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Review
. 2021;9(3):221-231.
doi: 10.1007/s40336-021-00426-z. Epub 2021 Apr 27.

Breast cancer: initial workup and staging with FDG PET/CT

David Groheux  1   2 , Elif Hindie  3
Affiliations
Review

Breast cancer: initial workup and staging with FDG PET/CT

David Groheux et al. Clin Transl Imaging. 2021.

Abstract

Purpose: Precise staging is needed to plan optimal management in breast cancer. 18F-fluorodeoxyglucose positron emission tomography coupled with computed tomography (FDG-PET/CT) offers high sensitivity in detecting extra axillary lymph nodes and distant metastases. This review aims to clarify in which groups of patients staging with FDG-PET/CT would be beneficial and should be offered. We also discuss how tumor biology and breast cancer subtypes should be taken into account when interpreting FDG-PET/CT scans.

Methods: We performed a comprehensive literature review and rigorous appraisal of research studies assessing indications for FDG-PET/CT in breast cancer. This assessment regarding breast cancer served as a basis for the recommendations set by a working group of the French Society of Nuclear Medicine, in collaboration with oncological societies, for developing good clinical practice recommendations on the use of FDG-PET/CT in oncology.

Results: FDG-PET/CT is useful for initial staging of breast cancer, independently of tumor phenotype (triple negative, luminal or HER2 +) and regardless of tumor grade. Considering histological subtype, FDG-PET/CT performs better for staging invasive ductal carcinoma, although it is also helpful for staging invasive lobular carcinomas. Based on the available data, FDG-PET/CT becomes useful for staging starting from clinical stage IIB. FDG-PET/CT is possibly useful in patients with clinical stage IIA (T1N1 or T2N0), but there is not enough strong data to recommend routine use in this subgroup. For clinical stage I (T1N0) patients, staging with FDG-PET/CT offers no added value.

Conclusion: FDG-PET/CT is useful for staging patients with breast cancer, starting from clinical stage IIB.

Keywords: Breast cancer; FDG; Initial workup; PET/CT; Staging.

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Conflict of interest statement

Conflict of interestAll the authors (David Groheux and Elif Hindié) declare no conflict of interest.

Figures

Fig. 1
Fig. 1
A 54 years, menopaused woman with an invasive ductal carcinoma of the right breast, grade 3, ER-, PR-, HER2 + . Examination and palpation show a mass of 80 mm, with inflammation of the skin, fixed axillary lymph nodes metastasis and no supraclavicular lymph nodes: TNM classification before PET/CT is cT4d cN2a cM0 (stage IIIB). PET/CT shows the primary breast cancer with axillary lymph nodes (level I, II and III), supra-clavicular and internal mammary lymph nodes: TNM classification after PET/CT is T4 N3c M0 (stage IIIC). PET/CT fusion images show FDG uptake in the primary tumor and in internal mammary lymph nodes
Fig. 2
Fig. 2
Same patient as seen in Fig. 1. PET/CT fusion images show numerous hypermetabolic lymph nodes in the axillary area (level I to level III) and in the supra-clavicular area
Fig. 3
Fig. 3
Patient with a 52-mm invasive ductal carcinoma of left breast and movable axillary lymph node: TNM classification before PET/CT is cT3 cN1 cM0 (stage IIIA). FDG-PET/CT shows high FDG uptake in primary tumor, axillary lymph node, and distant metastases to the sternum and liver: TNM classification after PET/CT is T3 N1 M1 (stage IV). Treatment was adapted to metastatic disease
See this image and copyright information in PMC

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