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Impact of FDG PET on the preoperative staging of newly diagnosed breast cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The main objective of this study was to determine the efficacy of 18F-fluorodeoxyglucose positron emission tomography (FDG PET) to assess the impact of this technique in staging of patients with newly diagnosed breast cancer.

Methods

Two hundred and seventy-one consecutive patients (median age = 51 ± 11 years) with biopsy-proven primary breast cancer who were examined by FDG PET were enrolled in this prospective preoperative staging study. Whole-body FDG-PET images were acquired approximately 60 min after the intravenous administration of FDG (5.2 MBq/kg). Visual assessment and the maximum standardized uptake value (SUVmax) of breast lesions for semiquantitative analysis were carried out. The PET results were compared with the histopathology results.

Results

For the tumor, node, metastases (TNM) staging, 240 patients (250 breasts) were considered eligible based on the criteria that were established for this analysis. Significant differences were noted in SUVmax of lesions according to the TNM staging (p < 0.05). The average SUVmax of the primary tumor was calculated in patients with axillary involvement (n = 58) and for the ones without axillary metastasis (n = 79), and SUVmax were 4.1 ± 3.5 and 2.8 ± 2.3, respectively, with a significant difference between the two groups (p = 0.03). PET imaging revealed pathological FDG uptake in 54% (46/85) of patients with axillary lymph node metastases. The sensitivities of FDG PET for detecting axillary lymph node metastasis were found 41% in pN1, 67% in pN2, and 100% in pN3, and the specificity was 89% for pN0 stage. Detection of extra-axillary regional node or distant metastatic lesions revealed by PET scan in 22 of 24 patients resulted in a significant change in the TNM stage. Distant metastasis without axillary lymph node metastasis was noted in 21% (5/24) of patients. The results revealed that FDG PET upgraded TNM stage in 9.2% (22/240) of patients and 7.5% (18/240) of patients were diagnosed as having one or more distant metastases.

Conclusion

FDG PET was able to identify extra-axillary regional nodal and distant lesions in newly diagnosed patients with breast cancer; FDG PET may alter the staging and management of therapy in patients with newly diagnosed breast cancer.

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Acknowledgements

This work was supported by U.S. Public Health Services Research Grant M01-RR00040 from the National Institutes of Health. This work was also supported in part by the International Union against Cancer, Geneva, Switzerland, under the ACSBI fellowship. The authors would like to thank Janet Saffer, Ph.D., for her valuable assistance in analyzing data from this study.

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Authors and Affiliations

  1. Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 110 Donner Bldg., Philadelphia, PA, 19104, USA

    Tevfik F. Çermik, Sandip Basu & Abass Alavi

  2. Department of Nuclear Medicine, Yeditepe University Hospital, Istanbul, Turkey

    Ayse Mavi

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  1. Tevfik F. Çermik
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  2. Ayse Mavi
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  3. Sandip Basu
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Correspondence to Abass Alavi.

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Çermik, T.F., Mavi, A., Basu, S. et al. Impact of FDG PET on the preoperative staging of newly diagnosed breast cancer. Eur J Nucl Med Mol Imaging 35, 475–483 (2008). https://doi.org/10.1007/s00259-007-0580-5

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  • DOI: https://doi.org/10.1007/s00259-007-0580-5

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