title: 18F-FDG PET/CT in staging patients with locally advanced or inflammatory breast cancer: comparison to conventional staging.
abstract: The prognosis of patients with locally advanced breast cancer (LABC) remains poor. We prospectively investigated the impact of (18)F-FDG PET/CT at initial staging in this clinical setting and compared PET/CT performance with that of conventional distant work-up.
  
  
  METHODS
  During 60 mo, consecutive patients with LABC (clinical T4 or N2-N3 disease) underwent (18)F-FDG PET/CT. The yield was assessed in the whole group and separately for noninflammatory and inflammatory cancer. The performance of PET/CT was compared with that of a conventional staging approach including bone scanning, chest radiography, or dedicated CT and abdominopelvic sonography or contrast-enhanced CT.
  
  
  RESULTS
  117 patients with inflammatory (n = 35) or noninflammatory (n = 82) LABC were included. (18)F-FDG PET/CT confirmed N3 nodal involvement in stage IIIC patients and revealed unsuspected N3 nodes (infraclavicular, supraclavicular, or internal mammary) in 32 additional patients. Distant metastases were visualized on PET/CT in 43 patients (46% of patients with inflammatory carcinoma and 33% of those with noninflammatory LABC). Overall, (18)F-FDG PET/CT changed the clinical stage in 61 patients (52%). Unguided conventional imaging detected metastases in only 28 of the 43 patients classified M1 with PET/CT (65%). (18)F-FDG PET/CT outperformed conventional imaging for bone metastases, distant lymph nodes, and liver metastases, whereas CT was more sensitive for lung metastases. The accuracy in diagnosing bone lesions was 89.7% for planar bone scanning versus 98.3% for (18)F-FDG PET/CT. The accuracy in diagnosing lung metastases was 98.3% for dedicated CT versus 97.4% for (18)F-FDG PET/CT.
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT had the advantage of allowing chest, abdomen and bone to be examined in a single session. Almost all distant lesions detected by conventional imaging were depicted with PET/CT, which also showed additional lesions.
authors.affiliation: Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France. dgroheux@yahoo.fr
authors.forename: David
authors.initials: D
authors.lastname: Groheux
authors.forename: Sylvie
authors.initials: S
authors.lastname: Giacchetti
authors.forename: Marc
authors.initials: M
authors.lastname: Delord
authors.forename: Elif
authors.initials: E
authors.lastname: Hindié
authors.forename: Laetitia
authors.initials: L
authors.lastname: Vercellino
authors.forename: Caroline
authors.initials: C
authors.lastname: Cuvier
authors.forename: Marie-Elisabeth
authors.initials: ME
authors.lastname: Toubert
authors.forename: Pascal
authors.initials: P
authors.lastname: Merlet
authors.forename: Christophe
authors.initials: C
authors.lastname: Hennequin
authors.forename: Marc
authors.initials: M
authors.lastname: Espié
mesh_terms: D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D064847:Multimodal Imaging / Q000379:methods*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18