Preface

Abstract

Rakesh Kumar, MD Guest EditorView Large Image Figure ViewerDownload (PPT)Ayşe Mavi, MD Guest EditorView Large Image Figure ViewerDownload (PPT)Abass Alavi, MD, MD (Hon), PhD (Hon), DSc (Hon) Guest EditorView Large Image Figure ViewerDownload (PPT)The future of functional imaging in breast carcinomaWith the rapid changes taking place in modern medicine, foreseeing the future is a perilous exercise. Nevertheless, such predictions allow strategies to be developed that may improve the outcome to some extent. The second part of the PET Clinics issue on breast cancer deals with the recent developments in breast cancer imaging, especially with regard to PET/computed tomography (CT), and covers a wide range of topics including technological developments and their potential applications, novel PET tracers beyond fluorodeoxyglucose (FDG), and speculation on the newer applications of FDG-PET imaging beyond diagnostic staging. The outstanding groups of investigators who have contributed to this issue have elegantly portrayed the potential future developments and great versatility of this powerful technology.With the growing list of treatment regimens and approaches that are available to oncologists, individualizing treatment in patients with cancer has been a hallmark of the modern clinical practice. Therefore, understanding the tumor biology is of utmost importance to select the appropriate therapy in a particular setting. Dr Mankoff and his associates have focused their review on breast cancer imaging on this important topic. The value of understanding this phenomenon in the management of breast cancer has not yet been fully explored. By elucidating the characteristics of tumor perfusion and angiogenesis, tumor receptor status, tumor proliferation index, multidrug resistance, and novel drug delivery and transport, oncologists may become more successful in selecting the appropriate modes of therapy for furthering patient outcomes as highlighted by this group.Parallel with the development of novel PET tracers, significant strides have been made toward specialized instruments with the aim of providing high-resolution images of this organ. A spatial resolution of about a few millimeters can now be reached with a specialized positron emission mammography (PEM) unit, which continues to evolve. In their review, Dr Zaidi and his associate highlight the recent advances and the advantages in PEM instrumentation and the challenges in adopting this novel approach in a routine clinical setting.Assessment of receptor status in breast cancer is of great interest because of its potential prognostic and therapeutic implications. Tumors expressing estrogen and/or progesterone receptors have a higher likelihood of responding to various hormonal therapeutic agents. Currently, the role of several other receptor imaging techniques in characterizing tumor biology is being explored including somatostatin receptor, gastrin-releasing peptide, and neuropeptide Y. The recent observation of a potential link between the estrogen responsiveness of breast cancer and SSTR2 overexpression is of considerable interest to tumor biologists. Dr Bénard and colleague have dealt with this exciting area of breast cancer research in their in-depth review of this topic.The importance of screening the contralateral breast for occult malignancy in patients with breast cancer has been emphasized in the recent literature. Detection of tumors in the contralateral side allows for effective surgical decision making, planning for reconstructive surgery, and future systemic therapies. The higher incidence of mortality associated with coincident malignancy in the contralateral breast requires aggressive surgical and medical therapeutic interventions in this population. Hence, selecting and defining the optimal imaging modality to screen both breasts is important at the time of initial diagnosis and at the subsequent follow-up studies. Magnetic resonance imaging and FDG-PET/CT can play an invaluable role in achieving high sensitivity and specificity in this clinical setting. Dr Weinstein and colleagues have placed these 2 powerful tools in perspective in their article. These investigators conclude that a combination of both modalities will provide the necessary screening information to guide subsequent management decisions.The introduction of PET/CT has provided a major boost to image-guided radiation therapy planning and may become the modality of choice in the near future. Increasingly, radiation oncologists have realized the advantages and the future potential of this powerful approach. Understanding the perspectives of the radiation oncologists and their community is crucial for the success of this promising application. In his review, Dr Beriwal provides the readers with an excellent overview of the rationale and applications of PET/CT imaging for radiation therapy planning in breast carcinoma.The future applications of FDG-PET imaging extend well beyond disease staging. Early response to therapy has been an area of significant interest in recent years in a wide array of malignancies and breast carcinoma is no exception. Using [18F]FDG-PET allows for predicting response early in the course of therapy and for identifying nonresponders, therefore, serious side effects can be avoided. Such knowledge enables the clinicians to switch to other therapeutic regimens and therapeutic approaches in a timely fashion. Dr Kumar and colleagues have provided a scholarly review of this important application of FDG-PET imaging in breast cancer.The behavior of breast cancers varies considerably from a slow-growing malignancy that can be managed effectively by locoregional modalities and adjuvant hormone therapy, to rapidly growing incurable disease with widespread metastases at presentation. Functional imaging led by FDG-PET imaging is playing an increasingly important role in defining tumor biology in this unpredictable malignancy. Dr Basu and colleagues have critically reviewed this new and promising application of FDG-PET imaging based on their own experience at the Hospital of the University of Pennsylvania and have reviewed the current literature on this topic. This article complements that of Çermik and colleagues on the present role of FDG-PET imaging in staging breast carcinoma at diagnosis and at different stages of the disease. FDG-PET imaging seems to have a promising role in assessing the extent of disease throughout the course of this cancer, which would allow optimal planning of various therapeutic interventions.Finally, we would like to congratulate and express our gratitude to all the authors. They have made painstaking efforts to communicate in a lucid manner what is truly cutting-edge information that will serve as a useful reference source for the next few years. We sincerely hope that our readers will enjoy reading these articles as much as we have. The future of functional imaging in breast carcinomaWith the rapid changes taking place in modern medicine, foreseeing the future is a perilous exercise. Nevertheless, such predictions allow strategies to be developed that may improve the outcome to some extent. The second part of the PET Clinics issue on breast cancer deals with the recent developments in breast cancer imaging, especially with regard to PET/computed tomography (CT), and covers a wide range of topics including technological developments and their potential applications, novel PET tracers beyond fluorodeoxyglucose (FDG), and speculation on the newer applications of FDG-PET imaging beyond diagnostic staging. The outstanding groups of investigators who have contributed to this issue have elegantly portrayed the potential future developments and great versatility of this powerful technology.With the growing list of treatment regimens and approaches that are available to oncologists, individualizing treatment in patients with cancer has been a hallmark of the modern clinical practice. Therefore, understanding the tumor biology is of utmost importance to select the appropriate therapy in a particular setting. Dr Mankoff and his associates have focused their review on breast cancer imaging on this important topic. The value of understanding this phenomenon in the management of breast cancer has not yet been fully explored. By elucidating the characteristics of tumor perfusion and angiogenesis, tumor receptor status, tumor proliferation index, multidrug resistance, and novel drug delivery and transport, oncologists may become more successful in selecting the appropriate modes of therapy for furthering patient outcomes as highlighted by this group.Parallel with the development of novel PET tracers, significant strides have been made toward specialized instruments with the aim of providing high-resolution images of this organ. A spatial resolution of about a few millimeters can now be reached with a specialized positron emission mammography (PEM) unit, which continues to evolve. In their review, Dr Zaidi and his associate highlight the recent advances and the advantages in PEM instrumentation and the challenges in adopting this novel approach in a routine clinical setting.Assessment of receptor status in breast cancer is of great interest because of its potential prognostic and therapeutic implications. Tumors expressing estrogen and/or progesterone receptors have a higher likelihood of responding to various hormonal therapeutic agents. Currently, the role of several other receptor imaging techniques in characterizing tumor biology is being explored including somatostatin receptor, gastrin-releasing peptide, and neuropeptide Y. The recent observation of a potential link between the estrogen responsiveness of breast cancer and SSTR2 overexpression is of considerable interest to tumor biologists. Dr Bénard and colleague have dealt with this exciting area of breast cancer research in their in-depth review of this topic.The importance of screening the contralateral breast for occult malignancy in patients with breast cancer has been emphasized in the recent literature. Detection of tumors in the contralateral side allows for effective surgical decision making, planning for reconstructive surgery, and future systemic therapies. The higher incidence of mortality associated with coincident malignancy in the contralateral breast requires aggressive surgical and medical therapeutic interventions in this population. Hence, selecting and defining the optimal imaging modality to screen both breasts is important at the time of initial diagnosis and at the subsequent follow-up studies. Magnetic resonance imaging and FDG-PET/CT can play an invaluable role in achieving high sensitivity and specificity in this clinical setting. Dr Weinstein and colleagues have placed these 2 powerful tools in perspective in their article. These investigators conclude that a combination of both modalities will provide the necessary screening information to guide subsequent management decisions.The introduction of PET/CT has provided a major boost to image-guided radiation therapy planning and may become the modality of choice in the near future. Increasingly, radiation oncologists have realized the advantages and the future potential of this powerful approach. Understanding the perspectives of the radiation oncologists and their community is crucial for the success of this promising application. In his review, Dr Beriwal provides the readers with an excellent overview of the rationale and applications of PET/CT imaging for radiation therapy planning in breast carcinoma.The future applications of FDG-PET imaging extend well beyond disease staging. Early response to therapy has been an area of significant interest in recent years in a wide array of malignancies and breast carcinoma is no exception. Using [18F]FDG-PET allows for predicting response early in the course of therapy and for identifying nonresponders, therefore, serious side effects can be avoided. Such knowledge enables the clinicians to switch to other therapeutic regimens and therapeutic approaches in a timely fashion. Dr Kumar and colleagues have provided a scholarly review of this important application of FDG-PET imaging in breast cancer.The behavior of breast cancers varies considerably from a slow-growing malignancy that can be managed effectively by locoregional modalities and adjuvant hormone therapy, to rapidly growing incurable disease with widespread metastases at presentation. Functional imaging led by FDG-PET imaging is playing an increasingly important role in defining tumor biology in this unpredictable malignancy. Dr Basu and colleagues have critically reviewed this new and promising application of FDG-PET imaging based on their own experience at the Hospital of the University of Pennsylvania and have reviewed the current literature on this topic. This article complements that of Çermik and colleagues on the present role of FDG-PET imaging in staging breast carcinoma at diagnosis and at different stages of the disease. FDG-PET imaging seems to have a promising role in assessing the extent of disease throughout the course of this cancer, which would allow optimal planning of various therapeutic interventions.Finally, we would like to congratulate and express our gratitude to all the authors. They have made painstaking efforts to communicate in a lucid manner what is truly cutting-edge information that will serve as a useful reference source for the next few years. We sincerely hope that our readers will enjoy reading these articles as much as we have. With the rapid changes taking place in modern medicine, foreseeing the future is a perilous exercise. Nevertheless, such predictions allow strategies to be developed that may improve the outcome to some extent. The second part of the PET Clinics issue on breast cancer deals with the recent developments in breast cancer imaging, especially with regard to PET/computed tomography (CT), and covers a wide range of topics including technological developments and their potential applications, novel PET tracers beyond fluorodeoxyglucose (FDG), and speculation on the newer applications of FDG-PET imaging beyond diagnostic staging. The outstanding groups of investigators who have contributed to this issue have elegantly portrayed the potential future developments and great versatility of this powerful technology. With the growing list of treatment regimens and approaches that are available to oncologists, individualizing treatment in patients with cancer has been a hallmark of the modern clinical practice. Therefore, understanding the tumor biology is of utmost importance to select the appropriate therapy in a particular setting. Dr Mankoff and his associates have focused their review on breast cancer imaging on this important topic. The value of understanding this phenomenon in the management of breast cancer has not yet been fully explored. By elucidating the characteristics of tumor perfusion and angiogenesis, tumor receptor status, tumor proliferation index, multidrug resistance, and novel drug delivery and transport, oncologists may become more successful in selecting the appropriate modes of therapy for furthering patient outcomes as highlighted by this group. Parallel with the development of novel PET tracers, significant strides have been made toward specialized instruments with the aim of providing high-resolution images of this organ. A spatial resolution of about a few millimeters can now be reached with a specialized positron emission mammography (PEM) unit, which continues to evolve. In their review, Dr Zaidi and his associate highlight the recent advances and the advantages in PEM instrumentation and the challenges in adopting this novel approach in a routine clinical setting. Assessment of receptor status in breast cancer is of great interest because of its potential prognostic and therapeutic implications. Tumors expressing estrogen and/or progesterone receptors have a higher likelihood of responding to various hormonal therapeutic agents. Currently, the role of several other receptor imaging techniques in characterizing tumor biology is being explored including somatostatin receptor, gastrin-releasing peptide, and neuropeptide Y. The recent observation of a potential link between the estrogen responsiveness of breast cancer and SSTR2 overexpression is of considerable interest to tumor biologists. Dr Bénard and colleague have dealt with this exciting area of breast cancer research in their in-depth review of this topic. The importance of screening the contralateral breast for occult malignancy in patients with breast cancer has been emphasized in the recent literature. Detection of tumors in the contralateral side allows for effective surgical decision making, planning for reconstructive surgery, and future systemic therapies. The higher incidence of mortality associated with coincident malignancy in the contralateral breast requires aggressive surgical and medical therapeutic interventions in this population. Hence, selecting and defining the optimal imaging modality to screen both breasts is important at the time of initial diagnosis and at the subsequent follow-up studies. Magnetic resonance imaging and FDG-PET/CT can play an invaluable role in achieving high sensitivity and specificity in this clinical setting. Dr Weinstein and colleagues have placed these 2 powerful tools in perspective in their article. These investigators conclude that a combination of both modalities will provide the necessary screening information to guide subsequent management decisions. The introduction of PET/CT has provided a major boost to image-guided radiation therapy planning and may become the modality of choice in the near future. Increasingly, radiation oncologists have realized the advantages and the future potential of this powerful approach. Understanding the perspectives of the radiation oncologists and their community is crucial for the success of this promising application. In his review, Dr Beriwal provides the readers with an excellent overview of the rationale and applications of PET/CT imaging for radiation therapy planning in breast carcinoma. The future applications of FDG-PET imaging extend well beyond disease staging. Early response to therapy has been an area of significant interest in recent years in a wide array of malignancies and breast carcinoma is no exception. Using [18F]FDG-PET allows for predicting response early in the course of therapy and for identifying nonresponders, therefore, serious side effects can be avoided. Such knowledge enables the clinicians to switch to other therapeutic regimens and therapeutic approaches in a timely fashion. Dr Kumar and colleagues have provided a scholarly review of this important application of FDG-PET imaging in breast cancer. The behavior of breast cancers varies considerably from a slow-growing malignancy that can be managed effectively by locoregional modalities and adjuvant hormone therapy, to rapidly growing incurable disease with widespread metastases at presentation. Functional imaging led by FDG-PET imaging is playing an increasingly important role in defining tumor biology in this unpredictable malignancy. Dr Basu and colleagues have critically reviewed this new and promising application of FDG-PET imaging based on their own experience at the Hospital of the University of Pennsylvania and have reviewed the current literature on this topic. This article complements that of Çermik and colleagues on the present role of FDG-PET imaging in staging breast carcinoma at diagnosis and at different stages of the disease. FDG-PET imaging seems to have a promising role in assessing the extent of disease throughout the course of this cancer, which would allow optimal planning of various therapeutic interventions. Finally, we would like to congratulate and express our gratitude to all the authors. They have made painstaking efforts to communicate in a lucid manner what is truly cutting-edge information that will serve as a useful reference source for the next few years. We sincerely hope that our readers will enjoy reading these articles as much as we have.