Feature | January 04, 2013

PET/CT Shows Advantages Over Conventional Staging for Locally Advanced Breast Cancer

 Breast Cancer Ribbon_iStock

Jan. 2, 2013 -– New research published in the January issue of The Journal of Nuclear Medicine shows that 18F-fludeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) imaging offers significant prognostic stratification information at initial staging for patients with locally advanced breast cancer. When compared to conventional imaging, 18F-FDG PET/CT more accurately showed lesions in the chest, abdomen and bones in a single session, changing management for more than 50 percent of the patients in the study.

Guidelines from the National Comprehensive Cancer Network (NCCN) recommend a physical examination, bilateral mammogram, sonography or breast magnetic resonance (MR) imaging to examine the breast, as well as chest diagnostic CT, abdominal or pelvic diagnostic CT or MR imaging and bone scanning for evaluation of distant involvement. The NCCN guidelines consider 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, lead author of the study “18F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging.”

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 sonography 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 identified by 18F-FDG PET/CT. The scans confirmed lymph node involvement in stage IIIC patients and revealed unsuspected lymph node involvement in 32 additional patients.  Furthermore, 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, in turn, impacted 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 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.”

Authors of the article “18F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging” include David Groheux, Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France, and B2T, Doctoral School, IUH, University of Paris VII, France; Laetitia Vercellino and Marie-Elisabeth Toubert, Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; Pascal Merlet, Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France, and Service Hospitalier Frederic Joliot, SHFJ/I2BM/DSVCEA, Orsay, France; Elif Hindie, B2T, Doctoral School, IUH, University of Paris VII, France, and Department of Nuclear Medicine, Haut-Leveque Hospital, CHU Bordeaux, University of Bordeaux-Segalen, Bordeaux, France; Sylvie Giacchetti, Caroline Cuvier and Marc Espie, Breast Diseases Unit, Department of Medical Oncology, Saint-Louis Hospital, Paris, France; Marc Delord, Department of Biostatistics and Bioinformatics, Institut Universitaire d’Hematologie, Paris, France; and Christophe Hennequin, Department of Radiation Oncology, Saint-Louis Hospital, Paris, France.

For more information: http://jnm.snmjournals.org

 

Related Content

This is an example of 3-D ultrasound imaging on a breast, designed to help increase efficiency and diagnostic accuracy in any practice. Image courtesy of Hologic.

This is an example of TriVu ultrasound imaging on a breast, designed to help increase efficiency and diagnostic accuracy in any practice. Image courtesy of Hologic.

Feature | Breast Imaging | September 15, 2021 | By Jennifer Meade
The...
While the Mammography Quality Standards Act (MQSA) and the introduction of EQUIP (Enhancing Quality Using the Inspection Program) have been successful in standardizing and enhancing mammographic imaging quality, inadequate breast positioning can dramatically impact the ability of radiologists and technicians to quickly and accurately detect breast cancer and potentially malignant lesions in their patients

Getty Images

Feature | Mammography | September 15, 2021 | By Christopher Austin, M.D. and Randy D. Hicks, M.D., MBA
Evaluation of therapeutic efficacy of drug candidates in preclinical oncology with positron emission tomography (PET)

Getty Images

Feature | PET Imaging | September 14, 2021 | By Todd Sasser, Ph.D.
According to ARRS’ American Journal of Roentgenology (AJR), immediately reading screening mammograms during the coronavirus disease (COVID-19) pandemic promises a new and improved paradigm—reducing care disparities, while increasing the speed of diagnostic workup.

Flow Chart of Patient Selection

News | Breast Imaging | September 09, 2021
September 9, 202
Laws designed to help women with increased risk for missed breast cancer diagnoses may help catch the disease earlier, according to Penn State College of Medicine researchers.

Getty Images | AleksandarNakic

News | Breast Imaging | September 09, 2021
September 9, 2021 — Laws designed to help women with increased risk for...
DenseBreast-info.org (DB-I) announced that the European Society of Radiology (ESR) now links to DB-I website and educational materials as a resource for members about the screening and risk implications of dense breast tissue.
News | Breast Density | August 13, 2021
August 13, 2021 — 
#coronavirus #COVID19 #pandemic #RSNA21 will require all attendees and exhibitors to show proof of #vaccination and wear a #mask

Getty Images

News | RSNA | August 12, 2021
August 12, 2021 — RSNA 2021 will require proof of CO...