PET/CT for restaging breast cancer – Impact on patient management and patient outcome

Abstract

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Objectives: The purpose of this study was to assess the diagnostic effectiveness of PET/CT for restaging breast cancer. Furthermore, impact on patient management and patient outcome was evaluated.

Methods: In this prospective bi-center trial, 118 patients with a history of breast cancer and newly diagnosed increase of tumor markers or other clinical signs for recurrent disease were included. 60-90 min after iv-injection of FDG, pts underwent PET/CT imaging (PET 3min/bp, i.v. contrast diagnostic CT) using PET/CT scanners. Each PET/CT mode was evaluated seperately by two physicians blinded to other modalities’ results using a 5-point score. A consensus for final lesion characterisation was made for PET/CT. Follow up data are available in 87/118 pts. Imaging results were correlated to patient management and patient outcome (Logrank test).

Results: PET/CT returned positive findings in 67% (79/118). Local recurrent breast cancer was observed in 14 pts (12%), metastases in lymph nodes in 42 (36%), in the lungs in 12 (10%), in pleura in 2 (2%), in liver in 17 (14%), in bone in 38 (32%) and in the adrenals in 4 pts (3%). PET negative lesions were found in 10% (12/118). So far there was a change of therapeutic management in 29/87 pts (33%). Furthermore, after mean follow-up of 3 years, in PET/CT negative pts median survival was not reached (>90% survivors), while in pts with a positive PET/CT scan, median survival was 3.3 years (p=0.013).

Conclusions: In pts with breast cancer suspicious for having recurrent disease, PET/CT detected local or distant recurrence in 67% and had a major impact on patient management. Our study also shows the prognostic potential of PET/CT for restaging breast cancer.