Diagnostic Performance of F18-FDG PET/CT in Male Breast Cancers Patients.

Andra Piciu,Simona Sorana Cainap,Dragos-Stefan Morariu,Calin Cainap,Doina Piciu,Alexandru Mester,Anita A Kovendi,Narcis Polocoser,Iulia Almasan

doi:10.3390/diagnostics11010119

Abstract

Introduction: F18-FDG PET/CT is the most important hybrid imaging used in the diagnostic, staging, follow-up, and treatment evaluation response in cancer patients. However, it is well-known that in breast cancer the use of F18-FDG is not included in the first line protocol of initial diagnostic, both in female and male breast cancer patients. F18-FDG PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases, and other occult primary cancers. This study assesses F18-FDG PET/CT systemic staging in male patients with diagnosed breast cancer and determines detection rates for unsuspected distant metastases and synchronous malignancies. Methods: We analyzed a number of 170 male patients with breast cancer, seen between 2000–2020, in a tertiary center. From this group, between 2013–2020 a number of 23 patients underwent F18-FDG PET/CT. Rates of upstaging were determined for each case and the detection of other primary malignancies was analyzed. Results: Median age of male breast cancer group was 61.3 y (range, 34–85 y), most had intraductal carcinoma (82.4%) and unsuspected distant metastases, which increased patient stage to IV, observed in 27%. In 4 out 23 patients (17.4%), F18-FDG PET/CT identified synchronous cancers (2 prostate cancers, 1 thyroid and 1 colon cancer). Conclusion: F18-FDG PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases, and other occult primary cancers. Baseline F18-FDG PET/CT has a substantial impact on the initial staging and on clinical management in male breast patients and should be considered for use in newly diagnosed patients.

Highlights

The inclusion criteria were: male breast cancer histological confirmed; hormonal receptors status: estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) described; we found an important number of patients
In a period of 20 years, the male breast cancer represents 0.1% from all breast cancer reported in our institution
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Summary

Introduction

The PET/CT hybrid imaging is an essential tool in primary diagnostic, staging, followup, and treatment response evaluation of many malignant diseases. In breast cancer the use of F18-FDG PET/CT has proven clinical value in selected cases: in patients with newly diagnosed breast cancer, F18-FDG PET/CT is recommended for stage III disease [1] and for restaging, follow-up, and treatment response evaluation. Some studies recommend due to the detection of unsuspected distant metastases, fact that alters treatment and prognosis, that the guidelines should consider adding in patients with stage IIB breast cancer the systemic staging with F18-FDG-PET/CT at the time of the initial diagnosis [2,3,4,5]. 37% of patients with clinical stage IIA-IIIC breast cancer who underwent F18-FDG PET/CT reduced false-positive risk by half and decreased workup of incidental findings, allowing earlier treatment and being cost-effective [4].

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Discussion

Conclusion