18F-2-Fluoro-2-Deoxy-D-Glucose Positron Emission
Tomography Scanning Affects Surgical Management in
Selected Patients With High-Risk, Operable Breast Carcinoma
Elisa Rush Port, MD,1Henry Yeung, MD,2Mithat Gonen, PhD,3Laura Liberman, MD,4
James Caravelli, MD,4Patrick Borgen, MD,1and Steven Larson, MD2
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021
2Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021
3Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021
4Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021
Background: 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
of18F-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.
Methods: 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.
Results: 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).
Conclusions: 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.
High risk—Extent of disease.
18F-2-fluoro-2-deoxy-D-glucose-positron emission tomography—Breast cancer—
Breast cancer is the most common solid malig-
nancy to affect women in the United States.1With
increased mammographic screening, the detection of
earlier, smaller tumors has become more common;
ductal carcinoma-in-situ constitutes approximately
25% of all newly diagnosed cases, and the mean tu-
mor size for invasive cancers is decreasing.1Deter-
mining the extent of disease at the time of diagnosis
can significantly influence treatment decisions. Pa-
tients who have recently received a diagnosis and for
whom surgery is planned may be diverted to primary
medical treatment if metastatic disease is discovered.
Received March 4, 2005; accepted October 19, 2005; published
online March 16, 2006.
Address correspondence and reprint requests to: Elisa Rush
Port, MD; E-mail: firstname.lastname@example.org.
Published by Springer Science+Business Media, Inc. ? 2006 The Society of
Surgical Oncology, Inc.
Annals of Surgical Oncology, 13(5): 677)684
restaging, therapy planning, and monitoring response of lung
cancer. Radiol Clin North Am 2005; 43:1?21, ix.
9. Wahl RL, Cody RL, Hutchins GD, Mudgett EE. Primary and
metastatic breast carcinoma: initial clinical evaluation with
PET with the radiolabeled glucose analogue 2-[F-18]-fluoro-2-
deoxy-D-glucose. Radiology 1991; 179:765?70.
10. Nieweg OE, Kim EE, Wong WH, et al. Positron emission
tomography with fluorine-18-deoxyglucose in the detection
and staging of breast cancer. Cancer 1993; 71:3920?5.
11. Lovrics PJ, Chen V, Coates G, et al. A prospective evaluation
of positron emission tomography scanning, sentinel lymph
node biopsy, and standard axillary dissection for axillary
staging in patients with early-stage breast cancer. Ann Surg
Oncol 2004; 11:846?53.
12. Crippa F, Agresti R, Donne VD, et al. The contribution of
positron emission tomography (PET) with 18F-fluorodeoxy-
glucose (FDG) in the preoperative detection of axillary
metastases of breast cancer: the experience of the National
Cancer Institute of Milan. Tumori 1997; 83:542? 3.
13. Smith IC, Ogston KN, Whitford P, et al. Staging of the axilla
in breast cancer: accurate in vivo assessment using positron
emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-
glucose. Ann Surg 1998; 228:220?7.
14. Wahl RL, Siegel BA, Coleman RE, Gatsonis CG. Prospective
multicenter study of axillary nodal staging by positron emis-
sion tomography in breast cancer: a report of the staging breast
cancer with PET Study Group. J Clin Oncol 2004; 22:277?85.
15. Ciatto S, Pacini P, Azzini V, et al. Preoperative staging of
primary breast cancer. A multicentric study. Cancer 1988;
16. Myers RE, Johnston M, Pritchard K, Levine M, Oliver T.
Breast Cancer Disease Site Group of the Cancer Care Ontario
Practice Guidelines Initiative. Baseline staging tests in primary
breast cancer: a practice guideline. CMAJ 2001; 164:1439?44.
17. van der Hoeven JJ, Krak NC, Hoekstra OS, et al.
fluoro-2-deoxy-d-glucose positron emission tomography in
staging of locally advanced breast cancer. J Clin Oncol
18. Schirrmeister H, Kuhn T, Guhlmann A, et al. Fluorine-18
2-deoxy-2-fluoro-D-glucose PET in the preoperative staging
of breast cancer: comparison with the standard staging
procedures. Eur J Nucl Med 2001; 28:351?8.
E. R. PORT ET AL.
Ann. Surg. Oncol. Vol. 13, No. 5, 2006