18F-2-fluoro-2-deoxy-d-glucose positron emission tomography in staging of locally advanced breast cancer.
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.
van der Hoeven
Jacobus J M
JJ
Departments of Nuclear Medicine and PET Research,Vrije Universiteit University Medical Center, Amsterdam, the Netherlands. jjho@zha.nl
Krak
Nanda C
NC
Hoekstra
Otto S
OS
Comans
Emile F I
EF
Boom
Robert P A
RP
van Geldere
Dick
D
Meijer
Sybren
S
van der Wall
Elsken
E
Buter
Jan
J
Pinedo
Herbert M
HM
Teule
Gerrit J J
GJ
Lammertsma
Adriaan A
AA
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
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18