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18 F-FDG PET/CT for initial staging in breast cancer patients – Is there a relevant impact on treatment planning compared to conventional staging modalities?

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Abstract

Objective

To evaluate the impact of whole-body 18 F-FDG PET/CT on initial staging of breast cancer in comparison to conventional staging modalities.

Methods

This study included 102 breast cancer patients, 101 patients were eligible for evaluation. Preoperative whole-body staging with PET/CT was performed in patients with clinical stage ≥ T2 tumours or positive local lymph nodes (n = 91). Postoperative PET/CT was performed in patients without these criteria but positive sentinel lymph node biopsy (n = 10). All patients underwent PET/CT and a conventional staging algorithm, which included bone scan, chest X-ray and abdominal ultrasound. PET/CT findings were compared to conventional staging and the impact on therapeutic management was evaluated.

Results

PET/CT led to an upgrade of the N or M stage in overall 19 patients (19 %) and newly identified manifestation of breast cancer in two patients (2 %). PET/CT findings caused a change in treatment of 11 patients (11 %). This is within the range of recent studies, all applying conventional inclusion criteria based on the initial T and N status.

Conclusions

PET/CT has a relevant impact on initial staging and treatment of breast cancer when compared to conventional modalities. Further studies should assess inclusion criteria beyond the conventional T and N status, e.g. tumour grading and receptor status.

Key Points

• PET/CT may be relevant in staging breast cancer patients at higher risk for metastases

• PET/CT may modify the N and M stage in multiple patients

• PET/CT may impact treatment planning in breast cancer patients

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Acknowledgments

We would like to thank Wolfgang A. Weber, Molecular Imaging and Therapy Service at the Memorial Sloan-Kettering Cancer Centre New York for critically reading and reviewing the manuscript. The scientific guarantor of this publication is Professor Dr. med. Stefan O. Schoenberg, Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Joachim Brade kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution

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Authors and Affiliations

  1. Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    J. Krammer, A. Schnitzer, C. G. Kaiser, K. A. Buesing, S. O. Schoenberg & K. Wasser

  2. Department of Radiation Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    E. Sperk

  3. Institute of Medical Statistics, Biomathematics and Data Processing, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    J. Brade

  4. Department of Gynaecology and Obstetrics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    S. Wasgindt & M. Suetterlin

  5. Department of Radiology, Memorial Sloan-Kettering Cancer Center, Evelyn H. Lauder Breast Center, 300 East 66th Street, New York, 10065, NY, USA

    E. J. Sutton

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  1. J. Krammer
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  2. A. Schnitzer
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  3. C. G. Kaiser
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  9. S. O. Schoenberg
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  10. E. J. Sutton
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  11. K. Wasser
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Correspondence to J. Krammer.

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Krammer, J., Schnitzer, A., Kaiser, C.G. et al. 18 F-FDG PET/CT for initial staging in breast cancer patients – Is there a relevant impact on treatment planning compared to conventional staging modalities?. Eur Radiol 25, 2460–2469 (2015). https://doi.org/10.1007/s00330-015-3630-6

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  • DOI: https://doi.org/10.1007/s00330-015-3630-6

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