title: ¹⁸F-FDG PET/CT provides powerful prognostic stratification in the primary staging of large breast cancer when compared with conventional explorations.
abstract: OBJECTIVE
  The objective of this study was to assess the impact on management and the prognostic value of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for initial staging of newly diagnosed large breast cancer (BC) when compared with conventional staging.
  
  
  METHODS
  We prospectively included 142 patients with newly diagnosed BC and at least grade T2 tumour. All patients were evaluated with complete conventional imaging (CI) procedures (mammogram and/or breast ultrasound, bone scan, abdominal ultrasound and/or CT, X-rays and/or CT of the chest), followed by FDG PET/CT exploration, prior to treatment. The treatment plan based on CI staging was compared with that based on PET/CT findings. CI and PET/CT findings were confirmed by imaging and clinical follow-up and/or pathology when assessable. Progression-free survival (PFS) was analysed using the Cox proportional hazards regression model.
  
  
  RESULTS
  According to CI staging, 79 patients (56%) were stage II, 46 (32%) stage III and 17 (12%) stage IV (distant metastases). Of the patients, 30 (21%) were upstaged by PET/CT, including 12 (8%) from stage II or III to stage IV. On the other hand, 23 patients (16%) were downstaged by PET/CT, including 4 (3%) from stage IV to stage II or III. PET/CT had a high or medium impact on management planning for 18 patients (13%). Median follow-up was 30 months (range 9-59 months); 37 patients (26%) experienced recurrence or progression of disease during follow-up and 17 patients (12%) died. The Cox model indicated that CI staging was significantly associated with PFS (p = 0.01), but PET/CT staging provided stronger prognostic stratification (p < 0.0001). Moreover, Cox regression multivariate analysis showed that only PET/CT staging remained associated with PFS (p < 0.0001).
  
  
  CONCLUSIONS
  FDG PET/CT provides staging information that more accurately stratifies prognostic risk in newly diagnosed large BC when compared with conventional explorations alone.
authors.affiliation: Department of Nuclear Medicine, Centre Georges-François Leclerc, 1 rue Professeur Marion, 21079, Dijon Cedex, France, acochet@cgfl.fr.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Cochet
authors.forename: Inna
authors.initials: I
authors.lastname: Dygai-Cochet
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Riedinger
authors.forename: Olivier
authors.initials: O
authors.lastname: Humbert
authors.forename: Alina
authors.initials: A
authors.lastname: Berriolo-Riedinger
authors.forename: Michel
authors.initials: M
authors.lastname: Toubeau
authors.forename: Séverine
authors.initials: S
authors.lastname: Guiu
authors.forename: Charles
authors.initials: C
authors.lastname: Coutant
authors.forename: Bruno
authors.initials: B
authors.lastname: Coudert
authors.forename: Pierre
authors.initials: P
authors.lastname: Fumoleau
authors.forename: François
authors.initials: F
authors.lastname: Brunotte
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002277:Carcinoma / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18