PET/CT Better Than Traditional Staging for Locally Advanced Breast Cancer Patients

French researchers have revealed that 18F-fludeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) imaging provides considerable prognostic stratification data at initial staging for patients with locally advanced breast cancer. When compared to conventional imaging, 18F-FDG PET/CT more effectively demonstrated lesions in the abdomen, chest, and bones in only one session, altering management for more than 50% of the patients in the study.

The study’s findings were published in the January 2013 issue of the Journal of Nuclear Medicine. Guidelines from the US National Comprehensive Cancer Network (NCCN) recommend a physical exam, bilateral mammogram, ultrasound, or breast magnetic resonance imaging (MRI) to assess the breast, as well as chest diagnostic CT, abdominal, or pelvic diagnostic CT or MR imaging and bone scanning for the assessment of distant involvement. The NCCN guidelines deem 18F-FDG PET/CT to be “most helpful in situations where standard staging studies are equivocal or suspicious.”

“The prognosis of patients with locally advanced breast cancer remains poor. In this study we aimed to investigate whether the use of 18F-FDG PET/CT at initial staging could have an impact on the prognostic stratification and management of patients with locally advanced breast cancer," said David Groheux, MD, PhD, from the department of nuclear medicine, Saint-Louis Hospital (Paris, France), and lead author of the study.

One hundred and seventeen patients with locally advanced breast cancer were prospectively included in the study over a course of five years. Patients underwent conventional imaging methods, including bone scanning, chest radiography, or dedicated CT and abdominopelvic examination by ultrasound or contrast-enhanced CT and were staged accordingly. They then received an 18F-FDG PET/CT scan, which was reviewed by nuclear medicine specialists with no knowledge of the conventional imaging results. The conventional imaging and 18F-FDG imaging results were then compared.

All primary tumors were detected by 18F-FDG PET/CT. The scans validated lymph node involvement in stage IIIC patients and revealed unanticipated lymph node involvement in 32 additional patients. Moreover, distant metastases (bone, distant lymph nodes, liver, lung, and pleura) were visualized with 18F-FDG PET/CT in 43 patients; conventional imaging only identified 28 patients with distant metastases. Overall, 18F-FDG PET/CT changed the stage of 61 out of 117 patients, which then affected the recommended treatment for the patients.

“This is a step toward the truly personalized medicine that molecular imaging can bring—acquiring an image that provides sufficient information to truly tailor management strategies to the singular needs of each patient,” noted Dr. Groheux. “Based on these findings, 18F-FDG PET/CT may become the single most important distant staging modality in patients with locally advanced breast cancer.”

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