Research ArticleClinical Investigations

The Yield of 18F-FDG PET/CT in Patients with Clinical Stage IIA, IIB, or IIIA Breast Cancer: A Prospective Study

David Groheux, Sylvie Giacchetti, Marc Espié, Laetitia Vercellino, Anne-Sophie Hamy, Marc Delord, Nathalie Berenger, Marie-Elisabeth Toubert, Jean-Louis Misset and Elif Hindié
Journal of Nuclear Medicine October 2011, 52 (10) 1526-1534; DOI: https://doi.org/10.2967/jnumed.111.093864

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    18F-FDG-PET/CT results at initial staging in 2 patients. (A–C) Patient with 40-mm invasive ductal carcinoma of left breast, with clinical T2N0 (stage IIA) disease; 18F-FDG PET/CT shows uptake in primary tumor (A) and evidences internal mammary lymph node (B and C). After PET/CT, cancer was classified T2N2bM0 (stage IIIA). Radiotherapy planning was modified according to PET/CT results to encompass internal mammary basin. (D–F) Patient with 52-mm invasive ductal carcinoma of left breast and movable axillary lymph node (T3N1; clinical stage IIIA). 18F-FDG PET/CT shows uptake in primary tumor (D and E), axillary lymph node (F), and distant metastases to the sternum (D) and liver (E and F). After PET/CT, cancer was classified stage IV. Treatment was adapted to metastatic disease.

Tables

  • TABLE 1

    Patient Demographics and Tumor Characteristics

    CharacteristicNo. of patients (total n = 131)
    AJCC clinical stage and TNM
     IIA36 (27)
      T1N1M02
      T2N0M034
     IIB48 (37)
      T2N1M028
      T3N0M020
     IIIA47 (36)
      T2N2M09
      T3N1M029
      T3N2M09
    Tumor type
     Invasive ductal carcinoma114 (87)
     Invasive lobular carcinoma8 (6)
     Others9 (7)
    Grade
     19 (7)
     265 (50)
     353 (40)
     Unknown4 (3)
    Estrogen receptor status*
     Positive82 (63)
     Negative46 (35)
     Unknown3 (2)
    Progesterone receptor status*
     Positive42 (32)
     Negative85 (65)
     Unknown4 (3)
    HER2 status
     Positive30 (23)
     Negative96 (73)
     Unknown5 (4)

    • * Tumors were considered positive for estrogen receptor or progesterone receptor if >10% of cells showed staining by immunohistochemistry.

    • Data in parentheses are percentages. Median age of patients was 48 y (range, 26–81 y).

  • TABLE 2

    Findings with 18F-FDG PET/CT in 3 Different Groups

    CharacteristicStage IIA (n = 36; 34 T2N2 and 2 T1N1)Stage IIB and primary operable IIIA (n = 77; 20 T3N0, 28 T2N1, and 29 T3N1)Stage IIIA with N2 disease (n = 18; 9 T2N2 and 9 T3N2)
    Overall stage modifications2 (5.5)10 (13)10 (56)
    Lymph nodes outside Berg-I and Berg-II axillary levels (% patients)1 (2.8)5 (6.5)5 (27.8)
     Internal mammary involvement142
     Infraclavicular013
     Supraclavicular002
    Distant metastases1 (2.8)7 (9.1)7 (38.9)
     Bone metastases047
     Liver metastases021
     Lung metastases032
     Other distant metastases1 (mediastinal lymph node)01 (pleura)

    • Total number of patients was 131: 36 (27%) stage IIA; 77 (59%) stage IIB plus primary operable IIIA; and 18 (14%) stage IIIA due to N2 disease. Data in parentheses are percentages. Results are expressed on per-patient basis.

  • TABLE 3

    Performance of Conventional Imaging Versus PET/CT in Depicting Distant Metastases in Overall Series of 131 Patients

    Type of imagingLung metastasesLiver metastasesBone metastasesOther distant metastases
    Total*53112
    Chest (chest radiography or CE-CT)5——1 (mediastinal lymph node†)
    Abdominal (ultrasonography or CE-CT ± MRI)—2——
    BS——7—
    PET/CT5‡3112 (mediastinal lymph node and pleura)

    • * Some women had distant metastases in different viscera; overall, 15 patients had metastases.

    • † Mediastinal lymph nodes were detected by CE-CT but not with chest radiography.

    • ‡ In 2 women, lung metastases had no 18F-FDG uptake and were detected only by CT part of PET/CT hybrid imaging.

    • Results are expressed on per-patient (not per-lesion) basis.

  • TABLE 4

    Studies Evaluating 18F-FDG PET/CT for Breast Cancer Staging

    StudySettingNo. of patientsPET/CT modalityConventional imaging (modalities performed)Impact of PET/CT results (% per-patient basis)
    ReferenceYearTypeDetection of unknown extraaxillary node metastasesDetection of unsuspected distant metastasesModification in initial stagingModification in treatment plan
    Groheux et al. (2)2008ProspectiveStage II or III breast cancer39Whole-body PET performed approximately 60 min after 18F-FDG injection; low-dose NE-CTMammography (± breast MRI), breast ultrasonography, abdominal ultrasonography (± abdominal CT), chest radiography, or CT, and BS8101813
    Heusner et al. (3)2008RetrospectiveT1–T3 N0–N+ M0–1 breast cancer40Whole-body PET performed approximately 60 min after 18F-FDG injection + additional breast PET acquired 110 min after injection; CE-CT and oral contrastBreast MRI, axilla ultrasonography, chest radiography, abdomen ultrasonography, and BS7.57.5NA12.5
    Fuster et al. (4)2008ProspectiveLarge (T > 3 cm) and noninflammatory breast cancer60Whole-body PET performed approximately 60 min after 18F-FDG injection; NE-CTBreast MRI, chest CE-CT, liver ultrasonography, and BS58.542*6.5
    Yang et al. (14)2008RetrospectiveInflammatory breast cancer24Whole-body PET performed approximately 60–90 min after 18F-FDG injection; NE-CTMammography, breast ultrasonography, and MRI2538NANA
    Carkaci et al. (15)2009RetrospectiveInflammatory breast cancer41Whole-body PET performed approximately 60–90 min after 18F-FDG injection; NE-CTMammography, breast ultrasonography or MRI, BS, chest radiography, chest and abdominal CTSC (15%); IM (22%)17NANA
    Alberini et al. (16)2009ProspectiveInflammatory breast cancer59Whole-body PET performed approximately 60 min after 18F-FDG injection; low-dose NE-CTChest radiography, abdominal ultrasonography, BS; if necessary, additional CT investigations were performed56†31NANA
    Aukema et al. (5)2010ProspectiveStage II–III breast cancer60Whole-body PET performed approximately 60 min after 18F-FDG injection + additional PET of thorax (including breasts and axillae) with patient prone; low-dose NE-CTMammography, breast ultrasonography, and breast MRI17NA1712
    Segaert et al. (6)2010RetrospectiveStage IIB–III breast cancer70Whole-body PET performed 75 min after 18F-FDG injection; CE-CT performed during breath-hold at expiration tidal volumeChest radiography, liver ultrasonography, BS, and breast and axilla ultrasonography13 (IM)10NANA

    • * High percentage of modification in this study can be explained by detection of axillary infiltrated nodes (17%), and PET findings downstaged 12% of patients with suspected metastases on conventional imaging.

    • † Some retropectoral nodes were considered extraaxillary.

    • NE-CT = nonenhanced CT; SC = supraclavicular area; IM = internal mammary basin; NA = not available (not stated).

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