The impact of PET/CT imaging performed in the early postoperative period on the management of breast cancer patients

Abstract

The aim of the study was to evaluate the role of F-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography (CT) in the early postoperative staging of breast cancer and to document (18)F-FDG PET/CT-based stage alterations and any subsequent impact on management. Between January 2009 and June 2012, PET/CT images of patients with histopathologically proven breast cancer who underwent surgery with no previous chemotherapy or radiotherapy were retrospectively reviewed. Any stage alteration due to a change in nodal or metastatic status on PET/CT was noted. A total of 77 women (median age: 52 years; range: 26-87 years) were included. PET/CT revealed distant metastases that were previously undetected in 12 of the 77 women (15.6%). Of these women, one (8.3%) was diagnosed with stage I, four (33.3%) with stage II, and seven (58.4%) with stage III disease before the PET study. In two patients, lung lesions were diagnosed as metastases by conventional imaging methods, and in one patient the lesions were revealed to have a low probability for malignancy on PET/CT, and they were confirmed as benign on follow-up CT. Thus, changes in disease stage occurred in 15 of 77 (19.5%) patients following PET/CT. The disease was upstaged in 14 patients (18.2%) and downstaged in one (1.3%). The impact of (18)F-FDG PET/CT is highest in newly diagnosed stage III breast cancer because of the identification of previously undetected extra-axillary lymph nodes and distant metastases. Early postoperative (18)F-FDG PET/CT imaging may alter the staging and potentially contribute to the management of these patients.