The Utility of FDG PET/CT Staging in Premenopausal Breast Cancer Patients
Breast cancer diagnosed in premenopausal women is frequently more aggressive and less responsive to therapy than in postmenopausal women in the US.
AIM: This study evaluates FDG PET/CT in the initial staging of premenopausal women with primary breast cancer.
Methods: Standard body FDG PET/CT scans were performed in 101 premenopausal women of a mean age 35.7 (range 24-51). All women had biopsy-proven breast cancer and all underwent axillary node sampling following scanning, typically using sentinel node technique. Conventional staging demonstrated no disease outside of the breast and ipsilateral axilla. All additional PET/CT abnormalities were confirmed pathologically or by correlative imaging.
Results: The T stage breakdown was: T1 18 patients, T2 62 patients and T3/3 21 patients. The primary breast cancers were visualized by PET/CT in all women and 18 additional foci were identified within the breast of concern. A single contralateral breast cancer was identified. Sixty-nine women had pathologically proven ipsilateral axillary node metastases. The sensitivity for PET/CT detection of axillary node metastases was related to T stage: T1 33%, T2 91% and T3/4 100% and the positive predictive value was 99%. In nine patients an FDG-avid nonaxillary node was identified. Distant metastases were identified in 28% of this patient population. In 37 patients, PET/CT identified abnormalities that produced upstaging.
Conclusion: PET/CT improved staging in premenopausal women with primary breast cancers by identified previously unrecognized breast cancer foci.