Impact of FDG PET/CT in management of recurrent breast carcinoma - Locoregional versus systemic treatment

Objectives About 35% of breast cancer patients treated initially with surgery present with recurrence in 10 years. Restaging of such patients is important as it would decide upon the aggressive locoregional treatment with curative intent in patients with locoregional disease versus systemic chemo or hormonal therapy in patients with metastatic disease.This study was carried to assess the impact of FDG PET/CT on the management of recurrent Breast Carcinoma.

Methods 58 previously treated breast cancer patients presenting with proven (16 ) or suspicion of local recurrence(16) or with bone pains(8) and suspicious on other imaging modalities (18 )referred for PET/CT were included in the study. Age group ranged from 22-74 years and all patients were females. 15 underwent initial breast conserving surgery and 43 underwent mastectomy.Patients with ipsilateral breast/chest wall/draining lymph nodal disease were classified as having locoregional disease and patients with metastases in contralateral axillary or supraclavicular,mediastinal/internal mammary nodes/lungs/skeletal/liver metastases were considered to have systemic disease.

Results Of 58 patients 6/58(10%) had no evidence of recurrence,52 had recurrence.15/58(26%) had locoregional disease, 31/58(54%) had distant metastases, 6/58 (10%) could not be classified definitely as 5 had subcentimetric non FDG avid lung nodules and one patient had a sclerotic lesion in vertebra without significant FDG uptake.PET/CT also identified unknown/unsuspected distant metastases in 16/58(27%) patients which accounted to about 50%(16/31) patients with distant metastases.

Conclusions On the basis of FDG PET/CT findings about 54% patients with recurrent breast carcinoma had distant metastases warranting systemic therapy.In addition FDG PET/CT identified unknown/unidentified distant metastases in about 27% patients.Therefore it can be concluded that FDG PET/CT had a significant impact on the management of patients with recurrent breast carcinoma