Top

Published in:

01-01-2021 | Computed Tomography | Clinical trial

FDG-PET/CT in high-risk primary breast cancer—a prospective study of stage migration and clinical impact

Authors: Marianne Vogsen, Jeanette Dupont Jensen, Ivar Yannick Christensen, Oke Gerke, Anne Marie Bak Jylling, Lisbet Brønsro Larsen, Poul-Erik Braad, Katrine Lydolph Søe, Camilla Bille, Marianne Ewertz, Malene Grubbe Hildebrandt

Published in: Breast Cancer Research and Treatment | Issue 1/2021

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.

Hortobagyi GN, Connolly JL, D'orsi CJ, Edge SB, Mittendorf EA, Rugo HS, Solin LJ, Weaver DL, Winchester DJ, Giuliano AE (2018) AJCC Cancer Staging Manual 8th, Breast, Part XI. In., 8 edn.,

Cardoso F, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rubio IT, Zackrisson S, Senkus E, Committee EG (2019) Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Annals Oncol 30(8):1194–1220. https://doi.org/10.1093/annonc/mdz173CrossRef

NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed Apr 8 2020

Koolen BB, Vrancken Peeters M-JTFD, Aukema TS, Vogel WV, Oldenburg HSA, van der Hage JA, Hoefnagel CA, Stokkel MPM, Loo CE, Rodenhuis S, Rutgers EJT, Valdés Olmos RA (2012) 18F-FDG PET/CT as a staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques. Breast Cancer Res Treat 131(1):117–126. https://doi.org/10.1007/s10549-011-1767-9CrossRefPubMed

Caresia Aroztegui AP, Garcia Vicente AM, Alvarez Ruiz S, Delgado Bolton RC, Orcajo Rincon J, Garcia Garzon JR, de Arcocha TM, Garcia-Velloso MJ (2017) 18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging. Tumour Biol 39(10):1010428317728285. https://doi.org/10.1177/1010428317728285CrossRefPubMed

Groheux D (2017) FDG-PET/CT for systemic staging of patients with newly diagnosed breast cancer. Eu J Nuclear Med Mol Imaging 44(9):1417–1419. https://doi.org/10.1007/s00259-017-3731-3CrossRef

Ulaner GA (2019) PET/CT for Patients With Breast Cancer: Where Is the Clinical Impact? Am J Roentgenol. https://doi.org/10.2214/ajr.19.21177CrossRef

Groheux D, Giacchetti S, Delord M, Hindie E, Vercellino L, Cuvier C, Toubert ME, Merlet P, Hennequin C, Espie M (2013) 18F-FDG PET/CT in staging patients with locally advanced or inflammatory breast cancer: comparison to conventional staging. J Nuclear Med 54(1):5–11. https://doi.org/10.2967/jnumed.112.106864CrossRef

Garg PK, Deo SVS, Kumar R, Shukla NK, Thulkar S, Gogia A, Sharma DN, Mathur SR (2016) Staging PET-CT Scanning Provides Superior Detection of Lymph Nodes and Distant Metastases than Traditional Imaging in Locally Advanced Breast Cancer. World J Surg 40(8):2036–2042. https://doi.org/10.1007/s00268-016-3570-6CrossRefPubMed

10.

Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, Lijmer JG, Moher D, Rennie D, de Vet HC, Kressel HY, Rifai N, Golub RM, Altman DG, Hooft L, Korevaar DA, Cohen JF (2015) STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ (Clinical research ed) 351:h5527. https://doi.org/10.1136/bmj.h5527CrossRef

11.

Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ (2011) Strategies for subtypes–dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 22(8):1736–1747. https://doi.org/10.1093/annonc/mdr304CrossRefPubMedPubMedCentral

12.

Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, Verzijlbergen FJ, Barrington SF, Pike LC, Weber WA, Stroobants S, Delbeke D, Donohoe KJ, Holbrook S, Graham MM, Testanera G, Hoekstra OS, Zijlstra J, Visser E, Hoekstra CJ, Pruim J, Willemsen A, Arends B, Kotzerke J, Bockisch A, Beyer T, Chiti A, Krause BJ (2015) FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 42(2):328–354. https://doi.org/10.1007/s00259-014-2961-xCrossRefPubMed

13.

Groheux D, Hindié E, Delord M, Giacchetti S, Hamy A-s, de Bazelaire C, de Roquancourt A, Vercellino L, Toubert M-E, Merlet P, Espié M (2012) Prognostic impact of (18)FDG-PET-CT findings in clinical stage III and IIB breast cancer. J Natl Cancer Inst 104(24):1879–1887. https://doi.org/10.1093/jnci/djs451CrossRefPubMedPubMedCentral

14.

Feinstein AR, Sosin DM, Wells CK (1985) The Will Rogers phenomenon Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. The New England journal of medicine 312(25):1604–1608. https://doi.org/10.1056/nejm198506203122504CrossRefPubMed

15.

Sormani MP (2009) The Will Rogers phenomenon: the effect of different diagnostic criteria. J Neurol Sci 287(Suppl 1):S46–49. https://doi.org/10.1016/s0022-510x(09)71300-0CrossRefPubMed

16.

Gajjala SR, Hulikal N, Kadiyala S, Kottu R, Kalawat T (2018) Whole-body (18)F-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET/CT) for staging locally advanced breast cancer: A prospective study from a tertiary cancer centre in south India. Indian J Med Res 147(3):256–262. https://doi.org/10.4103/ijmr.IJMR_1368_16CrossRefPubMedPubMedCentral

17.

Britt CJ, Maas AM, Kennedy TA, Hartig GK (2018) Incidental Findings on FDG PET/CT in Head and Neck Cancer. Otolaryngol Head Neck Surg 158(3):484–488. https://doi.org/10.1177/0194599817742579CrossRefPubMed

18.

Sponholtz SE, Mogensen O, Hildebrandt MG, Jensen PT (2020) Clinical impact of pre-treatment FDG-PET/CT staging of primary ovarian, fallopian tube, and peritoneal cancers in women. Acta Obstet Gynecol Scand 99(2):186–195. https://doi.org/10.1111/aogs.13726CrossRefPubMed

19.

Ishimori T, Patel PV, Wahl RL (2005) Detection of unexpected additional primary malignancies with PET/CT. J Nuclear Med 46(5):752–757

20.

Rohde M, Nielsen AL, Johansen J, Sorensen JA, Nguyen N, Diaz A, Nielsen MK, Asmussen JT, Christiansen JM, Gerke O, Thomassen A, Alavi A, Hoilund-Carlsen PF, Godballe C (2017) Head-to-Head Comparison of Chest X-Ray/Head and Neck MRI, Chest CT/Head and Neck MRI, and (18)F-FDG PET/CT for Detection of Distant Metastases and Synchronous Cancer in Oral, Pharyngeal, and Laryngeal Cancer. J Nuclear Med 58(12):1919–1924. https://doi.org/10.2967/jnumed.117.189704CrossRef

21.

Kousgaard SJ, Thorlacius-Ussing O (2017) Incidental colorectal FDG uptake on PET/CT scan and lesions observed during subsequent colonoscopy: a systematic review. Tech Coloproctol 21(7):521–529. https://doi.org/10.1007/s10151-017-1652-6CrossRefPubMed

22.

Netherlands I-CCCt Breast cancer guideline, NABON 2012. 2.0

Title: FDG-PET/CT in high-risk primary breast cancer—a prospective study of stage migration and clinical impact
Authors: Marianne Vogsen
Jeanette Dupont Jensen
Ivar Yannick Christensen
Oke Gerke
Anne Marie Bak Jylling
Lisbet Brønsro Larsen
Poul-Erik Braad
Katrine Lydolph Søe
Camilla Bille
Marianne Ewertz
Malene Grubbe Hildebrandt
Publication date: 01-01-2021
Publisher: Springer US
Keywords: Computed Tomography
Metastasis
Computed Tomography
Breast Cancer
Breast Cancer
Radiotherapy
Published in: Breast Cancer Research and Treatment / Issue 1/2021
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-020-05929-3

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Metformin and an insulin/IGF-1 receptor inhibitor are synergistic in blocking growth of triple-negative breast cancer

Width of margins in phyllodes tumors of the breast: the controversy drags on?—a systematic review and meta-analysis

Impact of patients’ refusal to undergo adjuvant treatment measures on survival

Body mass index (BMI) and benefit from adjuvant chemotherapy in breast cancer: is it enough?

Risk of heart failure after systemic treatment for early breast cancer: results of a cohort study

Vitiligo-like lesions in patients with advanced breast cancer treated with cycline-dependent kinases 4 and 6 inhibitors

Keynote webinar | Spotlight on antibody–drug conjugates in cancer