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Open Access 01-12-2021 | Metastasis | Original research

Benefits and harms of implementing [¹⁸F]FDG-PET/CT for diagnosing recurrent breast cancer: a prospective clinical study

Authors: Marianne Vogsen, Jeanette Dupont Jensen, Oke Gerke, Anne Marie Bak Jylling, Jon Thor Asmussen, Ivar Yannick Christensen, Poul-Erik Braad, Peter Thye-Rønn, Katrine Lydolph Søe, Marianne Ewertz, Malene Grubbe Hildebrandt

Published in: EJNMMI Research | Issue 1/2021

Abstract

Background

[¹⁸F]-fluorodeoxyglucose-positron emission tomography/computed tomography ([¹⁸F]FDG-PET/CT) has been implemented sporadically in hospital settings as the standard of care examination for recurrent breast cancer. We aimed to explore the clinical impact of implementing [¹⁸F]FDG-PET/CT for patients with clinically suspected recurrent breast cancer and validate the diagnostic accuracy.

Methods

Women with suspected distant recurrent breast cancer were prospectively enrolled in the study between September 2017 and August 2019. [¹⁸F]FDG-PET/CT was performed, and the appearance of incidental benign and malignant findings was registered. Additional examinations, complications, and the final diagnosis were registered to reflect the clinical consequence of such findings. The diagnostic accuracy of [¹⁸F]FDG-PET/CT as a stand-alone examination was analyzed. Biopsy and follow-up were used as a reference standard.

Results

[¹⁸F]FDG-PET/CT reported breast cancer metastases in 72 of 225 women (32.0%), and metastases were verified by biopsy in 52 (52/225, 23.1%). Prior probability and posterior probability of a positive test for suspected metastatic cancer and incidental malignancies were 27%/85% and 4%/20%, respectively. Suspected malignant incidental findings were reported in 46 patients (46/225, 20.4%), leading to further examinations and final detection of nine synchronous cancers (9/225, 4.0%). These cancers originated from the lung, thyroid, skin, pancreas, peritoneum, breast, kidney, one was malignant melanoma, and one was hematological cancer. False-positive incidental malignant findings were examined in 37/225 patients (16.4%), mainly in the colon (n = 12) and thyroid gland (n = 12). Ten incidental findings suspicious for benign disease were suggested by [¹⁸F]FDG-PET/CT, and further examinations resulted in the detection of three benign conditions requiring treatment. Sensitivity, specificity, and AUC-ROC for diagnosing distant metastases were 1.00 (0.93–1.0), 0.88 (0.82–0.92), and 0.98 (95% CI 0.97–0.99), respectively.

Conclusion

[¹⁸F]FDG-PET/CT provided a high posterior probability of positive test, and a negative test was able to rule out distant metastases in women with clinically suspected recurrent breast cancer. One-fifth of patients examined for incidental findings detected on [¹⁸F]FDG-PET/CT were diagnosed with clinically relevant conditions. Further examinations of false-positive incidental findings in one of six women should be weighed against the high accuracy for diagnosing metastatic breast cancer.

Trial registration Clinical.Trials.gov. NCT03358589. Registered 30 November 2017—Retrospectively registered, http://www.ClinicalTrials.gov

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Title: Benefits and harms of implementing [18F]FDG-PET/CT for diagnosing recurrent breast cancer: a prospective clinical study
Authors: Marianne Vogsen
Jeanette Dupont Jensen
Oke Gerke
Anne Marie Bak Jylling
Jon Thor Asmussen
Ivar Yannick Christensen
Poul-Erik Braad
Peter Thye-Rønn
Katrine Lydolph Søe
Marianne Ewertz
Malene Grubbe Hildebrandt
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Metastasis
Breast Cancer
Breast Cancer
Published in: EJNMMI Research / Issue 1/2021
Electronic ISSN: 2191-219X
DOI: https://doi.org/10.1186/s13550-021-00833-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Benefits and harms of implementing [¹⁸F]FDG-PET/CT for diagnosing recurrent breast cancer: a prospective clinical study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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