Tevfik F Cermik1, Ayse Mavi, Sandip Basu, Abass Alavi. 1. Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Abstract
PURPOSE: The main objective of this study was to determine the efficacy of (18)F-fluorodeoxyglucose positron emission tomography (FDG PET) to assess the impact of this technique in staging of patients with newly diagnosed breast cancer. METHODS: Two hundred and seventy-one consecutive patients (median age = 51 +/- 11 years) with biopsy-proven primary breast cancer who were examined by FDG PET were enrolled in this prospective preoperative staging study. Whole-body FDG-PET images were acquired approximately 60 min after the intravenous administration of FDG (5.2 MBq/kg). Visual assessment and the maximum standardized uptake value (SUVmax) of breast lesions for semiquantitative analysis were carried out. The PET results were compared with the histopathology results. RESULTS: For the tumor, node, metastases (TNM) staging, 240 patients (250 breasts) were considered eligible based on the criteria that were established for this analysis. Significant differences were noted in SUVmax of lesions according to the TNM staging (p < 0.05). The average SUVmax of the primary tumor was calculated in patients with axillary involvement (n = 58) and for the ones without axillary metastasis (n = 79), and SUVmax were 4.1 +/- 3.5 and 2.8 +/- 2.3, respectively, with a significant difference between the two groups (p = 0.03). PET imaging revealed pathological FDG uptake in 54% (46/85) of patients with axillary lymph node metastases. The sensitivities of FDG PET for detecting axillary lymph node metastasis were found 41% in pN1, 67% in pN2, and 100% in pN3, and the specificity was 89% for pN0 stage. Detection of extra-axillary regional node or distant metastatic lesions revealed by PET scan in 22 of 24 patients resulted in a significant change in the TNM stage. Distant metastasis without axillary lymph node metastasis was noted in 21% (5/24) of patients. The results revealed that FDG PET upgraded TNM stage in 9.2% (22/240) of patients and 7.5% (18/240) of patients were diagnosed as having one or more distant metastases. CONCLUSION: FDG PET was able to identify extra-axillary regional nodal and distant lesions in newly diagnosed patients with breast cancer; FDG PET may alter the staging and management of therapy in patients with newly diagnosed breast cancer.
PURPOSE: The main objective of this study was to determine the efficacy of (18)F-fluorodeoxyglucose positron emission tomography (FDG PET) to assess the impact of this technique in staging of patients with newly diagnosed breast cancer. METHODS: Two hundred and seventy-one consecutive patients (median age = 51 +/- 11 years) with biopsy-proven primary breast cancer who were examined by FDG PET were enrolled in this prospective preoperative staging study. Whole-body FDG-PET images were acquired approximately 60 min after the intravenous administration of FDG (5.2 MBq/kg). Visual assessment and the maximum standardized uptake value (SUVmax) of breast lesions for semiquantitative analysis were carried out. The PET results were compared with the histopathology results. RESULTS: For the tumor, node, metastases (TNM) staging, 240 patients (250 breasts) were considered eligible based on the criteria that were established for this analysis. Significant differences were noted in SUVmax of lesions according to the TNM staging (p < 0.05). The average SUVmax of the primary tumor was calculated in patients with axillary involvement (n = 58) and for the ones without axillary metastasis (n = 79), and SUVmax were 4.1 +/- 3.5 and 2.8 +/- 2.3, respectively, with a significant difference between the two groups (p = 0.03). PET imaging revealed pathological FDG uptake in 54% (46/85) of patients with axillary lymph node metastases. The sensitivities of FDG PET for detecting axillary lymph node metastasis were found 41% in pN1, 67% in pN2, and 100% in pN3, and the specificity was 89% for pN0 stage. Detection of extra-axillary regional node or distant metastatic lesions revealed by PET scan in 22 of 24 patients resulted in a significant change in the TNM stage. Distant metastasis without axillary lymph node metastasis was noted in 21% (5/24) of patients. The results revealed that FDG PET upgraded TNM stage in 9.2% (22/240) of patients and 7.5% (18/240) of patients were diagnosed as having one or more distant metastases. CONCLUSION:FDG PET was able to identify extra-axillary regional nodal and distant lesions in newly diagnosed patients with breast cancer; FDG PET may alter the staging and management of therapy in patients with newly diagnosed breast cancer.
Authors: Alberto Ravaioli; Giuseppe Pasini; Antonio Polselli; Maximilian Papi; Davide Tassinari; Valentina Arcangeli; Carlo Milandri; Dino Amadori; Matteo Bravi; Daniela Rossi; Pier Paolo Fattori; Enzo Pasquini; Ilaria Panzini Journal: Breast Cancer Res Treat Date: 2002-03 Impact factor: 4.872
Authors: N Avril; S Bense; S I Ziegler; J Dose; W Weber; C Laubenbacher; W Römer; F Jänicke; M Schwaiger Journal: J Nucl Med Date: 1997-08 Impact factor: 10.057
Authors: Ahmedin Jemal; Taylor Murray; Elizabeth Ward; Alicia Samuels; Ram C Tiwari; Asma Ghafoor; Eric J Feuer; Michael J Thun Journal: CA Cancer J Clin Date: 2005 Jan-Feb Impact factor: 508.702
Authors: I C Smith; K N Ogston; P Whitford; F W Smith; P Sharp; M Norton; I D Miller; A K Ah-See; S D Heys; J A Jibril; O Eremin Journal: Ann Surg Date: 1998-08 Impact factor: 12.969
Authors: Bernd Gerber; Eva Seitz; Heiner Müller; Annette Krause; Toralf Reimer; Günther Kundt; Klaus Friese Journal: Breast Cancer Res Treat Date: 2003-11 Impact factor: 4.872
Authors: William B Eubank; David Mankoff; Mallar Bhattacharya; Julie Gralow; Hannah Linden; Georgiana Ellis; Skyler Lindsley; Mary Austin-Seymour; Robert Livingston Journal: AJR Am J Roentgenol Date: 2004-08 Impact factor: 3.959
Authors: Jennifer R Bellon; Robert B Livingston; William B Eubank; Julie R Gralow; Georgiana K Ellis; Lisa K Dunnwald; David A Mankoff Journal: Am J Clin Oncol Date: 2004-08 Impact factor: 2.339
Authors: Teresa W-M Fan; Pawel K Lorkiewicz; Katherine Sellers; Hunter N B Moseley; Richard M Higashi; Andrew N Lane Journal: Pharmacol Ther Date: 2011-12-23 Impact factor: 12.310
Authors: Maxine S Jochelson; Lizza Lebron; Stefanie S Jacobs; Junting Zheng; Chaya S Moskowitz; Simon N Powell; Virgilio Sacchini; Gary A Ulaner; Elizabeth A Morris; D David Dershaw Journal: AJR Am J Roentgenol Date: 2015-10 Impact factor: 3.959
Authors: Min Jung Seo; Jong Jin Lee; Hye Ok Kim; Sun-Young Chae; Seol Hoon Park; Jin-Sook Ryu; Sei Hyun Ahn; Jong Won Lee; Byung Ho Son; Gyung-Yub Gong; Dae Hyuk Moon Journal: Eur J Nucl Med Mol Imaging Date: 2013-11-06 Impact factor: 9.236