J Breast Cancer.  2012 Dec;15(4):441-448. 10.4048/jbc.2012.15.4.441.

The Effects of Preoperative 18F-FDG PET/CT in Breast Cancer Patients in Comparison to the Conventional Imaging Study

• Choi YJ
• Shin YD
• Kang YH
• Lee MS
• Lee MK
• Cho BS
• Kang YJ
• Park JS

• KMID: 2286442
• DOI: http://doi.org/10.4048/jbc.2012.15.4.441

Abstract

PURPOSE
There have been recent studies of the 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) in the staging, detection, and follow-up of the breast cancer occurrence and recurrence. There was controversy concerning the use of 18F-FDG PET/CT for staging primary breast cancer. In this study, we investigated the potential effects of 18F-FDG PET/CT in the initial assessment of patients with primary breast cancer.
METHODS
From January 2008 to December 2009, 154 consecutive biopsy-proven invasive breast cancer patients were enrolled in this study. Patients underwent conventional imaging studies including mammography, breast ultrasonography (USG), and magnetic resonance imaging for local assessment, and plain chest X-ray, liver USG, and bone scan to rule out distant metastasis. All 154 patients underwent 18F-FDG PET/CT in the initial assessment.
RESULTS
18F-FDG PET/CT did not detect primary breast lesions in 16 patients with a sensitivity of 89.6% and detected only 5 multiple lesions (12.5%) out of 40 cases. Histologically confirmed axillary lymph node (LN) metastases were in 51 patients, and the sensitivity and specificity of 18F-FDG PET/CT to detect metastatic axilla were 37.3% and 95.8%, respectively; whereas the corresponding estimates of USG were 41.2% and 93.7%, respectively. Eleven extra-axillary LN metastases were found in eight patients, and seven lesions were detected by 18F-FDG PET/CT only. The sensitivity and specificity of 18F-FDG PET/CT in detecting distant metastasis were 100% and 96.4%, respectively; whereas the sensitivity and specificity of the conventional imaging were 61.5% and 99.2%, respectively.
CONCLUSION
18F-FDG PET/CT cannot be recommended as a primary diagnostic procedure in breast cancer, but it has the potential to be used as an additional imaging tool for the detection of axillary metastasis, distant metastasis, and extra-axillary LN metastasis. 18F-FDG PET/CT cannot solely replace the conventional diagnostic procedure in primary breast cancer. The best approach may be the combination of different imaging modalities.

Keyword

Breast; Carcinoma; Computed tomography; Diagnostic imaging; Positron-emission tomography

MeSH Terms

Axilla
Breast
Breast Neoplasms
Diagnostic Imaging
Fluorodeoxyglucose F18
Follow-Up Studies
Humans
Liver
Lymph Nodes
Magnetic Resonance Imaging
Mammography
Neoplasm Metastasis
Positron-Emission Tomography
Positron-Emission Tomography and Computed Tomography
Recurrence
Sensitivity and Specificity
Thorax
Ultrasonography, Mammary
Fluorodeoxyglucose F18

Figure

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  Figure 1 Image findings of a 38-year-old breast cancer patient with multiple bone metastases. Mild hypermetabolism were seen at right sacrum and left iliac bone on 18F-fluorodeoxyglucose positron emission tomography and computed tomography (A, arrows) which was equivocal on bone scan (B). The lesions revealed as osteolytic bone metastasis with low SI on T1- and increased SI on T2 weighted images, with strong enhancement on contrast enhanced magnetic resonance imaging (C, arrows).

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