/CT • whole-body imaging • mammography

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.


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