PET/CT successful in staging advanced breast cancer cases

FDG-PET/CT is more successful than other staging modalities in staging patients with locally advanced breast cancer, according to a study in the January issue of the Journal of Nuclear Medicine.

In the study, researchers prospectively studied 117 patients with locally advanced breast cancer over a five-year period. The patients underwent conventional imaging such as bone scanning, chest radiography, dedicated CT, abdominopelvic sonography and contrast-enhanced CT. They then underwent an 18F-FDG PET/CT scan, after which the imaging results were compared.

According to the study, FDG PET/CT identified all primary tumors and confirmed lymph node involvement in stage IIIC patients, and revealed unsuspected lymph node involvement in 32 additional patients. In addition, FDG PET/CT visualized distant metastases in 43 patients compared to conventional imaging, which only identified 28 patients with distant metastases. Overall, the use of FDG PET/CT changed the clinical staging of 61 patients.

National Comprehensive Cancer Network guidelines recommend physical examination, bilateral mammogram, sonography or breast magnetic resonance imaging to examine the breast, as well as chest diagnostic CT, abdominal or pelvic diagnostic CT or MR imaging and bone scanning for evaluation of distant involvement, while it considers FDG PET/CT to be useful in circumstances that are "equivocal or suspicious."

But 18F-FDG PET/CT could become the first line imaging study for distant staging, rather than an optional study to be used in the case of ambiguous findings from conventional staging modalities, lead study author David Groheux, M.D., of the Department of Nuclear Medicine at Saint-Louis Hospital in Paris, told DOTmed News.

"This is a step toward the truly personalized medicine that molecular imaging can bring -- acquiring an image that provides sufficient information to truly tailor management strategies to the singular needs of each patient," Groheux said in an announcement. "Based on these findings, 18F-FDG PET/CT may become the single most important distant staging modality in patients with locally advanced breast cancer."

For more:
- see the study abstract
- see the story in DOTmed News
- read the announcement