18F-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography Scanning Affects Surgical Management in Selected Patients With High-Risk, Operable Breast Carcinoma

Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York, 10021, USA.
Annals of Surgical Oncology (Impact Factor: 3.93). 06/2006; 13(5):677-84. DOI: 10.1245/ASO.2006.03.035
Source: PubMed


The role of positron emission tomography (PET) scanning in determining the extent of disease in patients with breast cancer has not been defined. We investigated the utility of (18)F-2-fluoro-2-deoxy-D: -glucose (FDG)-PET scanning compared with conventional imaging with computed tomographic scanning and bone scanning in determining the extent of disease in patients with high-risk, operable breast cancer.
This was a prospective study of patients who presented to Memorial Sloan-Kettering Cancer Center for operative treatment of breast cancer. Eighty eligible patients were enrolled and underwent computed tomographic chest, abdomen, pelvis, and bone scans, followed by FDG-PET. Changes in treatment based on scan findings were recorded by the operating surgeons. Imaging findings were verified by biopsy or long-term follow-up.
Eight (10%) of 80 patients were found to have metastatic disease that was seen on both conventional imaging and PET. Four additional patients (5%) had additional foci of disease on PET that affected treatment decisions. No patient had findings on conventional imaging alone. Conventional imaging studies resulted in a higher number of findings that generated additional tests and biopsies that ultimately had negative results (17% vs. 5% for PET). There was a statistically significant difference in specificity for PET compared with conventional imaging (P = .01).
Conventional imaging and PET were equally sensitive in detecting metastatic disease in patients with high-risk, operable breast cancer, but PET generated fewer false-positive results. FDG-PET scanning should be further studied in this setting and considered in the preoperative evaluation of selected patients with breast cancer.

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    • "This disease subset is likely to become a distinct entity due to the diffusion of imaging methods with higher sensitivity for distant metastases in the workup of clinically localized breast cancer. In the past, a number of reports have suggested that the incidence of distant metastases in breast cancer patients candidates to surgery could be as high as 20% when CT-PET scanning is used [18] [19]. More recently, a prospective study involving 254 women with clinical stages II and III breast cancer evaluated the diagnostic yield of CT-PET scanning [20]. "
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    • "PET has proved superior to conventional imaging modalities and has a high positive predictive value for the axillary lymph nodes involvement, especially patients with advanced tumors [40,41]. According to Port et al, conventional imaging and PET were equally sensitive in detecting metastatic disease in patients with high-risk, operable breast cancer, but PET generated fewer false-positive results [42]. In this pilot study GCPET has been shown to be feasible in a district general hospital, enabling the provision of a limited on-site PET imaging service. "
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