The role of 18F-FDG-PET in the local/regional evaluation of women with breast cancer.
OBJECTIVE
In women with breast cancer, knowledge of the local/regional extent of the tumor is essential for staging, treatment planning, monitoring response to therapy, and follow-up. Positron emission tomography (PET) is an important imaging test which can detect tumor at multiple sites in women with breast cancer. We compared the ability of PET to provide a comprehensive view of the local/regional extent of tumor in women with stage I, II and stage III, IV breast cancer.


METHODS
Forty-six women with breast cancer underwent PET using 18F-FDG. 18FDG uptake in the breast primary tumor, associated skin, axillary and internal mammary lymph nodes, and the contralateral breast was determined qualitatively, and correlated with histologic, clinical and radiographic findings.


RESULTS
Twenty-four patients were premenopausal and 22 were postmenopausal, with the following distribution according to clinical stage: stage I--2 patients, stage II--16, stage III--16, stage IV--12 patients. Among stage I, II patients, the sensitivity for detection of the primary tumor was 83.3%, and for detection of axillary lymph node metastases was 42.9%. 18FDG-PET was negative for the breast skin, contralateral breast, and internal mammary lymph nodes in all stage I, II patients, in agreement with clinical and radiographic findings. Among 28 stage III, IV patients, the sensitivity of 18FDG-PET for detection of the primary tumor was 90.5%, and for detection of axillary lymph node metastases 83.3%. Fourteen patients had clinically advanced changes in the skin, and the sensitivity of PET for detection of skin changes was 76.9%. 18FDG-PET was positive in the internal mammary lymph nodes in 25.0%, and negative in the contralateral breast in all patients with stage III, IV breast cancer. 18FDG-PET was studied in 10 patients following neoadjuvant chemotherapy, and showed a strong correlation with clinical response, and with clinical and pathological findings post-treatment at multiple local/regional sites.


CONCLUSIONS
18FDG-PET can provide a comprehensive image of local/regional tumor in women with breast cancer. 18FDG-PET may play a greater role in women with stage III, IV breast cancer because of increased sensitivity and the increased involvement of multiple local/regional sites with tumor.
Danforth
David N
DN
Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. david.danforth@nih.gov
Aloj
Luigi
L
Carrasquillo
Jorge A
JA
Bacharach
Stephen L
SL
Chow
Cathy
C
Zujewski
JoAnne
J
Whatley
Millie
M
Galen
Barbara
B
Merino
Maria
M
Neumann
Ronald D
RD
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D014055:Tomography, Emission-Computed / Q000379:methods*; D014915:Whole-Body Counting
D001786:Blood Glucose; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18