The role of FDG PET/CT in patients with locoregional breast cancer recurrence: A comparison to conventional imaging techniques

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Abstract

Purpose

The aim of this study was to evaluate the impact of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) on clinical management in patients with locoregional breast cancer recurrence amenable for locoregional treatment and to compare the PET/CT results with the conventional imaging data.

Patients and methods

From January 2006 to August 2008, all patients with locoregional breast cancer recurrence underwent whole-body PET/CT. PET/CT findings were compared with results of the conventional imaging techniques and final pathology. The impact of PET/CT results on clinical management was evaluated based on clinical decisions obtained from patient files.

Results

56 patients were included. In 32 patients (57%) PET/CT revealed additional tumour localisations. Distant metastases were detected in 11 patients on conventional imaging and in 23 patients on PET/CT images (p < 0.01). In 25 patients (45%), PET/CT detected additional lesions not visible on conventional imaging. PET/CT had an impact on clinical management in 27 patients (48%) by detecting more extensive locoregional disease or distant metastases. In 20 patients (36%) extensive surgery was prevented and treatment was changed to palliative treatment. The sensitivity, specificity, accuracy, positive and negative predictive values of FDG PET/CT were respectively 97%, 92%, 95%, 94% and 96%.

Conclusions

PET/CT, in addition to conventional imaging techniques, plays an important role in staging patients with locoregional breast cancer recurrence since its result changed the clinical management in almost half of the patients. PET/CT could potentially replace conventional staging imaging in patients with a locoregional breast cancer recurrence.

Introduction

Locoregional breast cancer recurrence occurs in about 10% of all breast cancer patients,1 with a 5-year survival rate of approximately 60%.2 Curative local treatment remains an option if the recurrence is truly locoregional. Even patients with locally advanced breast cancer recurrences can be treated with lasting local control, provided that there are no distant metastases.3 Therefore, adequate and accurate staging of the recurrence is imperative for optimal treatment of these patients.

At the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital (NKI/AVL) conventional staging procedures in patients with locoregional breast cancer recurrence generally consists of physical examination to evaluate the local-regional situation, magnetic resonance imaging-scan (MRI) for local-regional evaluation and a chest radiograph, liver ultrasound or computed tomography (CT) scan and a bone scan, to diagnose potential distant metastases. With these conventional imaging techniques, approximately 10% of the patients will show overt distant metastases at the time of diagnosis of the locoregional breast cancer recurrence.4, 5 However, the performance of this diagnostic strategy appears to be suboptimal since approximately 40% of patients will be diagnosed with distant metastases within 5 years.2, 5, 6, 7

18F-fluorodeoxyglucose positron-emission tomography (FDG PET) was found to be a sensitive modality in the assessment of breast cancer recurrence with a sensitivity ranging from 89 to 100%.8, 9, 10, 11 Unfortunately the lack of anatomic information of FDG PET alone may affect its specificity.12, 13 The recently introduced integrated PET/CT can provide both morphologic and metabolic information, by combining anatomic CT data and functional FDG PET data. Since FDG PET/CT is not organ specific and provides a whole-body overview, it can potentially replace the array of conventional imaging.

This retrospective study evaluates the diagnostic performance of FDG PET/CT, compared to conventional imaging techniques, and evaluates the impact of these results on clinical management of patients with a confirmed locoregional breast cancer recurrence.

Section snippets

Patients

From January 2006 until August 2008, 56 patients underwent total body FDG PET/CT imaging because of a confirmed locoregional breast cancer recurrence at the NKI-AVL. All recurrences were confirmed by fine needle aspiration or core needle biopsy. Because extensive locoregional surgery was deemed necessary, patients were referred to visualise the extent of the recurrence and to exclude metastatic disease. The patient's age and tumour stage at primary diagnosis of breast carcinoma, the initial

Patient characteristics

The median age at the time of primary breast carcinoma was 48 years (range 27–74). The median time to recurrence was 4.0 years (range 0.4–17.8 years). The characteristics of the original primary tumours and the initial treatments are summarized in Table 1.

Conventional imaging

Besides FDG PET/CT imaging, 21 patients underwent MRI of the chest, 32 patients underwent chest radiography, 20 patients underwent a diagnostic CT of the chest, 35 patients underwent bone scintigraphy and 30 patients underwent ultrasound of

Discussion

Patients with locoregional breast cancer recurrence can be treated adequately with surgery. The clinical management and prognosis of these patients are mainly based on the extent of the locoregional recurrence and the presence of distant metastases.2, 3, 14, 15 Therefore, accurate staging is essential for surgical treatment of patients with a locoregional recurrence.

The sensitivity of conventional imaging techniques for the detection of distant metastases in breast cancer patients ranges from

Conflict of interest statement

The authors declare no conflict of interest.

References (29)

  • A.C. Voogd et al.

    Local recurrence after breast conservation therapy for early stage breast carcinoma: detection, treatment, and outcome in 266 patients. Dutch study group on local recurrence after breast conservation (BORST)

    Cancer

    (1999)
  • H.J. Gallowitsch et al.

    F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging

    Invest Radiol

    (2003)
  • D. Grahek et al.

    [18F]-FDG in recurrent breast cancer: diagnostic performances, clinical impact and relevance of induced changes in management

    Eur J Nucl Med Mol Imaging

    (2004)
  • C.R. Isasi et al.

    A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases

    Breast Cancer Res Treat

    (2005)
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