Marianne Vogsen1,2,3,4,5,6, Jeanette Dupont Jensen7, Ivar Yannick Christensen8, Oke Gerke9,10, Anne Marie Bak Jylling11, Lisbet Brønsro Larsen8, Poul-Erik Braad9,10, Katrine Lydolph Søe12, Camilla Bille13, Marianne Ewertz10, Malene Grubbe Hildebrandt9,10,14,15. 1. Department of Oncology, Odense University Hospital, Odense, Denmark. marianne.vogsen@rsyd.dk. 2. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. marianne.vogsen@rsyd.dk. 3. Department of Clinical Research, University of Southern Denmark, Odense, Denmark. marianne.vogsen@rsyd.dk. 4. Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. marianne.vogsen@rsyd.dk. 5. Centre for Personalized Response Monitoring in Oncology (PREMIO), Odense University Hospital, Odense, Denmark. marianne.vogsen@rsyd.dk. 6. Department of Oncology and Department of Nuclear Medicine, Odense University Hospital, Kloevervaenget 47, 5000, Odense C, Denmark. marianne.vogsen@rsyd.dk. 7. Department of Oncology, Odense University Hospital, Odense, Denmark. 8. Department of Radiology, Odense University Hospital, Odense, Denmark. 9. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark. 10. Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 11. Department of Pathology, Odense University Hospital, Odense, Denmark. 12. Department of Breast Surgery, Odense University Hospital, Odense, Denmark. 13. Department of Plastic Surgery, Odense University Hospital, Odense, Denmark. 14. Centre for Personalized Response Monitoring in Oncology (PREMIO), Odense University Hospital, Odense, Denmark. 15. Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.
Abstract
PURPOSE: To investigate the clinical impact of FDG-PET/CT for staging and treatment planning in high-risk primary breast cancer. METHODS: Women with high-risk primary breast cancer were enrolled between September 2017 and August 2019 at Odense University Hospital, Denmark. Conventional mammography with/without MRI was performed before staging by FDG-PET/CT. We studied the accuracy of FDG-PET/CT for the detection of distant metastases, the effect on the change of treatment, and the prevalence of incidental findings. Biopsy and follow-up were used as a reference standard for the accuracy analysis. RESULTS: Of 103 women, 24 (23%) were diagnosed with distant metastases by FDG-PET/CT. Among these, breast surgery was omitted in 18 and could have been spared in six. Another sixteen (16%) patients were upstaged to more advanced loco-regional disease, leading to more extensive radiotherapy. Sensitivity and specificity for diagnosing distant metastases were 1.00 (95% confidence interval: 0.86-1.00) and 0.95 (0.88-0.99), respectively. Twenty-nine incidental findings were detected in 24 women (23%), leading to further examinations in 22 and diagnosis of eight (8/22, 36%) synchronous diseases: cancer (n = 4), thyroiditis (n = 2), aorta aneurysm (n = 1), and meningioma (n = 1). CONCLUSIONS: FDG-PET/CT had a substantial impact on staging and change of treatment in women with high-risk primary breast cancer, and further examination of incidental findings was considered clinically relevant. Our findings suggest that FDG-PET/CT should be considered for primary staging in high-risk primary breast cancer to improve treatment planning.
PURPOSE: To investigate the clinical impact of FDG-PET/CT for staging and treatment planning in high-risk primary breast cancer. METHODS:Women with high-risk primary breast cancer were enrolled between September 2017 and August 2019 at Odense University Hospital, Denmark. Conventional mammography with/without MRI was performed before staging by FDG-PET/CT. We studied the accuracy of FDG-PET/CT for the detection of distant metastases, the effect on the change of treatment, and the prevalence of incidental findings. Biopsy and follow-up were used as a reference standard for the accuracy analysis. RESULTS: Of 103 women, 24 (23%) were diagnosed with distant metastases by FDG-PET/CT. Among these, breast surgery was omitted in 18 and could have been spared in six. Another sixteen (16%) patients were upstaged to more advanced loco-regional disease, leading to more extensive radiotherapy. Sensitivity and specificity for diagnosing distant metastases were 1.00 (95% confidence interval: 0.86-1.00) and 0.95 (0.88-0.99), respectively. Twenty-nine incidental findings were detected in 24 women (23%), leading to further examinations in 22 and diagnosis of eight (8/22, 36%) synchronous diseases: cancer (n = 4), thyroiditis (n = 2), aorta aneurysm (n = 1), and meningioma (n = 1). CONCLUSIONS:FDG-PET/CT had a substantial impact on staging and change of treatment in women with high-risk primary breast cancer, and further examination of incidental findings was considered clinically relevant. Our findings suggest that FDG-PET/CT should be considered for primary staging in high-risk primary breast cancer to improve treatment planning.
Entities:
Keywords:
Breast cancer; Clinical impact; FDG-PET/CT; Incidental findings; Stage migration
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