Abstract
Background
The role of positron emission tomography (PET) scanning in determining the extent of disease in patients with breast cancer has not been defined. We investigated the utility of 18F-2-fluoro-2-deoxy-D-glucose (FDG)-PET scanning compared with conventional imaging with computed tomographic scanning and bone scanning in determining the extent of disease in patients with high-risk, operable breast cancer.
Methods
This was a prospective study of patients who presented to Memorial Sloan-Kettering Cancer Center for operative treatment of breast cancer. Eighty eligible patients were enrolled and underwent computed tomographic chest, abdomen, pelvis, and bone scans, followed by FDG-PET. Changes in treatment based on scan findings were recorded by the operating surgeons. Imaging findings were verified by biopsy or long-term follow-up.
Results
Eight (10%) of 80 patients were found to have metastatic disease that was seen on both conventional imaging and PET. Four additional patients (5%) had additional foci of disease on PET that affected treatment decisions. No patient had findings on conventional imaging alone. Conventional imaging studies resulted in a higher number of findings that generated additional tests and biopsies that ultimately had negative results (17% vs. 5% for PET). There was a statistically significant difference in specificity for PET compared with conventional imaging (P = .01).
Conclusions
Conventional imaging and PET were equally sensitive in detecting metastatic disease in patients with high-risk, operable breast cancer, but PET generated fewer false-positive results. FDG-PET scanning should be further studied in this setting and considered in the preoperative evaluation of selected patients with breast cancer.
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References
Jemal A, Murray T, Ward E, et al. Cancer Statistics 2005. CA Cancer J Clin 2005; 55:10–30
Puglisi F, Follador A, Minisini AM, et al. Baseline staging tests after a new diagnosis of breast cancer: further evidence of their limited indications. Ann Oncol 2005; 16:263–6
Samant R, Ganguly P. Staging investigations in patients with breast cancer: the role of bone scans and liver imaging. Arch Surg 1999; 134:551–3; discussion 554
NCCN Practice Guidelines in Oncology, Vol 1. 2005
Warburg O. The Metabolism of Tumors. New York: Smith, 1931; 129–69
van Westreenen HL, Westerterp M, Bossuyt PM, et al. Systematic review of the staging performance of 18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol 2004; 22:3805–12
Naumann R, Beuthien-Baumann B, Reiss A, et al. Substantial impact of FDG PET imaging on the therapy decision in patients with early-stage Hodgkin’s lymphoma. Br J Cancer 2004; 90:620–5
Mavi A, Lakhani P, Zhuang H, Gupta NC, Alavi A. Fluorodeoxyglucose-PET in characterizing solitary pulmonary nodules, assessing pleural diseases, and the initial staging, restaging, therapy planning, and monitoring response of lung cancer. Radiol Clin North Am 2005; 43:1–21, ix
Wahl RL, Cody RL, Hutchins GD, Mudgett EE. Primary and metastatic breast carcinoma: initial clinical evaluation with PET with the radiolabeled glucose analogue 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 1991; 179:765–70
Nieweg OE, Kim EE, Wong WH, et al. Positron emission tomography with fluorine-18-deoxyglucose in the detection and staging of breast cancer. Cancer 1993; 71:3920–5
Lovrics PJ, Chen V, Coates G, et al. A prospective evaluation of positron emission tomography scanning, sentinel lymph node biopsy, and standard axillary dissection for axillary staging in patients with early-stage breast cancer. Ann Surg Oncol 2004; 11:846–53
Crippa F, Agresti R, Donne VD, et al. The contribution of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in the preoperative detection of axillary metastases of breast cancer: the experience of the National Cancer Institute of Milan. Tumori 1997; 83:542–3
Smith IC, Ogston KN, Whitford P, et al. Staging of the axilla in breast cancer: accurate in vivo assessment using positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose. Ann Surg 1998; 228:220–7
Wahl RL, Siegel BA, Coleman RE, Gatsonis CG. Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J Clin Oncol 2004; 22:277–85
Ciatto S, Pacini P, Azzini V, et al. Preoperative staging of primary breast cancer. A multicentric study. Cancer 1988; 61:1038–40
Myers RE, Johnston M, Pritchard K, Levine M, Oliver T. Breast Cancer Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative. Baseline staging tests in primary breast cancer: a practice guideline. CMAJ 2001; 164:1439–44
van der Hoeven JJ, Krak NC, Hoekstra OS, et al. 18F-2-fluoro-2-deoxy-d-glucose positron emission tomography in staging of locally advanced breast cancer. J Clin Oncol 2004; 22:1253–9
Schirrmeister H, Kuhn T, Guhlmann A, et al. Fluorine-18 2-deoxy-2-fluoro-D-glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures. Eur J Nucl Med 2001; 28:351–8
Acknowledgment
This study was funded by a grant from The Susan G. Komen Breast Cancer Foundation.
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Port, E.R., Yeung, H., Gonen, M. et al. 18F-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography Scanning Affects Surgical Management in Selected Patients With High-Risk, Operable Breast Carcinoma. Ann Surg Oncol 13, 677–684 (2006). https://doi.org/10.1245/ASO.2006.03.035
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DOI: https://doi.org/10.1245/ASO.2006.03.035