Clinical Investigation
Effect of 18F-FDG PET/CT Imaging in Patients With Clinical Stage II and III Breast Cancer

https://doi.org/10.1016/j.ijrobp.2008.02.056Get rights and content

Purpose

To investigate the potential effect of using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in the initial assessment of patients with clinical Stage II or III breast cancer.

Methods and Materials

During 14 consecutive months, 39 patients (40 tumors) who presented with Stage II or III breast cancer on the basis of a routine extension assessment were prospectively included in this study. PET/CT was performed in addition to the initial assessment.

Results

In 3 cases, PET/CT showed extra-axillary lymph node involvement that had not been demonstrated with conventional techniques. Two of these patients had hypermetabolic lymph nodes in the subpectoral and infraclavicular regions, and the third had a hypermetabolic internal mammary node. PET/CT showed distant uptake in 4 women. Of these 4 women, 1 had pleural involvement and 3 had bone metastasis. Overall, of the 39 women, the PET/CT results modified the initial stage in 7 (18%). The modified staging altered the treatment plan for 5 patients (13%). It led to radiotherapy in 4 patients (bone metastasis, pleural lesion, subpectoral lymph nodes, and internal mammary nodes) and excision of, and radiotherapy to, the infraclavicular lymph nodes in 1 patient.

Conclusions

PET/CT can provide information on extra-axillary lymph node involvement and can uncover occult distant metastases in a significant percentage of patients. Therefore, initial PET/CT could enable better treatment planning for patients with Stage II and III breast cancer.

Introduction

Women who undergo breast cancer screening are mostly diagnosed with Stage I disease and metastatic dissemination is unlikely. It does not, therefore, appear appropriate to systematically perform an extension assessment in this patient subgroup. However, in Stage II and III disease, the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has not been fully investigated. In these higher risk patients, performing PET/CT might modify the treatment course by refining the locoregional assessment and by revealing occult distant metastases. Preliminary studies have demonstrated the possible usefulness of FDG-PET for the initial staging of locally advanced breast cancer 1, 2. We investigated the role of FDG-PET/CT during the initial staging of patients with clinical Stage II or III breast cancer, according to the American Joint Committee on Cancer classification (3).

Section snippets

Study method and population

None of the 39 patients in this series had undergone chemotherapy or radiotherapy before PET/CT. The diagnosis of breast cancer was obtained by fine-needle biopsy. The routine extension assessment included mammography, ultrasonography of the breast and axilla, chest radiography, abdominal ultrasonography, and bone scintigraphy. If needed, CT of the chest and abdomen was also performed. In women who were to undergo neoadjuvant chemotherapy, mammary magnetic resonance imaging (MRI) was also

Results

Table 2 summarizes the results for all 39 patients (40 tumors).

Discussion

Although the initial studies put forth the high sensitivity of PET/CT for the diagnosis of axillary involvement 5, 6, 7, 8, 9, 10, it is now known that micrometastases cannot be seen with PET/CT 11, 12, 13. Therefore, PET/CT is not recommended for the specific purpose of staging the superficial axillaries lymph nodes. The purpose of our study was not to evaluate the role of PET for depicting axillary metastases.

In patients with Stage II or III breast cancer, systematic PET/CT might be justified

Conclusions

The use of FDG-PET/CT appears valuable for the initial extension assessment of patients with Stage II or III breast cancer. It can detect lymph node disease in regions that are not easily accessible by conventional techniques (sub- and interpectoral, supra- and infraclavicular, Berg's Level III, internal mammary chain), thus guiding complementary treatment. It might also uncover occult distant metastases. It still needs to be established what effect this early 18F-FDG-PET/CT detection has in

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    Note—An online CME test for this article can be taken at http://asro.astro.org under Continuing Education.

    Conflict of interest: none.

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