PET for breast cancer staging – pro

There are few reports in the literature comparing PET with conventional imaging methods for breast cancer staging or restaging. In one report, the accuracy of PET was compared with CT and MRI in 75 patients with suspected recurrent or metastatic disease. PET performed well in this small series, detecting 28 of 29 patients with lymph node disease, 15 of 15 patients with bone metastases, 5 of 6 patients with lung metastases, and 2 of 2 patients with liver metastases. PET detected 8 lymph node metastases and 7 bone metastases that were not detected by CT or MRI. Hubner et al14 found PET to have an 85% sensitivity and 73% specificity versus 71% and 54%, respectively, for CT. In another series of 57 patients, all referred because of a suspicion of disease recurrence, sensitivity and specificity of PET on a per patient basis were 93% and 79%, respectively. On a per lesion basis, the sensitivity and specificity values were 85% and 79%, respectively. A disproportionate number of false-negative exams involved osseous metastases. When only non-osseous metastases were included in the lesion analysis, the sensitivity rose to 96%. Lower sensitivity for detection of bone metastases has been noted in other series. Cook et al found that bone scintigraphy is more accurate than PET for osteoblastic bone metastases, while PET is more accurate for osteolytic metastases. It is also well established that PET is not sufficiently sensitive for detecting brain metastases. This is attributed to the high background FDG activity in cerebral gray matter, obscuring small metastases. Nevertheless, PET has generally replaced CT scans for staging and restaging, although it will likely not replace MRI of the brain and whole body bone scintigraphy for evaluating brain and bones9see MS-48).

NCCN does not specifically address PET for restaging. NCCN accepts PET for initial staging of patients with locally advanced or metastatic breast cancer  as an option.

David Groheux et al, 18F-FDG PET/CT for Staging and Restaging of Breast Cancer. J Nucl Med February 1, 2016 vol. 57 no. Supplement 1 17S-26S

NCCN, Breast Cacner 2017

Eric L. Rosen FDG PET, PET/CT, and Breast Cancer Imaging 1 October 2007 RadioGraphics, 27, S215-S229.

National Collaborating Centre for Cancer. Advanced breast cancer: diagnosis and treatment. London (UK): National Institute for Health and Clinical Excellence (NICE); 2009 Feb. 25 p. (NICE clinical guideline; no. 81).

David Mankoff Imaging in breast cancer – breast cancer imaging revisited, Breast Cancer Research 2005, 7:276-278

Benard F, Turcotte E: Imaging breast cancer with single photon computed tomography and positron emission tomography. Breast Cancer Res 2005, 7:153-162.

Bender H, Kirst J, Palmedo H, et al. Value of 18Fluoro-deoxyglucose positron emission tomography in the staging of recurrent breast carcinoma. Anticanc Res. 1997;17:1687-1692.

Hubner KF, Smith GT, Thie JA, et al. The potential of F-18-FDG PET in breast cancer: Detection of primary lesions, axillary lymph node metastases, or distant metastases. Clin Pos Imag. 2000;3:197-205.

Moon DH, Maddahi J, Silverman DHS, et al. Accuracy of whole-body fluorine-18-FDG PET for the detection of recurrent or metastatic breast carcinoma. J Nucl Med. 1998:39:431-435.

Cook GC, Houston S, Rubens R, et al. Detection of bone metastases in breast cancer by 18FDG PET: Differing metabolic activity in osteoblastic and osteolytic lesions. J Clin Oncol. 1998;16:33752379.

Griffeth LK, Rich KM, Dehdashti F, et al. Brain metastases from non-central nervous system tumors: Evaluation with PET. Radiology. 1993;186:13-15.

Participate in our Forums

To ask questions or participate in a discussion, please visit our Forums. You must LOGIN to participate.

Help Us Help Others

You can become a Site Sponsor. Or you may wish to support our work with a Donation.

Focused Articles For You

Lay Portal