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30.04.2016 | Original Article | Ausgabe 11/2016

European Journal of Nuclear Medicine and Molecular Imaging 11/2016

18F-FDG-PET/CT for systemic staging of newly diagnosed triple-negative breast cancer

Zeitschrift:
European Journal of Nuclear Medicine and Molecular Imaging > Ausgabe 11/2016
Autoren:
Gary A. Ulaner, Raychel Castillo, Debra A. Goldman, Jonathan Wills, Christopher C. Riedl, Katja Pinker-Domenig, Maxine S. Jochelson, Mithat Gönen

Abstract

Purpose

National Comprehensive Cancer Network guidelines recommend 18F-FDG-PET/CT, in addition to standard staging procedures, for systemic staging of newly diagnosed stage III breast cancer patients. However, factors in addition to stage may influence PET/CT utility. As breast cancers that are negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor (triple-negative breast cancer, or TNBC) are more aggressive and metastasize earlier than other breast cancers, we hypothesized that receptor expression may be one such factor. This study assesses 18F-FDG-PET/CT for systemic staging of newly diagnosed TNBC.

Methods

In this Institutional Review Board-approved retrospective study, our Healthcare Information System was screened for patients with TNBC who underwent 18F-FDG-PET/CT in 2007–2013 prior to systemic or radiation therapy. Initial stage was determined from mammography, ultrasound, magnetic resonance imaging, and/or surgery, if performed prior to 18F-FDG-PET/CT. 18F-FDG-PET/CT was evaluated to identify unsuspected extra-axillary regional nodal and distant metastases, as well as unsuspected synchronous malignancies. Kaplan Meier survival estimates were calculated for initial stage IIB patients stratified by whether or not stage 4 disease was detected by 18F-FDG-PET/CT.

Results

A total of 232 patients with TNBC met inclusion criteria. 18F-FDG-PET/CT revealed unsuspected distant metastases in 30 (13 %): 0/23 initial stage I, 4/82 (5 %) stage IIA, 13/87 (15 %) stage IIB, 4/23 (17 %) stage IIIA, 8/14 (57 %) stage IIIB, and 1/3 (33 %) stage IIIC. Twenty-six of 30 patients upstaged to IV by 18F-FDG-PET/CT were confirmed by pathology, with the remaining four patients confirmed by follow-up imaging. In addition, seven unsuspected synchronous malignancies were identified in six patients. Initial stage 2B patients who were upstaged to 4 by 18F-FDG-PET/CT had significantly shorter survival compared to initial stage 2B patients who were not (3-year Kaplan Meier estimate 0.33, 95 % CI 0.13-0.55 versus 0.97, CI 0.76-0.93, p < .0001).

Conclusion

F-FDG-PET/CT revealed distant metastases in 15 % of patients with stage IIB TNBC. Stage IIB patients upstaged to 4 by 18F-FDG-PET/CT had significantly shorter survival than those who were not, consistent with 18F-FDG-PET/CT detecting an increased burden of disease. This study provides further evidence that populations of patients with stage IIB breast cancer, such as TNBC, should be considered for systemic staging with 18F-FDG-PET/CT at the time of initial diagnosis.

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