The clinical utility of FDG-PET/CT in follow up and restaging of breast cancer patients

Abstract Background Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) is a predictor of improved outcomes in breast cancer. In patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2) -negative breast cancer, the response to NAC is variable and mostly limited. This study was an investigation of the predictive relevance of parameters of 18F-FDG PET/CT for the pCR to NAC in patients with HR-positive, HER2–negative breast cancer. Methods: AH total of 109 consecutive HR-positive and HER2-negative breast cancer patients who were treated with NAC were enrolled in this prospective cohort study. The relationships between pretreatment 18F-FDG PET/CT and clinical outcomes including pathologic response to NAC were evaluated. Results: All patients finished their planned NAC cycles and eight patients (7.3%) achieved pCR. In the receiver operating characteristic (ROC) curve analysis, pSUVmax exhibited high sensitivity and specificity for predicting pCR. Furthermore, multivariate logistic regression analysis revealed pSUVmax as a predictive factor for pCR (hazard ratio = 17.452; 95% CI = 1.847–164.892; p = 0.013). Conclusion The results of this study suggest that 18F-FDG PET/CT pSUVmax is a predictive factor for pCR of HR-positive, HER2-negative breast cancer to NAC.

Download Full-text

Diagnostic implications of a small-voxel reconstruction for loco-regional lymph node characterization in breast cancer patients using FDG-PET/CT

EJNMMI Research ◽

10.1186/s13550-018-0359-7 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 4

Author(s):

Daniëlle Koopman ◽

Jorn A. van Dalen ◽

Hester Arkies ◽

Ad H. J. Oostdijk ◽

Anne Brecht Francken ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Fdg Pet ◽

Regional Lymph Node ◽

Breast Cancer Patients ◽

Pet Ct ◽

Fdg Pet Ct

Download Full-text

0084 Selective sentinel node plus additional non-sentinel node biopsy based on an FDG-PET/CT scan in early breast cancer patients; single institutional experience

The Breast ◽

10.1016/s0960-9776(09)70126-2 ◽

2009 ◽

Vol 18 ◽

pp. S39

Author(s):

J. Kim ◽

J. Lee ◽

B. Choi ◽

Y. Kim ◽

C. Lee ◽

...

Keyword(s):

Breast Cancer ◽

Sentinel Node ◽

Cancer Patients ◽

Fdg Pet ◽

Breast Cancer Patients ◽

Node Biopsy ◽

Pet Ct ◽

Institutional Experience ◽

Fdg Pet Ct ◽

Pet Ct Scan

Download Full-text

FDG PET-CT in breast cancer: A single institution experience from India.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e11027 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e11027-e11027

Author(s):

Nalini K Rao ◽

Basavalinga S Ajaikumar ◽

Kumar G Kallur ◽

P S Sridhar ◽

Bhattacharjee Somorat ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Fdg Pet ◽

Treatment Plan ◽

Whole Body ◽

Breast Cancer Patients ◽

Term Survival ◽

New Findings ◽

Pet Ct ◽

Fdg Pet Ct

e11027 Background: Whole body FDG PET CT is a useful tool in diagnosis, staging and prognosis; and its timely use is critical for early intervention and achieving long term survival in patients with early and advanced breast cancer. Methods: In this observational retrospective study, we report FDG PET CT findings of all breast cancer patients enrolled in our hospital based cancer registry between the years 2008 to 2011. Results: One thousand and fifty three women underwent a total of 1638 scans. Two hundred and forty five scans (14.96%) were done for staging /restaging/diagnosis, 1208 (73.75%) were for response evaluation to chemotherapy and 185 (11.29%) were for surveillance. The median age at diagnosis was 53 years. We identified a possible synchronous breast primary in 28 (2.66%) women and a probable new or existing second non-breast primary in 21(1.99%) women. Internal nodal metastasis was identified in 76 (7.21%) women at diagnosis. There were 26 (2.47%) patients with multicentric tumors. There was an increased uptake in the thyroid gland in 49(2.99%) and in the adrenal in 41 (2.50%) women. There were other random ‘Incidental findings of concern’ in 7 (0.37%) of women, diagnosed either on the CT or PET-CT component. Findings on PET-CT, including- upstaging of the breast primary and unexpected new findings, unrelated to the breast primary, changed the treatment plan in approximately 7% -10% of the patients. We did find that PET-CT did not impact early tumors; however, it did contribute in, 1) the assessment of internal mammary nodes, 2) prognostication based on tumor burden and, 3) aggressive management of oligometastases. Conclusions: Whole body FDG PET CT is a useful tool for staging and prognostication in breast cancer patients. However, the timing of such scans for surveillance needs to be defined for early detection of progression to have an impact on survival.

Download Full-text

A single institution’s experience with the value of FDG-PET-CT imaging in patients with newly diagnosed stage IIB-IIIB breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.123 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 123-123

Author(s):

Gary Schnur ◽

Katherine Glass ◽

Chad W Cummings ◽

Alberto J. Montero ◽

Jame Abraham ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Fdg Pet ◽

Ct Imaging ◽

Stage Iiib ◽

Breast Cancer Patients ◽

Pet Ct ◽

Tumor Boards ◽

Fdg Pet Ct ◽

The Impact

123 Background: The Cleveland Clinic is utilizing disease specific teams to craft care paths for value based disease management. The report by Groheux (JNCI 2012; 104:1879-1887), reported 18 FDG-PET-CT detected distant metastasis in 10.7, 17.5 and 36.5% of stage IIB- IIIB breast cancer patients. Based on this report, the breast team incorporated 18 FDG-PET- CT imaging for initial staging of IIB-IIIB patients. Methods: Treatment algorithms were developed by a multi-disciplinary breast cancer team. The content was reviewed by stakeholders throughout the health system, and feedback was incorporated into the care paths as appropriate. Content was communicated using physician meetings, electronic communication, tumor boards, and operational pilots. The treatment algorithm, along with the supporting narrative, was placed on the cancer center intranet, accessible to all practicing physicians. Additional intranet analysis was performed using Google Analytics, which identifies the site location and frequency of document downloads. We retrospectively examined the impact of this posting after one year (7/2014-7/2015). Manual chart review identified new patient consults for Stage IIB-IIIB breast cancer at our main campus and highest volume regional sites. Results: PET scans were ordered in 36 stage IIB, 19 stage IIIA, and 3 stage IIIB patients. Of the 36 IIB patients scanned, occult metastatic disease was noted in 1, and 2 patients migrated to IIIA without a change in treatment. 19 IIIA patients had no change in stage, although an asymptomatic second primary lung cancer was discovered in 1 .Three stage IIIB patients were without staging change. Conclusions: PET/CT imaging did not contribute to patient management for stage IIB-IIIB breast cancer patients at our institution, unlike the results reported elsewhere. Analysis of care path metrics allows us to expediently review and adjust recommendations to affiliated physicians.

Download Full-text