title: The value of 18-FDG PET/CT in early-stage breast cancer compared to traditional diagnostic modalities with an emphasis on changes in disease stage designation and treatment plan.
abstract: BACKGROUND
  Proper preoperative staging is vital in the treatment of breast cancer patients. The aim of our study was to assess the value of the diagnostic information provided by PET/CT in surgical practice in breast cancer cases considered early-stage by conventional diagnostic modalities.
  
  
  METHODS
  Whole-body 18-FDG PET/CT was performed on 115 breast cancer patients in whom traditional diagnostic modalities showed no signs of distant metastases or extensive axillary and/or extra-axillary lymphatic spreading, and the size of the primary tumor was <4 cm.
  
  
  RESULTS
  The sensitivity of PET/CT in the detection of the primary tumor was 93%. The sensitivity of the traditional diagnostic modalities in the detection of multifocality was 43.8% while that of PET/CT was 100% (p < 0.001). In the assessment of axillary lymph nodes, ultrasound had a sensitivity of 30% and a specificity of 95%. The corresponding estimates for PET/CT were 72% and 96%, respectively. PET/CT detected distant metastases in 8 patients. TNM classification was modified after PET/CT scanning in 54 patients (47%). PET/CT data changed the treatment plan established upon the results of traditional imaging modalities in 18 patients (15.6%).
  
  
  CONCLUSIONS
  PET/CT is able to assess primary tumor size and axillary lymphatic status more accurately than traditional diagnostic methods. It can detect distant metastases in 7-8% of those patients who were declared free of metastasis by clinical investigations. PET/CT scan modifies the disease stage determined by traditional diagnostic modalities in almost half of the patients and leads to a change in the treatment plan in every 6th patient.
authors.affiliation: Institute of Surgery, University of Debrecen, Medical and Health Sciences Center, Debrecen, 4032 Debrecen, Móricz Zs. krt. 22, Hungary. drgaramiz@chello.hu
authors.forename: Z
authors.initials: Z
authors.lastname: Garami
authors.forename: Z
authors.initials: Z
authors.lastname: Hascsi
authors.forename: J
authors.initials: J
authors.lastname: Varga
authors.forename: T
authors.initials: T
authors.lastname: Dinya
authors.forename: M
authors.initials: M
authors.lastname: Tanyi
authors.forename: I
authors.initials: I
authors.lastname: Garai
authors.forename: L
authors.initials: L
authors.lastname: Damjanovich
authors.forename: L
authors.initials: L
authors.lastname: Galuska
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D055088:Early Detection of Cancer; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D006814:Hungary; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18