title: Whole-body FDG PET/CT is more accurate than conventional imaging for staging primary breast cancer patients.
abstract: OBJECTIVE
  This retrospective study aimed (1) to compare the diagnostic accuracy of whole-body FDG PET/CT for initial breast cancer staging with the accuracy of a conventional, multimodal imaging algorithm, and (2) to assess potential alteration in patient management based on the FDG PET/CT findings.
  
  
  METHODS
  Patients with primary breast cancer (106 women, mean age 57 ± 13 years) underwent whole-body FDG PET/CT and conventional imaging (X-ray mammography, MR mammography, chest plain radiography, bone scintigraphy and breast, axillary and liver ultrasonography). The diagnostic accuracies of FDG PET/CT and a conventional algorithm were compared. Diagnostic accuracy was assessed in terms of primary tumour detection rate, correct assessment of primary lesion focality, T stage and the detection rates for lymph node and distant metastases. Histopathology, imaging or clinical follow-up served as the standards of reference.
  
  
  RESULTS
  FDG PET/CT was significantly more accurate for detecting axillary lymph node and distant metastases (p = 0.0125 and p < 0.005, respectively). No significant differences were detected for other parameters. Synchronous tumours or locoregional extraaxillary lymph node or distant metastases were detected in 14 patients (13%) solely by FDG PET/CT. Management of 15 patients (14%) was altered based on the FDG PET/CT findings, including 3 patients with axillary lymph node metastases, 5 patients with extraaxillary lymph node metastases, 4 patients with distant metastases and 3 patients with synchronous malignancies.
  
  
  CONCLUSIONS
  Full-dose, intravenous contrast-enhanced FDG PET/CT was more accurate than conventional imaging for initial breast cancer staging due to the higher detection rate of metastases and synchronous tumours, although the study had several limitations including a retrospective design, a possible selection bias and a relevant false-positive rate for the detection of axillary lymph node metastases. FDG PET/CT resulted in a change of treatment in a substantial proportion of patients.
authors.affiliation: Medical Faculty, Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, 40225 Dusseldorf, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Riegger
authors.forename: J
authors.initials: J
authors.lastname: Herrmann
authors.forename: J
authors.initials: J
authors.lastname: Nagarajah
authors.forename: J
authors.initials: J
authors.lastname: Hecktor
authors.forename: S
authors.initials: S
authors.lastname: Kuemmel
authors.forename: F
authors.initials: F
authors.lastname: Otterbach
authors.forename: S
authors.initials: S
authors.lastname: Hahn
authors.forename: A
authors.initials: A
authors.lastname: Bockisch
authors.forename: T
authors.initials: T
authors.lastname: Lauenstein
authors.forename: G
authors.initials: G
authors.lastname: Antoch
authors.forename: T A
authors.initials: TA
authors.lastname: Heusner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging
chemical_list: D019788:Fluorodeoxyglucose F18