The role of FDG-PET/CT in suspected recurrence of breast cancer.
BACKGROUND
Early diagnosis of recurrent breast cancer is crucial to selection of the most appropriate therapy. The current study evaluated the role of FDG-PET/CT in the assessment of suspected recurrent breast cancer in patients who presented with elevated serum tumor markers.


METHODS
Forty-seven consecutive FDG-PET/CT studies of 46 women (aged 32-79 years; mean, 59.9 years) with a history of breast cancer presented with elevated serum tumor markers 1-21 years (mean = 6.2 years) after their initial diagnosis and were retrospectively evaluated. PET/CT results were confirmed by pathology (n = 11), further imaging, and follow-up (mean = 17.2 months; n = 36). Changes in further management based on PET/CT were recorded.


RESULTS
Thirty (65%) patients had tumor recurrence, and 16 (35%) patients showed no further evidence of disease. Thirty-one patients had 32 abnormal PET/CT studies, and 15 patients had normal studies with an overall sensitivity, specificity, and accuracy of 90%, 71%, and 83%, respectively. In 37 patients, PET/CT was compared with contrast-enhanced CT and had a higher sensitivity (85% vs 70%), specificity (76% vs 47%), and accuracy (81% vs 59%). PET/CT had an impact on the management of 24 (5l%) patients. Of these, chemotherapy or radiotherapy was started in 16 patients, treatment was modified in 2 patients, and 6 patients were referred to biopsy, followed by referral to surgery for 2 patients.


CONCLUSIONS
In patients with breast cancer and rising tumor markers, FDG-PET/CT had high performance indices and was superior to CT for diagnosis of tumor recurrence, which led to changes in the subsequent clinical management of 51% of these patients.
Radan
Lea
L
Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.
Ben-Haim
Simona
S
Bar-Shalom
Rachel
R
Guralnik
Luda
L
Israel
Ora
O
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001943:Breast Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007457:Iodine Radioisotopes; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D014408:Biomarkers, Tumor; D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18