Role of F-18 FDG PET/CT in Patients with Suspected Recurrent Breast  Cancer: Additional Value over Conventional Imaging Modalities

Mehrdad Bakhshayeshkaram; Farahnaz Aghahosseini; Sara Alavinejad; Yalda Salehi; Sharareh Seifi; Maryam Hassanzad

doi:10.32768/abc.20218288-93

Mehrdad Bakhshayeshkaram ⁽¹⁾, Farahnaz Aghahosseini ⁽²⁾, Sara Alavinejad ⁽³⁾, Yalda Salehi ⁽⁴⁾, Sharareh Seifi ⁽⁵⁾, Maryam Hassanzad ⁽⁶⁾

(1) Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Tehran, Iran, Iran, Islamic Republic of,

(2) Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Tehran, Iran, Iran, Islamic Republic of,

(3) Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Tehran, Iran, Iran, Islamic Republic of,

(4) Department of Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran, Iran, Islamic Republic of,

(5) Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Tehran, Iran, Iran, Islamic Republic of,

(6) Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran AND Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Tehran, Iran, Iran, Islamic Republic of

https://doi.org/10.32768/abc.20218288-93

Issue
Vol 8, No 2: May 2021

Submitted
November 30, 2020

Published
April 15, 2021

Keywords:

F-18 FDG PET/CT, Recurrence, Breast Cancer, Conventional Imaging

PDF XML

Abstract

Background: The aim of the present study was to investigate the added value of F-18 fludeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) compared with conventional imaging modalities for the evaluation of locoregional and distant sites of recurrence in breast cancer patients.
Methods: From May 2013 to September 2016, 109 patients with suspected recurrent breast cancer who underwent conventional imaging and F-18 FDG PET/CT with an interval of 6 weeks were consecutively enrolled (mean age: 52.66 years; range: 29?79). Histopathologic results and clinical follow up based on the gold-standard imaging modality or serial imaging were considered as the reference for verification of F-18 FDG PET/CT findings.
Results: Of 109 patients, 81 were found to have at least one site of recurrence (74.31%). Local recurrence was correctly identified in 32/32 patients following PET/CT, which was higher than that on conventional imaging (20/32, 62.5%). PET/CT detected 27 additional nodal metastases compared with conventional imaging (59 vs. 32, 45.76%), most frequently in the hilar/mediastinal region (n=27), followed by the supraclavicular lymph nodes (n=20, 62.5%), internal mammary lymph nodes (n=6, 18.77%), and axillary basin (n=6, 18.77%). Additional sites of distant metastasis were identified in 41 patients (37.61%) following F-18 FDG PET/CT imaging, 48.78% of which were localized in the skeletal system (n=20), 21.95% in the liver (n=9), 12.19% in the lungs (n=5), 12.19% in the brain (n=5), and 4.87% in the adrenal glands (n=2).
Conclusion: F-18 FDG PET/CT serves as a useful supplement to conventional imaging techniques by identifying additional sites of disease recurrence in patients with breast cancer, which may change the preferred treatment strategy, particularly in regions that are not routinely evaluated by conventional imaging.

Full text article

Generated from XML file

References

Cardoso F, Harbeck N, Fallowfield L, Kyriakides S, Senkus E. ESMO Guidelines Working Group: Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(7).

Christiansen P, Al-Suliman N, Bjerre K, Møller S. Recurrence pattern and prognosis in low-risk breast cancer patients–data from the DBCG 89-A programme. Acta oncologica. 2008;47(4): 691-703.

Gerber B, Freund M, Reimer T. Recurrent breast cancer: treatment strategies for maintaining and prolonging good quality of life. Deutsches Arzteblatt international. 2010;107(6):85.

Colzani E, Johansson A, Liljegren A, Foukakis T, Clements M, Adolfsson J, et al. Time-dependent risk of developing distant metastasis in breast cancer patients according to treatment, age and tumour characteristics. British journal of cancer. 2014;110(5):1378-84.

Cancer NCCf. Advanced breast cancer: diagnosis and treatment. 2009.

Khatcheressian JL, Hurley P, Bantug E, Esserman LJ, Grunfeld E, Halberg F, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol [internet]. 2012.

Preda L, Villa G, Rizzo S, Bazzi L, Origgi D, Cassano E, et al. Magnetic resonance mammo-graphy in the evaluation of recurrence at the prior lumpectomy site after conservative surgery and radiotherapy. Breast Cancer Research. 2006;8(5):1-9.

Yang S, Liang J, Lin F, Kao C, Lin C, Lee C. Comparing whole body 18 F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphonate bone scan to detect bone metastases in patients with breast cancer. Journal of cancer research and clinical oncology. 2002;128(6):325-8.

Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN, Ueno NT. Bone imaging in metastatic breast cancer. Journal of Clinical Oncology. 2004;22(14):2942-53.

Schirrmeister H. Detection of bone metastases in breast cancer by positron emission tomography. Radiologic clinics of North America. 2007;45(4):669-76.

Edinburgh RCoPo, Committee AoRSA. Evidence-based indications for the use of PET-CT in the United Kingdom 2016. Clinical radiology. 2016;71(7):e171-e88.

Aukema TS, Rutgers ET, Vogel WV, Teertstra HJ, Oldenburg HS, Peeters MV, et al. The role of FDG PET/CT in patients with locoregional breast cancer recurrence: a comparison to conventional imaging techniques. European Journal of Surgical Oncology (EJSO). 2010;36(4):387-92.

Eubank WB, Mankoff D, Bhattacharya M, Gralow J, Linden H, Ellis G, et al. Impact of FDG PET on defining the extent of disease and on the treatment of patients with recurrent or metastatic breast cancer. American Journal of Roentgenology. 2004;183(2):479-86.

Heindel W, Gübitz R, Vieth V, Weckesser M, Schober O, Schäfers M. The diagnostic imaging of bone metastases. Deutsches Ärzteblatt International. 2014;111(44):741.

Morris PG, Lynch C, Feeney JN, Patil S, Howard J, Larson SM, et al. Integrated positron emission tomography/computed tomography may render bone scintigraphy unnecessary to investigate suspected metastatic breast cancer. Journal of clinical oncology. 2010;28(19):3154.

Kinkel K, Lu Y, Both M, Warren RS, Thoeni RF. Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology. 2002;224(3):748-56.

Bipat S, van Leeuwen MS, Comans EF, Pijl ME, Bossuyt PM, Zwinderman AH, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis. Radiology. 2005;237(1):123-31.

Grassetto G, Fornasiero A, Bonciarelli G, Banti E, Rampin L, Marzola MC, et al. Additional value of FDG-PET/CT in management of “solitary” liver metastases: preliminary results of a prospective multicenter study. Molecular imaging and biology. 2010;12(2):139-44.

Lee YTN. Breast carcinoma: pattern of metastasis at autopsy. Journal of surgical oncology. 1983;23(3):175-80.

Kitajima K, Nakamoto Y, Okizuka H, Onishi Y, Senda M, Suganuma N, et al. Accuracy of whole-body FDG-PET/CT for detecting brain metastases from non-central nervous system tumors. Annals of nuclear medicine. 2008;22(7): 595-602.

Hjorthaug K, Højbjerg JA, Knap MM, Tietze A, Haraldsen A, Zacho HD, et al. Accuracy of 18F-FDG PET-CT in triaging lung cancer patients with suspected brain metastases for MRI. Nuclear medicine communications. 2015;36(11):1084-90.