Role of preoperative 18-FDG- PET/CT in early-stage breast cancer upstaging and modification of treatment

Anshu Tewari, Shanmuga Palaniswamy Sundaram, Padma Subramanyam


Purpose: The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer.

Methods: A total of 72 consecutive patients (age: range 24-78 years, mean 51 years), with newly diagnosed operable breast cancer (Infiltrating Ductal carcinoma: Lobular carcinoma: Others - 49:15:8) with tumor size 10-65 mm were examined preoperatively. All patients underwent conventional assessment imaging modalities like mammography, breast/axillary ultrasound and PET/CT.

Results:  PET/CT identified a primary tumor in all but two patients. PET/CT solely detected unsuspected distant metastases (bones, lung, brain etc) in 9 patients and new primary cancers (endometrium and lung) in another two patients, as well as 11 cases of extra-axillary lymph node involvement. In 6 patients, extra-axillary malignancy was detected by PET/CT only, leading to an upgrade of initial staging in 9% (6/70) and ultimately a modification of planned treatment in 12% (9/70) of patients. PET/CT evaluation led 5 patients of stage II A to stage IV, 3 patients of stage II B to stage IV and 1 patient to Stage IIIB which further modified treatment plan from an adjuvant to a metastatic approach.

Conclusion: PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases and other occult primary cancers. Preoperative 18F fluorodeoxyglucose PET/CT has a substantial impact on initial staging and on clinical management in patients with early-stage breast cancer.


Breast cancer, Initial staging, PET/CT, Upstaging, Treatment modification

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Hayashi M, Murakami K, Oyama T, et al. PET/CT supports breast cancer diagnosis and treatment. Breast Cancer. 2008;15(3):224–30.

Bar-Shalom R, Yefremov N, Guralnik L, et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med. 2003;44(8):1200–9.

Tatsumi M, Cohade C, Mourtzikos KA, et al. Initial experience with FDG-PET/CT in the evaluation of breast cancer.Eur J Nucl Med Mol Imaging. 2006;33(3):254–62.

Schirrmeister H, Kuhn T, Guhlmann A, et al. Fluorine-18 2-deoxy-2-fluoro-D glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures. Eur J Nucl Med. 2001;28(3):351–8.

Fuster D, Duch J, Paredes P, et al. Preoperative staging of large primary breast cancer with [18F] fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J Clin Oncol. 2008;26(29):4746–51.

Dose J, Bleckmann C, Bachmann S, et al. Comparison of fluorodeoxyglucose positron emission tomography and ‘‘conventional diagnostic procedures’’ for the detection of distant metastases in breast cancer patients. Nucl Med Commun. 2002;23(9):857–64.

Klaeser B, Wiederkehr O, Koeberle D, et al. Therapeutic impact of 2-[fluorine-18] fluoro-2-deoxy-D-glucose positron emission tomography in the pre- and postoperative staging of patients with clinically intermediate or high-risk breast cancer. Ann Oncol. 2007;18(8):1329–34.

Landheer ML, Steffens MG, Klinkenbijl JH, et al. Value of fluorodeoxyglucose positron emission tomography in women with breast cancer. Br J Surg. 2005;92(11):1363–7.

Dirisamer A, Halpern BS, Flory D, et al. Integrated contrast-enhanced diagnostic whole-body PET/CT as a first-line restaging modality in patients with suspected metastatic recurrence of breast cancer. Eur J Radiol. 2010;73(2):294–99.

Jessen K, Panzer W, Shrimpton P. European Guidelines on Quality Criteria for Computed Tomography. Luxemburg: Office for Official Publications of the European Communities 2000. [EUR 16262].

Hubner KF, McDonald TW, Niethammer JG, et al. Assessment of primary and metastatic ovarian cancer by positron emission tomography (PET) using 2-[18F]deoxyglucose (2-[18F]FDG). Gynecol Oncol. 1993;51(2):197–204.

Eubank WB, Mankoff DA, Schmiedl UP, et al. Imaging of oncologic patients: benefit of combined CT and FDG PET in the diagnosis of malignancy. AJR Am J Roentgenol. 1998;171(4):1103–10.

Fueger BJ, Weber WA, Quon A, et al. Performance of 2-deoxy-2-[F-18]fluoro-D-glucosepositron emission tomography and integrated PET/CT in restaged breast cancer patients. Mol Imaging Biol. 2005;7(5):369–76.

Jager JJ, Keymeulen K, Beets-Tan RG, et al. FDG-PET-CT for staging of high-risk breast cancer patients reduces the number of further examinations: a pilot study. Acta Oncol. 2010;49(2):185–91.

Groheux D, Moretti JL, Baillet G, et al. Effect of (18)F-FDG PET/CT imaging in patients with clinical stage II and III breast cancer. Int J Radiat Oncol Biol Phys. 2008;71(3):695–704.

Gil-Rendo A, Zornoza G, Garcia-Velloso MJ, et al. Fluorodeoxyglucose positron emission tomography with sentinel lymph node biopsy for evaluation of axillary involvement in breast cancer. Br J Surg. 2006;93(6):707–12.

Wahl RL, Siegel BA, Coleman RE, et al. Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J Clin Oncol. 2004;22(2):277–85.

Kim J, Lee J, Chang E, et al. Selective sentinel node plus additional non-sentinel node biopsy based on an FDG-PET/CT scan in early breast cancer patients: single institutional experience. World J Surg. 2009;33(5):943–9.


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