International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationEffect of 18F-FDG PET/CT Imaging in Patients With Clinical 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.