Clinical Usefulness of F18-FDG PET/CT in Young Patients with Breast Cancer

Objectives F18-FDG PET/CT imaging is recommended only in clinical stage III breast cancer patients as per NCCN guidelines. However, TNM staging should not be the sole criteria in evaluation of breast cancer with PET/CT but age of patient may also be an additional important factor. Young breast cancer patients often tend to have more aggressive disease and are likely to have high mortality than older patients. This infact may be due to the higher rate of metastatic disease which remains undetected by conventional staging investigation. The aim of this study was to evaluate the role of F18-FDG PET/CT in staging, restaging and changes in management, if any, in young breast cancer patients.PET/CT but age of patient may also be an additional important factor. Young breast cancer patients often tend to have more aggressive disease and are likely to have high mortality than older patients. This infact may be due to the higher rate of metastatic disease which remains undetected by conventional staging investigation. The aim of this study was to evaluate the role of F18-FDG PET/CT in staging, restaging and changes in management, if any, in young breast cancer patients.

Methods A retrospective analysis of the records of breast cancer patients who underwent PET/CT was done. Of the 3500 breast cancer studies from April 2010 to June 2014, 162 were less than 40 years of age. Clinical staging of all these 162 patients was determined based on physical examination, mammography, ultrasound and other conventional imaging investigation before PET/CT scan. PET/CT scan was done within 1-2 weeks of clinical staging to evaluate loco-regional and distant metastases and changes, if any, in the patient management.

Results A total of 162 younger diagnosed patients of breast cancer were analyzed with mean age of 30 years (range 21-40 years). Clinically 17 patients were stage I, 88 in stage II and 47 in stage III. PET/CT was performed for initial staging in 74 patients, restaging/ response evaluation in 45 patients and recurrence detection in 43 patients. 50 patients underwent follow-up PET scans. PET/CT scan detected extra-axillary lymph node metastases in 82 patients, lung lesions in 25 patients, bone lesions in 45 patients, liver lesions in 15 patients. The lesions found on PET/CT scan were confirmed by histopathological examination; follow-up imaging with PET scan / conventional imaging and also clinical examination. PET/CT scans changed the clinical stage from II/III to stage III/IV in 70 patients. Based on PET/CT finding patient’s management were changed in 45 patients, out of this 11 patients underwent additional surgery, 8 patients underwent chemo-radiotherpy and 26 patients underwent additional/changes in chemotherapeutic regimen after PET/CT.

Conclusions Our results show that PET/CT should be performed in all young patients with breast cancer irrespective of clinical stage, as it changed the stage in 70 patients as well as changed the management strategy in 45 patients.