title: 18F-2-fluoro-2-deoxy-d-glucose positron emission tomography in staging of locally advanced breast cancer.
abstract: OBJECTIVE
  To prospectively evaluate the effect of adding whole-body (18)F-2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) to conventional screening for distant metastases in patients with locally advanced breast cancer (LABC).
  
  
  METHODS
  All women with LABC referred for participation in the LABC Spinoza trial were considered eligible for this study. Patients were included if chest x-ray, bone scan, liver ultrasound, or computed tomography scan performed by the referring physician failed to reveal distant metastases. They underwent whole-body FDG PET scanning before therapy. Patients with subsequently proven distant metastases were switched to alternative forms of chemotherapy, hormonal therapy, or both.
  
  
  RESULTS
  Among the 48 patients evaluated with PET, 14 had abnormal FDG uptake, and metastases were suspected in 12. After simple clinical evaluation (plain x-ray, history), 10 sites that were suggestive of abnormality remained. Further work-up revealed that four sites were metastases. Proven false positivity occurred in one patient with sarcoidosis. In the other five patients, the reason for abnormal FDG uptake (liver, lung, bone) remained unclear, and patients were treated as planned. Eleven months later, distant metastases were found in one patient at sites unrelated to the previous FDG uptake.
  
  
  CONCLUSIONS
  The addition of FDG PET to the standard work-up of patients with LABC may lead to the detection of unexpected distant metastases. This may contribute to a more realistic stratification between patients with true stage III breast cancer and those who are in fact suffering from stage IV disease. Abnormal PET findings should be confirmed to prevent patients from being denied appropriate treatment.
authors.affiliation: Departments of Nuclear Medicine and PET Research,Vrije Universiteit University Medical Center, Amsterdam, the Netherlands. jjho@zha.nl
authors.forename: Jacobus J M
authors.initials: JJ
authors.lastname: van der Hoeven
authors.forename: Nanda C
authors.initials: NC
authors.lastname: Krak
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: Emile F I
authors.initials: EF
authors.lastname: Comans
authors.forename: Robert P A
authors.initials: RP
authors.lastname: Boom
authors.forename: Dick
authors.initials: D
authors.lastname: van Geldere
authors.forename: Sybren
authors.initials: S
authors.lastname: Meijer
authors.forename: Elsken
authors.initials: E
authors.lastname: van der Wall
authors.forename: Jan
authors.initials: J
authors.lastname: Buter
authors.forename: Herbert M
authors.initials: HM
authors.lastname: Pinedo
authors.forename: Gerrit J J
authors.initials: GJ
authors.lastname: Teule
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Lammertsma
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary; D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D044584:Carcinoma, Ductal / Q000000981:diagnostic imaging / Q000556:secondary; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000556:secondary; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009367:Neoplasm Staging; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18