title: Role of 18F-FDG PET/CT in identifying distant metastatic disease missed by conventional imaging in patients with locally advanced breast cancer.
abstract: OBJECTIVE
  This study was conducted to evaluate the role of (18)F-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography (CT) in identifying missed distant metastases in patients with locally advanced breast cancer (LABC) who were assessed by conventional imaging methods.
  
  
  METHODS
  Forty-three consecutive patients with histopathologically proven LABC with negative conventional imaging results for distant metastases were included in the study. All of them underwent (18)F-FDG PET/CT within a week after conventional imaging.
  
  
  RESULTS
  (18)F-FDG PET/CT findings suggestive of distant metastases were noted in 11/43 patients, and 10 of them were confirmed to have true-positive distant metastatic disease on clinical follow-up of 6 months. None of the patients with negative (18)F-FDG PET/CT for distant metastases developed distant metastases during the follow-up. (18)F-FDG PET/CT had a sensitivity, specificity, positive predictive value, and negative predictive value of 100, 96.8, 91, and 100%, respectively, for identifying distant metastases missed by conventional imaging. In addition, (18)F-FDG PET/CT suggested previously unknown lymph nodal metastases in 16/43 (37%) patients. Change in stage was noticed in 17/43 (39.5%) patients.
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT is a sensitive and specific imaging modality for identifying distant metastases in patients with LABC missed by conventional imaging. In addition, it detects unknown lymph nodal metastases in a significant proportion of patients and hence can be used routinely in staging of patients with LABC.
authors.affiliation: Department of Nuclear Medicine and PET and General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Kuruva
authors.initials: K
authors.lastname: Manohar
authors.forename: Bhagwant R
authors.initials: BR
authors.lastname: Mittal
authors.forename: Amit
authors.initials: A
authors.lastname: Bhoil
authors.forename: Anish
authors.initials: A
authors.lastname: Bhattacharya
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005188:False Negative Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18