Research ArticleOncology

18F-FDG PET/CT for Systemic Staging of Newly Diagnosed Breast Cancer in Men

Gary A. Ulaner, Jessica Juarez, Christopher C. Riedl and Debra A. Goldman
Journal of Nuclear Medicine April 2019, 60 (4) 472-477; DOI: https://doi.org/10.2967/jnumed.118.217836

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Standards for Reporting of Diagnostic Accuracy Diagram (STARD) for patients in this study. MSKCC = Memorial Sloan Kettering Cancer Center.

  • FIGURE 2.
    FIGURE 2.

    A 53-y-old man with a pre-PET/CT stage IIB breast cancer, which was upstaged to stage IV by 18F-FDG PET/CT. (A) 18F-FDG maximum-intensity-projection image demonstrates 18F-FDG avidity in left breast (arrow), left axilla (dashed arrow), as well as overlying midline chest (curved arrow). (B) Axial 18F-FDG PET, CT on soft-tissue window, and fused 18F-FDG PET/CT demonstrate the 18F-FDG–avid known primary left breast malignancy (arrow). (C) Axial 18F-FDG PET, CT on soft-tissue window, and fused 18F-FDG PET/CT demonstrate 18F-FDG–avid known left axillary nodal metastases (dashed arrow). (D) Axial 18F-FDG PET, CT on bone window, and fused 18F-FDG PET/CT demonstrate 18F-FDG avidity in midline chest on the maximum-intensity-projection image corresponding to a thoracic vertebra without CT correlate. This lesion was biopsied and proven to be a previously unsuspected osseous metastasis, increasing patient’s stage to IV. This altered patient’s management from surgical management to systemic therapy without surgical management.

  • FIGURE 3.
    FIGURE 3.

    A 58-y-old man with a pre-PET/CT stage IIB breast cancer, which was upstaged to stage IV on 18F-FDG PET/CT. (A) 18F-FDG maximum-intensity-projection image demonstrates mild 18F-FDG avidity in left mastectomy bed (arrow) and left axillary node (dashed arrow), as well as overlying midline chest (curved arrow). (B) Axial 18F-FDG PET, CT on bone window, and fused 18F-FDG PET/CT demonstrate an 18F-FDG–avid thoracic vertebra (curved arrow) corresponding only with small, benign-appearing sclerotic focus on CT. This patient was subsequently treated with systemic therapy. (C) Axial 18F-FDG PET, CT on bone tissue window, and fused 18F-FDG PET/CT after systemic therapy demonstrate resolution of 18F-FDG avidity (curved arrow) and increased sclerosis of the vertebra (white arrow), consistent with therapy response in an osseous metastasis and osseous healing. (D) 18F-FDG maximum-intensity-projection image after systemic therapy demonstrates persistence of 18F-FDG–avid postmastectomy inflammation (arrow) but resolution of avidity in the node and osseous metastasis.

Tables

  • TABLE 1

    Characteristics of Patients with Male Breast Cancer and Their Primary Tumors

    Characteristicn (%)
    No. of patients39
    Median age (y)62 (range, 31–90)
    Race
     African American4 (10)
     Asian3 (8)
     Caucasian31 (79)
     Other1 (3)
    Histology
     Ductal37 (95)
     Adenoid cystic1 (3)
     Papillary1 (3)
    Tumor grade
     High28 (72)
     Intermediate9 (23)
     Unknown2 (5)
    Receptor status
     ER+/HER2−33 (84)
     HER2+5 (13)
     Triple-negative1 (3)
    BRCA1 or 2 mutation
     Yes4 (10)
     No16 (41)
     Unknown19 (49)
    Initial staging
     Pre-PET/CT stage
      I2 (5)
      IIA6 (15)
      IIB19 (49)
      IIIA5 (13)
      IIIB4 (10)
      IIIC3 (8)
     T stage
      T15 (13)
      T229 (74)
      T31 (3)
      T44 (10)
     N stage
      N010 (26)
      N122 (56)
      N24 (10)
      N33 (8)
    M stage, M039 (100)

    • Data in parentheses are percentages, unless otherwise indicated.

  • TABLE 2

    Summary of Patients with Male Breast Cancer Upstaged by 18F-FDG PET/CT Stratified by Pre-PET/CT Stage

    Post-PET/CT stage
    Pre-PET/CT stageTotalIIIAIIBIIIAIIIBIIICIV (%)
    I220 (0)
    IIA660 (0)
    IIB19163 (16)
    IIIA541 (20)
    IIIB4103 (75)
    IIIC330 (0)
    Total3926164137 (18)
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