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18F-FDG PET/CT provides powerful prognostic stratification in the primary staging of large breast cancer when compared with conventional explorations

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Abstract

Purpose

The objective of this study was to assess the impact on management and the prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for initial staging of newly diagnosed large breast cancer (BC) when compared with conventional staging.

Methods

We prospectively included 142 patients with newly diagnosed BC and at least grade T2 tumour. All patients were evaluated with complete conventional imaging (CI) procedures (mammogram and/or breast ultrasound, bone scan, abdominal ultrasound and/or CT, X-rays and/or CT of the chest), followed by FDG PET/CT exploration, prior to treatment. The treatment plan based on CI staging was compared with that based on PET/CT findings. CI and PET/CT findings were confirmed by imaging and clinical follow-up and/or pathology when assessable. Progression-free survival (PFS) was analysed using the Cox proportional hazards regression model.

Results

According to CI staging, 79 patients (56 %) were stage II, 46 (32 %) stage III and 17 (12 %) stage IV (distant metastases). Of the patients, 30 (21 %) were upstaged by PET/CT, including 12 (8 %) from stage II or III to stage IV. On the other hand, 23 patients (16 %) were downstaged by PET/CT, including 4 (3 %) from stage IV to stage II or III. PET/CT had a high or medium impact on management planning for 18 patients (13 %). Median follow-up was 30 months (range 9–59 months); 37 patients (26 %) experienced recurrence or progression of disease during follow-up and 17 patients (12 %) died. The Cox model indicated that CI staging was significantly associated with PFS (p = 0.01), but PET/CT staging provided stronger prognostic stratification (p < 0.0001). Moreover, Cox regression multivariate analysis showed that only PET/CT staging remained associated with PFS (p < 0.0001).

Conclusion

FDG PET/CT provides staging information that more accurately stratifies prognostic risk in newly diagnosed large BC when compared with conventional explorations alone.

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Acknowledgments

This study is part of the Pharmimage project. The authors thank Paul M. Walker for his help in the revision of the manuscript.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Centre Georges-François Leclerc, 1 rue Professeur Marion, 21079, Dijon Cedex, France

    Alexandre Cochet, Inna Dygai-Cochet, Jean-Marc Riedinger, Olivier Humbert, Alina Berriolo-Riedinger, Michel Toubeau & François Brunotte

  2. Le2i UMR CNRS 6306, Dijon, France

    Alexandre Cochet, Olivier Humbert & François Brunotte

  3. MRI and Spectroscopy Unit, CHU Dijon, Dijon, France

    Olivier Humbert & François Brunotte

  4. Department of Oncology, Centre Georges-François Leclerc, Dijon, France

    Séverine Guiu & Bruno Coudert

  5. Department of Surgery, Centre Georges-François Leclerc, Dijon, France

    Charles Coutant & Pierre Fumoleau

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  1. Alexandre Cochet
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Correspondence to Alexandre Cochet.

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Cochet, A., Dygai-Cochet, I., Riedinger, JM. et al. 18F-FDG PET/CT provides powerful prognostic stratification in the primary staging of large breast cancer when compared with conventional explorations. Eur J Nucl Med Mol Imaging 41, 428–437 (2014). https://doi.org/10.1007/s00259-013-2595-4

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  • DOI: https://doi.org/10.1007/s00259-013-2595-4

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