title: Retrospective analysis of 18F-FDG PET/CT for staging asymptomatic breast cancer patients younger than 40 years.
abstract: National Comprehensive Cancer Network guidelines consider (18)F-FDG PET/CT for only clinical stage III breast cancer patients. However, there is debate whether TNM staging should be the only factor in considering if PET/CT is warranted. Patient age may be an additional consideration, because young breast cancer patients often have more aggressive tumors with potential for earlier metastases. This study assessed PET/CT for staging of asymptomatic breast cancer patients younger than 40 y.
  
  
  METHODS
  In this Institutional Review Board-approved retrospective study, our hospital information system was screened for breast cancer patients younger than 40 y who underwent staging PET/CT before any treatment. Patients with symptoms or conventional imaging findings suggestive of distant metastases or with prior malignancy were excluded. Initial stage was based on physical examination, mammography, ultrasound, and breast MR imaging. PET/CT was then evaluated to identify unsuspected extraaxillary regional nodal and distant metastases.
  
  
  RESULTS
  One hundred thirty-four patients with initial breast cancer stage I to IIIC met inclusion criteria. PET/CT findings led to upstaging to stage III or IV in 28 patients (21%). Unsuspected extraaxillary regional nodes were found in 15 of 134 patients (11%) and distant metastases in 20 of 134 (15%), with 7 of 134 (5%) demonstrating both. PET/CT revealed stage IV disease in 1 of 20 (5%) patients with initial clinical stage I, 2 of 44 (5%) stage IIA, 8 of 47 (17%) stage IIB, 4 of 13 (31%) stage IIIA, 4 of 8 (50%) stage IIIB, and 1 of 2 (50%) stage IIIC. All 20 patients upstaged to stage IV were histologically confirmed. Four synchronous thyroid and 1 rectal malignancies were identified.
  
  
  CONCLUSIONS
  PET/CT revealed distant metastases in 17% of asymptomatic stage IIB breast cancer patients younger than 40 y. Although guidelines of the National Comprehensive Cancer Network recommend against systemic staging in patients with stage II disease, our data suggest that PET/CT might be valuable in younger patients with stage IIB and III disease. Use of PET/CT in younger patients has the potential to reduce the morbidity and cost of unnecessary therapies in young breast cancer patients.
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Riedl
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Elina
authors.initials: E
authors.lastname: Slobod
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York Department of Radiology, Weill Cornell Medical College, New York, New York.
authors.forename: Maxine
authors.initials: M
authors.lastname: Jochelson
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; and.
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Goldman
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York Department of Radiology, Weill Cornell Medical College, New York, New York.
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Weber
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York Department of Radiology, Weill Cornell Medical College, New York, New York ulanerg@mskcc.org.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ulaner
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008327:Mammography / Q000379:methods; D064847:Multimodal Imaging / Q000379:methods; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: FDG; PET; breast cancer; metastases; staging