title: Early detection of metastatic disease in asymptomatic breast cancer patients with whole-body imaging and defined tumour marker increase.
abstract: BACKGROUND
  Follow-up care in breast cancer is still an issue of debate. Diagnostic methods are more sensitive, and more effective therapeutic options are now available. The risk of recurrence is not only influenced by tumour stage but also by the different molecular subtypes. This study was performed to evaluate the use of whole-body imaging combined with tumour marker monitoring for the early detection of asymptomatic metastatic breast cancer (MBC).
  
  
  METHODS
  This analysis was performed as part of a follow-up study evaluating 813 patients with a median follow-up of 63 months. After primary therapy, all patients underwent tumour marker monitoring for CEA, CA 15-3 and CA 125 at 6-week intervals within an intensified diagnostic aftercare algorithm. A reproducible previously defined increase was considered as a strong indicator of MBC. From 2007 to 2010, 44 patients with tumour marker increase underwent whole-body magnetic resonance imaging and/or an FDG-PET/CT scan. Histological clarification and/or imaging follow-up were done.
  
  
  RESULTS
  Metastases were detected in 65.9% (29/44) of patients, 13.6% (6/44) had secondary malignancies besides breast cancer and 20.5% (9/44) had no detectable malignancy. Limited disease was found in 24.1% (7/29) of patients. Median progression-free survival of MBC was 9.2 months and median overall survival was 41.1 months. The 3- and 5-year survival rates were 64.2% and 40.0%, respectively.
  
  
  CONCLUSIONS
  A reproducible tumour marker increase followed by whole-body imaging is highly effective for early detection. By consequence, patients might benefit from earlier detection and improved therapeutic options with a prolonged survival.
authors: Department of Internal Medicine III, University Hospital Munich-Grosshadern, 81377 Munich, Germany.
authors: D
authors: D
authors: Di Gioia
authors: Institute of Clinical Chemistry, University Hospital Munich-Grosshadern, 81377 Munich, Germany.
authors: P
authors: P
authors: Stieber
authors: Institute of Clinical Radiology, University Hospital Munich-Grosshadern, 81377 Munich, Germany.
authors: G P
authors: GP
authors: Schmidt
authors: Institute of Clinical Chemistry, University Hospital Munich-Grosshadern, 81377 Munich, Germany.
authors: D
authors: D
authors: Nagel
authors: Department of Internal Medicine III, University Hospital Munich-Grosshadern, 81377 Munich, Germany.
authors: V
authors: V
authors: Heinemann
authors: Institute of Clinical Radiology, University Hospital Munich-Grosshadern, 81377 Munich, Germany.
authors: A
authors: A
authors: Baur-Melnyk
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D014408:Biomarkers, Tumor
references: Breast Cancer Res Treat. 1995;36(1):41-8
references: 7579505
references: J Nucl Med. 2009 May;50 Suppl 1:122S-50S
references: 19403881
references: J Clin Oncol. 2010 Jul 10;28(20):3271-7
references: 20498394
references: Breast Cancer. 2012 Jul;19(3):218-37
references: 22532161
references: N Engl J Med. 2012 Jan 12;366(2):109-19
references: 22149875
references: Q J Nucl Med. 2002 Jun;46(2):113-21
references: 12114874
references: Acta Radiol. 2012 Feb 1;53(1):12-6
references: 22067206
references: Radiology. 2004 Oct;233(1):139-48
references: 15317952
references: J Natl Cancer Inst. 2010 Apr 7;102(7):456-63
references: 20220104
references: JAMA. 1994 May 25;271(20):1587-92
references: 8182811
references: Br J Cancer. 1991 Jul;64(1):154-8
references: 1854615
references: Eur Radiol. 1998;8(8):1345-51
references: 9853211
references: J Natl Compr Canc Netw. 2014 Jan;12(1):71-80
references: 24453294
references: Biomed Pharmacother. 2003 Dec;57(10):452-9
references: 14637388
references: Breast Cancer. 2001;8(3):206-12
references: 11668242
references: Clin Lab. 2003;49(1-2):15-24
references: 12593471
references: J Clin Oncol. 2013 Sep 1;31(25):3083-90
references: 23897954
references: Tumour Biol. 2005 Nov-Dec;26(6):281-93
references: 16254457
references: JAMA. 1994 May 25;271(20):1593-7
references: 7848404
references: Eur J Radiol. 2010 Feb;73(2):294-9
references: 19181468
references: Radiology. 1991 Aug;180(2):319-22
references: 2068292
references: AJR Am J Roentgenol. 2003 Sep;181(3):809-17
references: 12933487
references: Lancet. 2005 May 14-20;365(9472):1687-717
references: 15894097
references: J Clin Oncol. 1987 Jan;5(1):55-61
references: 3806159
references: J Clin Oncol. 1995 Jan;13(1):8-10
references: 7799047
references: Radiology. 2001 Jul;220(1):145-9
references: 11425987
references: Eur Radiol. 2004 Jan;14(1):99-105
references: 12845463
references: Invest Radiol. 2003 May;38(5):250-6
references: 12750613
references: MMW Fortschr Med. 2005 May 19;147(20):35, 37-9
references: 15957858
references: Yonsei Med J. 2014 May;55(3):558-62
references: 24719119
references: Ann Oncol. 2002 Feb;13(2):197-207
references: 11885995
references: Radiology. 2004 Nov;233(2):400-9
references: 15459328
references: J Clin Oncol. 2004 Aug 15;22(16):3302-8
references: 15310773
references: ORL J Otorhinolaryngol Relat Spec. 2000 Jul-Aug;62(4):186-98
references: 10859519
references: CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
references: 15761078
references: Breast J. 2013 Mar-Apr;19(2):149-55
references: 23350584
references: Breast Cancer. 2012 Jul;19(3):200-5
references: 21491123
references: J Clin Oncol. 2013 Mar 1;31(7):961-5
references: 23129741
references: Clin Nucl Med. 2007 Jun;32(6):429-34
references: 17515747
references: J Cancer Res Clin Oncol. 2013 Sep;139(9):1569-77
references: 23892409
references: AJR Am J Roentgenol. 1985 Feb;144(2):261-5
references: 3871268
references: Hepatogastroenterology. 2002 Nov-Dec;49(48):1597-601
references: 12397744
references: N Engl J Med. 2012 Feb 9;366(6):520-9
references: 22149876
references: Anticancer Res. 1999 Jul-Aug;19(4A):2551-5
references: 10470193
references: Breast. 2005 Apr;14(2):87-93
references: 15767177
references: Int J Biol Markers. 1992 Jul-Sep;7(3):160-6
references: 1431339
references: Eur J Nucl Med Mol Imaging. 2010 Jan;37(1):181-200
references: 19915839
references: J Clin Oncol. 2008 Oct 20;26(30):4891-8
references: 18725649
references: Cancer. 2006 Dec 1;107(11):2545-51
references: 17063499