Role of preoperative 18-FDG- PET/CT in early-stage breast cancer upstaging and modification of treatment

Abstract

Purpose: The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer. Methods: A total of 72 consecutive patients (age: range 24-78 years, mean 51 years), with newly diagnosed operable breast cancer (Infiltrating Ductal carcinoma: Lobular carcinoma: Others - 49:15:8) with tumor size 10-65 mm were examined preoperatively. All patients underwent conventional assessment imaging modalities like mammography, breast/axillary ultrasound and PET/CT. Results: PET/CT identified a primary tumor in all but two patients. PET/CT solely detected unsuspected distant metastases (bones, lung, brain etc) in 9 patients and new primary cancers (endometrium and lung) in another two patients, as well as 11 cases of extra-axillary lymph node involvement. In 6 patients, extra-axillary malignancy was detected by PET/CT only, leading to an upgrade of initial staging in 9% (6/70) and ultimately a modification of planned treatment in 12% (9/70) of patients. PET/CT evaluation led 5 patients of stage II A to stage IV, 3 patients of stage II B to stage IV and 1 patient to Stage IIIB which further modified treatment plan from an adjuvant to a metastatic approach. Conclusion: PET/CT is a valuable tool to provide information on extra-axillary lymph node involvement, distant metastases and other occult primary cancers. Preoperative 18 F fluorodeoxyglucose PET/CT has a substantial impact on initial staging and on clinical management in patients with early-stage breast cancer.