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Groheux D, Vaz SC, de Geus-Oei LF, Dibble EH, Ulaner GA, Cook GJR, Hindié E, Poortmans P, Mann RM, Jacene H, Pilkington Woll JP, Rubio IT, Vrancken Peeters MJ, Graff SL, Cardoso F. 18F-Labeled Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Staging and Restaging Patients With Breast Cancer. J Clin Oncol 2025:JCO2401945. [PMID: 40132148 DOI: 10.1200/jco-24-01945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 12/17/2024] [Accepted: 02/06/2025] [Indexed: 03/27/2025] Open
Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
- University Paris-Diderot, INSERM U976, Paris, France
- Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France
| | - Sofia C Vaz
- Department of Nuclear Medicine and Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
- Department of Radiation Science & Technology, Delft University of Technology, the Netherlands
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Gary A Ulaner
- Department of Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA
- Departments of Radiology and Translational Genomics, University of Southern Caliifornia, Los Angeles, CA
| | - Gary J R Cook
- Department of Cancer Imaging, King's College London, London, United Kingdom
- King's College London and Guy's & St Thomas' PET Centre, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Elif Hindié
- Department of Nuclear Medicine, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
- Institut Universitaire de France (IUF), Paris, France
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Heather Jacene
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Isabel T Rubio
- Department of Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
- Cancer Center Clinica Universidad de Navarra, Spain
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Stephanie L Graff
- Brown University Health Cancer Institute, Providence, RI
- Legorreta Cancer Center at Brown University, Providence, RI
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
- Advanced Breast Cancer Global Alliance, Lisbon, Portugal
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Gerke O, Naghavi-Behzad M, Nygaard ST, Sigaroudi VR, Vogsen M, Vach W, Hildebrandt MG. Diagnosing Bone Metastases in Breast Cancer: A Systematic Review and Network Meta-Analysis on Diagnostic Test Accuracy Studies of 2-[ 18F]FDG-PET/CT, 18F-NaF-PET/CT, MRI, Contrast-Enhanced CT, and Bone Scintigraphy. Semin Nucl Med 2025; 55:137-151. [PMID: 39547916 DOI: 10.1053/j.semnuclmed.2024.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/09/2024] [Accepted: 10/10/2024] [Indexed: 11/17/2024]
Abstract
This systematic review and network meta-analysis aimed to compare the diagnostic accuracy of 2-[18F]FDG-PET/CT, 18F-NaF-PET/CT, MRI, contrast-enhanced CT, and bone scintigraphy for diagnosing bone metastases in patients with breast cancer. Following PRISMA-DTA guidelines, we reviewed studies assessing 2-[18F]FDG-PET/CT, 18F-NaF-PET/CT, MRI, contrast-enhanced CT, and bone scintigraphy for diagnosing bone metastases in high-stage primary breast cancer (stage III or IV) or known primary breast cancer with suspicion of recurrence (staging or re-staging). A comprehensive search of MEDLINE/PubMed, Scopus, and Embase was conducted until February 2024. Inclusion criteria were original studies using these imaging methods, excluding those focused on AI/machine learning, primary breast cancer without metastases, mixed cancer types, preclinical studies, and lesion-based accuracy. Preference was given to studies using biopsy or follow-up as the reference standard. Risk of bias was assessed using QUADAS-2. Screening, bias assessment, and data extraction were independently performed by two researchers, with discrepancies resolved by a third. We applied bivariate random-effects models in meta-analysis and network meta-analyzed differences in sensitivity and specificity between the modalities. Forty studies were included, with 29 contributing to the meta-analyses. Of these, 13 studies investigated one single modality only. Both 2-[18F]FDG-PET/CT (sensitivity: 0.94, 95% CI: 0.89-0.97; specificity: 0.98, 95% CI: 0.96-0.99), MRI (0.94, 0.82-0.98; 0.93, 0.87-0.96), and 18F-NaF-PET/CT (0.95, 0.85-0.98; 1, 0.93-1) outperformed the less sensitive modalities CE-CT (0.70, 0.62-0.77; 0.98, 0.97-0.99) and bone scintigraphy (0.83, 0.75-0.88; 0.96, 0.87-0.99). The network meta-analysis of multi-modality studies supports the comparable performance of 2-[18F]FDG-PET/CT and MRI in diagnosing bone metastases (estimated differences in sensitivity and specificity, respectively: 0.01, -0.16 - 0.18; -0.02, -0.15 - 0.12). The results from bivariate random effects modelling and network meta-analysis were consistent for all modalities apart from 18F-NaF-PET/CT. We concluded that 2-[18F]FDG-PET/CT and MRI have high and comparable accuracy for diagnosing bone metastases in breast cancer patients. Both outperformed CE-CT and bone scintigraphy regarding sensitivity. Future multimodality studies based on consented thresholds are warranted for further exploration, especially in terms of the potential role of 18F-NaF-PET/CT in bone metastasis diagnosis in breast cancer.
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Affiliation(s)
- Oke Gerke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
| | - Mohammad Naghavi-Behzad
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark
| | - Sofie Tind Nygaard
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Marianne Vogsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Werner Vach
- Basel Academy for Quality and Research in Medicine, Basel, Switzerland
| | - Malene Grubbe Hildebrandt
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Centre for Personalized Response Monitoring in Oncology, Odense University Hospital, Odense, Denmark; Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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Cao JQ, Surgeoner B, Manna M, Boileau JF, Gelmon KA, Brackstone M, Brezden-Masley C, Jerzak KJ, Prakash I, Sehdev S, Wong SM, Bouganim N, Cescon DW, Chia S, Dayes IS, Joy AA, Henning JW. Guidance for Canadian Breast Cancer Practice: National Consensus Recommendations for Clinical Staging of Patients Newly Diagnosed with Breast Cancer. Curr Oncol 2024; 31:7226-7243. [PMID: 39590163 PMCID: PMC11592626 DOI: 10.3390/curroncol31110533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 11/05/2024] [Accepted: 11/12/2024] [Indexed: 11/28/2024] Open
Abstract
The accurate staging of breast cancer is fundamental for guiding treatment decisions and predicting patient outcomes. However, there can be considerable variation in routine clinical practice based on individual interpretation of guidelines and depending on the healthcare provider initially involved in working up patients newly diagnosed with breast cancer, ranging from primary care providers, triage nurses, surgeons, and/or oncologists. The optimal approach for clinical staging, particularly in asymptomatic patients presenting with intermediate-risk disease, remains a topic of dialogue among clinicians. Given this area of uncertainty, the Research Excellence, Active Leadership (REAL) Canadian Breast Cancer Alliance conducted a modified Delphi process to assess the level of agreement among Canadian expert clinicians on various staging recommendations. In total, 20 items were drafted covering staging based on biological status, the utilization of localization clips, both for the axilla during diagnosis and primary surgical site for margins and radiation therapy planning, and the use of advanced imaging for the investigation of distant metastases. Overall, the consensus threshold among all participants (i.e., ≥75% agreement) was reached in 20/20 items. Differences in clinical practice and recent findings from the literature are provided in the discussion. These consensus recommendations are meant to help standardize breast cancer staging practices in Canada, ensuring accurate diagnosis and optimal treatment planning.
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Affiliation(s)
- Jeffrey Q. Cao
- Arthur Child Comprehensive Cancer Centre, Calgary, AB T2N 5G2, Canada
| | | | - Mita Manna
- Saskatoon Cancer Centre, Saskatoon, SK S7N 4H4, Canada
| | | | - Karen A. Gelmon
- Department of Medical Oncology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | | | | | | | | | - Sandeep Sehdev
- The Ottawa Hospital Cancer Centre, Ottawa, ON K1H 8L6, Canada
| | | | | | - David W. Cescon
- Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Stephen Chia
- BC Cancer—Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Ian S. Dayes
- Juravinski Cancer Center, McMaster University, Hamilton, ON L8V 5C2, Canada
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Edmonds CE, O'Brien SR, McDonald ES, Mankoff DA, Pantel AR. PET Imaging of Breast Cancer: Current Applications and Future Directions. JOURNAL OF BREAST IMAGING 2024; 6:586-600. [PMID: 39401324 DOI: 10.1093/jbi/wbae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Indexed: 11/07/2024]
Abstract
As molecular imaging use expands for patients with breast cancer, it is important for breast radiologists to have a basic understanding of molecular imaging, including PET. Although breast radiologists may not directly interpret such studies, basic knowledge of molecular imaging will enable the radiologist to better direct diagnostic workup of patients as well as discuss diagnostic imaging with the patient and other treating physicians. Several new tracers are now available to complement imaging glucose metabolism with FDG. Because it provides a noninvasive assessment of disease status across the whole body, PET offers specific advantages over tissue-based assays. Paired with targeted therapy, molecular imaging has the potential to guide personalized treatment of breast cancer, including guiding dosing during drug trials as well as predicting and assessing clinical response. This review discusses the current established applications of FDG, which remains the most widely used PET radiotracer for malignancy, including breast cancer, and highlights potential areas for expanded use based on recent research. It also summarizes research to date on the U.S. Food and Drug Administration (FDA)-approved PET tracer 16α-18F-fluoro-17β-estradiol (FES), which targets ER, including the current guidelines from the Society of Nuclear Medicine and Molecular Imaging on the appropriate use of FES-PET/CT for breast cancer as well as areas of active investigation for other potential applications. Finally, the review highlights several of the most promising novel PET tracers that are poised for clinical translation in the near future.
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Affiliation(s)
- Christine E Edmonds
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sophia R O'Brien
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth S McDonald
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David A Mankoff
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Austin R Pantel
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Groheux D, Vaz SC, Poortmans P, Mann RM, Ulaner GA, Cook GJR, Hindié E, Pilkington Woll JP, Jacene H, Rubio IT, Vrancken Peeters MJ, Dibble EH, de Geus-Oei LF, Graff SL, Cardoso F. Role of [ 18F]FDG PET/CT in patients with invasive breast carcinoma of no special type: Literature review and comparison between guidelines. Breast 2024; 78:103806. [PMID: 39303572 PMCID: PMC11440802 DOI: 10.1016/j.breast.2024.103806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/29/2024] [Accepted: 09/07/2024] [Indexed: 09/22/2024] Open
Abstract
PURPOSE The recently released EANM/SNMMI guideline, endorsed by several important clinical and imaging societies in the field of breast cancer (BC) care (ACR, ESSO, ESTRO, EUSOBI/ESR, EUSOMA), emphasized the role of [18F]FDG PET/CT in management of patients with no special type (NST) BC. This review identifies and summarizes similarities, discrepancies and novelties of the EANM/SNMMI guideline compared to NCCN, ESMO and ABC recommendations. METHODS The EANM/SNMMI guideline was based on a systematic literature search and the AGREE tool. The level of evidence was determined according to NICE criteria, and 85 % agreement or higher was reached regarding each statement. Comparisons with NCCN, ESMO and ABC guidelines were examined for specific clinical scenarios in patients with early stage through advanced and metastatic BC. RESULTS Regarding initial staging of patients with NST BC, [18F]FDG PET/CT is the preferred modality in the EANM-SNMMI guideline, showing superiority as a single modality to a combination of contrast-enhanced CT of thorax-abdomen-pelvis plus bone scan in head-to-head comparisons and a randomized study. Its use is recommended in patients with clinical stage IIB or higher and may be useful in certain stage IIA cases of NST BC. In NCCN, ESMO, and ABC guidelines, [18F]FDG PET/CT is instead recommended as complementary to conventional imaging to solve inconclusive findings, although ESMO and ABC also suggest [18F]FDG PET/CT can replace conventional imaging for staging patients with high-risk and metastatic NST BC. During follow up, NCCN and ESMO only recommend diagnostic imaging if there is suspicion of recurrence. Similarly, EANM-SNMMI states that [18F]FDG PET/CT is useful to detect the site and extent of recurrence only when there is clinical or laboratory suspicion of recurrence, or when conventional imaging methods are equivocal. The EANM-SNMMI guideline is the first to emphasize a role of [18F]FDG PET/CT for assessing early metabolic response to primary systemic therapy, particularly for HER2+ BC and TNBC. In the metastatic setting, EANM-SNMMI state that [18F]FDG PET/CT may help evaluate bone metastases and determine early response to treatment, in agreement with guidelines from ESMO. CONCLUSIONS The recently released EANM/SNMMI guideline reinforces the role of [18F]FDG PET/CT in the management of patients with NST BC supported by extensive evidence of its utility in several clinical scenarios.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM, U976, Paris, France; Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France.
| | - Sofia C Vaz
- Department of Nuclear Medicine and Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Ritse M Mann
- Department of Radiology, Radboud umc, Nijmegen, the Netherlands
| | - Gary A Ulaner
- Department of Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, United States; Departments of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, United States
| | - Gary J R Cook
- Department of Cancer Imaging, King's College London, London, UK; King's College London and Guy's & St Thomas' PET Centre, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Elif Hindié
- Department of Nuclear Medicine, Bordeaux University Hospital, Bordeaux, France
| | | | - Heather Jacene
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, and Harvard Medical School, United States
| | - Isabel T Rubio
- Department of Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Cancer Center Clinica Universidad de Navarra, Spain
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands; Department of Radiation Science & Technology, Delft University of Technology, Delft, the Netherlands
| | - Stephanie L Graff
- Lifespan Cancer Institute, Providence, RI, United States; Legorreta Cancer Center at Brown University, Providence, RI, United States
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
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Cardoso F, Paluch-Shimon S, Schumacher-Wulf E, Matos L, Gelmon K, Aapro MS, Bajpai J, Barrios CH, Bergh J, Bergsten-Nordström E, Biganzoli L, Cardoso MJ, Carey LA, Chavez-MacGregor M, Chidebe R, Cortés J, Curigliano G, Dent RA, El Saghir NS, Eniu A, Fallowfield L, Francis PA, Franco Millan SX, Gilchrist J, Gligorov J, Gradishar WJ, Haidinger R, Harbeck N, Hu X, Kaur R, Kiely B, Kim SB, Koppikar S, Kuper-Hommel MJJ, Lecouvet FE, Mason G, Mertz SA, Mueller V, Myerson C, Neciosup S, Offersen BV, Ohno S, Pagani O, Partridge AH, Penault-Llorca F, Prat A, Rugo HS, Senkus E, Sledge GW, Swain SM, Thomssen C, Vorobiof DA, Vuylsteke P, Wiseman T, Xu B, Costa A, Norton L, Winer EP. 6th and 7th International consensus guidelines for the management of advanced breast cancer (ABC guidelines 6 and 7). Breast 2024; 76:103756. [PMID: 38896983 PMCID: PMC11231614 DOI: 10.1016/j.breast.2024.103756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
This manuscript describes the Advanced Breast Cancer (ABC) international consensus guidelines updated at the last two ABC international consensus conferences (ABC 6 in 2021, virtual, and ABC 7 in 2023, in Lisbon, Portugal), organized by the ABC Global Alliance. It provides the main recommendations on how to best manage patients with advanced breast cancer (inoperable locally advanced or metastatic), of all breast cancer subtypes, as well as palliative and supportive care. These guidelines are based on available evidence or on expert opinion when a higher level of evidence is lacking. Each guideline is accompanied by the level of evidence (LoE), grade of recommendation (GoR) and percentage of consensus reached at the consensus conferences. Updated diagnostic and treatment algorithms are also provided. The guidelines represent the best management options for patients living with ABC globally, assuming accessibility to all available therapies. Their adaptation (i.e. resource-stratified guidelines) is often needed in settings where access to care is limited.
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Affiliation(s)
- Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, and ABC Global Alliance, Lisbon, Portugal.
| | - Shani Paluch-Shimon
- Hadassah University Hospital - Sharett Institute of Oncology, Jerusalem, Israel
| | | | - Leonor Matos
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - Karen Gelmon
- BC Cancer Agency, Department of Medical Oncology, Vancouver, Canada
| | - Matti S Aapro
- Cancer Center, Clinique de Genolier, Genolier, Switzerland
| | | | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Grupo Oncoclínicas, Porto Alegre, Brazil
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Laura Biganzoli
- Department of Oncology, Hospital of Prato - Azienda USL Toscana Centro Prato, Italy and European Society of Breast Cancer Specialists (EUSOMA), Italy
| | - Maria João Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation and Lisbon University, Faculty of Medicine, Lisbon, Portugal
| | - Lisa A Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - Mariana Chavez-MacGregor
- Health Services Research, Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, USA and American Society of Clinical Oncology (ASCO), Houston, USA
| | | | - Javier Cortés
- International Breast Cancer Center (IBCC), Madrid and Barcelona, Spain
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | | | - Nagi S El Saghir
- NK Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alexandru Eniu
- Hôpital Riviera-Chablais, Vaud-Valais Rennaz, Switzerland and European School of Oncology (ESO), United Kingdom
| | - Lesley Fallowfield
- Brighton & Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | | | | | - Joseph Gligorov
- Department of Medical Oncology, Cancer Est APHP Tenon, University Paris VI, Nice/St Paul Guidelines, Paris, France
| | - William J Gradishar
- Northwestern Medicine, Illinois, USA and National Comprehensive Cancer Network (NCCN), USA
| | | | - Nadia Harbeck
- Breast Centre, University of Munich, Munich and Arbeitsgemeinschaft Gynäkologische Onkologie, Kommission Mamma (AGO Guidelines), Germany
| | - Xichun Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ranjit Kaur
- Breast Cancer Welfare Association, Petaling Jaya, Malaysia
| | - Belinda Kiely
- NHMRC Clinical Trials Centre, Sydney Medical School, Sydney, Australia
| | - Sung-Bae Kim
- Asan Medical Centre, Department of Oncology, Seoul, South Korea
| | - Smruti Koppikar
- Lilavati Hospital and Research Centre, Bombay Hospital Institute of Medical Sciences, Asian Cancer Institute, Mumbai, India
| | - Marion J J Kuper-Hommel
- Te Whatu Ora Waikato, Midland Regional Cancer Centre, NZ ABC Guidelines, Hamilton, New Zealand
| | - Frédéric E Lecouvet
- Department of Radiology, Institut Roi Albert II and Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ginny Mason
- Inflammatory Breast Cancer Research Foundation, West Lafayette, USA
| | - Shirley A Mertz
- MBC US Alliance and Metastatic Breast Cancer Network US, Inverness, USA
| | - Volkmar Mueller
- University Medical Center Hamburg-Eppendorf, Hamburg and Arbeitsgemeinschaft Gynäkologische Onkologie, Kommission Mamma (AGO Guidelines), Germany
| | | | - Silvia Neciosup
- Department of Medical Oncology, National Institute of Neoplastic Diseases, Lima, ABC Latin America Guidelines, Peru
| | - Birgitte V Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, European Society for Radiotherapy and Oncology (ESTRO), Denmark
| | - Shinji Ohno
- Breast Oncology Centre, Cancer Institute Hospital, Tokyo, Japan
| | - Olivia Pagani
- Hôpital Riviera-Chablais, Vaud-Valais Rennaz, Switzerland
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Department of Medical Oncology and Division of Breast Oncology, Boston, USA and American Society of Clinical Oncology (ASCO), USA
| | - Frédérique Penault-Llorca
- Centre Jean Perrin, Université Clermont Auvergne, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, F-63000, Clermont Ferrand, Nice/St Paul Guidelines, France
| | - Aleix Prat
- Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Hope S Rugo
- Breast Oncology and Clinical Trials Education, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - Elzbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - George W Sledge
- Division of Oncology, Stanford School of Medicine, Stanford, USA
| | - Sandra M Swain
- Georgetown University Lombardi Comprehensive Cancer Center and MedStar Health, Washington DC, USA
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale) and Arbeitsgemeinschaft Gynäkologische Onkologie, Kommission Mamma (AGO Guidelines), Germany
| | | | - Peter Vuylsteke
- University of Botswana, Gaborone, Botswana and CHU UCL Namur Hospital, UCLouvain, Belgium
| | - Theresa Wiseman
- The Royal Marsden NHS Foundation Trust, University of Southampton, United Kingdom and European Oncology Nursing Society (EONS), United Kingdom
| | - Binghe Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Alberto Costa
- European School of Oncology, Milan, Italy and Bellinzona, Switzerland
| | - Larry Norton
- Breast Cancer Programs, Memorial Sloan-Kettering Cancer Centre, New York, USA
| | - Eric P Winer
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
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7
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Vaz SC, Woll JPP, Cardoso F, Groheux D, Cook GJR, Ulaner GA, Jacene H, Rubio IT, Schoones JW, Peeters MJV, Poortmans P, Mann RM, Graff SL, Dibble EH, de Geus-Oei LF. Joint EANM-SNMMI guideline on the role of 2-[ 18F]FDG PET/CT in no special type breast cancer : (endorsed by the ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA). Eur J Nucl Med Mol Imaging 2024; 51:2706-2732. [PMID: 38740576 PMCID: PMC11224102 DOI: 10.1007/s00259-024-06696-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/20/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION There is much literature about the role of 2-[18F]FDG PET/CT in patients with breast cancer (BC). However, there exists no international guideline with involvement of the nuclear medicine societies about this subject. PURPOSE To provide an organized, international, state-of-the-art, and multidisciplinary guideline, led by experts of two nuclear medicine societies (EANM and SNMMI) and representation of important societies in the field of BC (ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA). METHODS Literature review and expert discussion were performed with the aim of collecting updated information regarding the role of 2-[18F]FDG PET/CT in patients with no special type (NST) BC and summarizing its indications according to scientific evidence. Recommendations were scored according to the National Institute for Health and Care Excellence (NICE) criteria. RESULTS Quantitative PET features (SUV, MTV, TLG) are valuable prognostic parameters. In baseline staging, 2-[18F]FDG PET/CT plays a role from stage IIB through stage IV. When assessing response to therapy, 2-[18F]FDG PET/CT should be performed on certified scanners, and reported either according to PERCIST, EORTC PET, or EANM immunotherapy response criteria, as appropriate. 2-[18F]FDG PET/CT may be useful to assess early metabolic response, particularly in non-metastatic triple-negative and HER2+ tumours. 2-[18F]FDG PET/CT is useful to detect the site and extent of recurrence when conventional imaging methods are equivocal and when there is clinical and/or laboratorial suspicion of relapse. Recent developments are promising. CONCLUSION 2-[18F]FDG PET/CT is extremely useful in BC management, as supported by extensive evidence of its utility compared to other imaging modalities in several clinical scenarios.
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Affiliation(s)
- Sofia C Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal.
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - David Groheux
- Nuclear Medicine Department, Saint-Louis Hospital, Paris, France
- University Paris-Diderot, INSERM U976, Paris, France
- Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France
| | - Gary J R Cook
- Department of Cancer Imaging, King's College London, London, UK
- King's College London and Guy's & St Thomas' PET Centre, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, USA
- University of Southern California, Los Angeles, CA, USA
| | - Heather Jacene
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Cancer Center Clinica Universidad de Navarra, Navarra, Spain
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium
- University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Ritse M Mann
- Radiology Department, RadboudUMC, Nijmegen, The Netherlands
| | - Stephanie L Graff
- Lifespan Cancer Institute, Providence, Rhode Island, USA
- Legorreta Cancer Center at Brown University, Providence, Rhode Island, USA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands.
- Department of Radiation Science & Technology, Technical University of Delft, Delft, The Netherlands.
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8
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Diwanji D, Onishi N, Hathi DK, Lawhn-Heath C, Kornak J, Li W, Guo R, Molina-Vega J, Seo Y, Flavell RR, Heditsian D, Brain S, Esserman LJ, Joe BN, Hylton NM, Jones EF, Ray KM. 18F-FDG Dedicated Breast PET Complementary to Breast MRI for Evaluating Early Response to Neoadjuvant Chemotherapy. Radiol Imaging Cancer 2024; 6:e230082. [PMID: 38551406 PMCID: PMC10988337 DOI: 10.1148/rycan.230082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/30/2023] [Accepted: 02/16/2024] [Indexed: 04/02/2024]
Abstract
Purpose To compare quantitative measures of tumor metabolism and perfusion using fluorine 18 (18F) fluorodeoxyglucose (FDG) dedicated breast PET (dbPET) and breast dynamic contrast-enhanced (DCE) MRI during early treatment with neoadjuvant chemotherapy (NAC). Materials and Methods Prospectively collected DCE MRI and 18F-FDG dbPET examinations were analyzed at baseline (T0) and after 3 weeks (T1) of NAC in 20 participants with 22 invasive breast cancers. FDG dbPET-derived standardized uptake value (SUV), metabolic tumor volume, and total lesion glycolysis (TLG) and MRI-derived percent enhancement (PE), signal enhancement ratio (SER), and functional tumor volume (FTV) were calculated at both time points. Differences between FDG dbPET and MRI parameters were evaluated after stratifying by receptor status, Ki-67 index, and residual cancer burden. Parameters were compared using Wilcoxon signed rank and Mann-Whitney U tests. Results High Ki-67 tumors had higher baseline SUVmean (difference, 5.1; P = .01) and SUVpeak (difference, 5.5; P = .04). At T1, decreases were observed in FDG dbPET measures (pseudo-median difference T0 minus T1 value [95% CI]) of SUVmax (-6.2 [-10.2, -2.6]; P < .001), SUVmean (-2.6 [-4.9, -1.3]; P < .001), SUVpeak (-4.2 [-6.9, -2.3]; P < .001), and TLG (-29.1 mL3 [-71.4, -6.8]; P = .005) and MRI measures of SERpeak (-1.0 [-1.3, -0.2]; P = .02) and FTV (-11.6 mL3 [-22.2, -1.7]; P = .009). Relative to nonresponsive tumors, responsive tumors showed a difference (95% CI) in percent change in SUVmax of -34.3% (-55.9%, 1.5%; P = .06) and in PEpeak of -42.4% (95% CI: -110.5%, 8.5%; P = .08). Conclusion 18F-FDG dbPET was sensitive to early changes during NAC and provided complementary information to DCE MRI that may be useful for treatment response evaluation. Keywords: Breast, PET, Dynamic Contrast-enhanced MRI Clinical trial registration no. NCT01042379 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Devan Diwanji
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Natsuko Onishi
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Deep K. Hathi
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Courtney Lawhn-Heath
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - John Kornak
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Wen Li
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Ruby Guo
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Julissa Molina-Vega
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Youngho Seo
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Robert R. Flavell
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Diane Heditsian
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Susie Brain
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Laura J. Esserman
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Bonnie N. Joe
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Nola M. Hylton
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Ella F. Jones
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Kimberly M. Ray
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
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9
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Cecil K, Huppert L, Mukhtar R, Dibble EH, O'Brien SR, Ulaner GA, Lawhn-Heath C. Metabolic Positron Emission Tomography in Breast Cancer. PET Clin 2023; 18:473-485. [PMID: 37369614 DOI: 10.1016/j.cpet.2023.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Metabolic PET, most commonly 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT), has had a major impact on the imaging of breast cancer and can have important clinical applications in appropriate patients. While limited for screening, FDG PET/CT outperforms conventional imaging in locally advanced breast cancer. FDG PET/CT is more sensitive than conventional imaging in assessing treatment response, accurately predicting complete response or nonresponse in early-stage cases. It also aids in determining disease extent and treatment response in the metastatic setting. Further research, including randomized controlled trials with FDG and other metabolic agents such as fluciclovine, is needed for optimal breast cancer imaging.
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Affiliation(s)
- Katherine Cecil
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Laura Huppert
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Rita Mukhtar
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Sophia R O'Brien
- Divisions of Molecular Imaging and Therapy Breast Imaging, Department of Radiology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Irvine, CA, USA; Departments of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | - Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
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10
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Groheux D. Breast Cancer Systemic Staging (Comparison of Computed Tomography, Bone Scan, and 18F-Fluorodeoxyglucose PET/Computed Tomography). PET Clin 2023; 18:503-515. [PMID: 37268506 DOI: 10.1016/j.cpet.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
After an overview of the principles of bone scintigraphy, contrast-enhanced computed tomography (CE-CT) and 18F-fluorodeoxyglucose (FDG)-PET/CT, the advantages and limits of these modalities in the staging of breast cancer are discussed in this paper. CT and PET/CT are not optimal for delineating primary tumor volume, and PET is less efficient than the sentinel node biopsy to depict small axillary lymph node metastases. In large breast cancer tumor, FDG PET/CT is useful to show extra-axillary lymph nodes. FDG PET/CT is superior to bone scan and CE-CT in detecting distant metastases, and it results in a change of treatment plan in nearly 15% of patients.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM U976, HIPI, Paris, France; Centre d'Imagerie Radio-isotopique, La Rochelle, France.
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11
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Vaz SC, Oliveira C, Teixeira R, Arias-Bouda LMP, Cardoso MJ, de Geus-Oei LF. The current role of nuclear medicine in breast cancer. Br J Radiol 2023; 96:20221153. [PMID: 37097285 PMCID: PMC10461286 DOI: 10.1259/bjr.20221153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 04/26/2023] Open
Abstract
Breast cancer is the most common cancer in females worldwide. Nuclear medicine plays an important role in patient management, not only in initial staging, but also during follow-up. Radiopharmaceuticals to study breast cancer have been used for over 50 years, and several of these are still used in clinical practice, according to the most recent guideline recommendations.In this critical review, an overview of nuclear medicine procedures used during the last decades is presented. Current clinical indications of each of the conventional nuclear medicine and PET/CT examinations are the focus of this review, and are objectively provided. Radionuclide therapies are also referred, mainly summarising the methods to palliate metastatic bone pain. Finally, recent developments and future perspectives in the field of nuclear medicine are discussed. In this context, the promising potential of new radiopharmaceuticals not only for diagnosis, but also for therapy, and the use of quantitative imaging features as potential biomarkers, are addressed.Despite the long way nuclear medicine has gone through, it looks like it will continue to benefit clinical practice, paving the way to improve healthcare provided to patients with breast cancer.
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Affiliation(s)
| | - Carla Oliveira
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Ricardo Teixeira
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
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12
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Dayes IS, Metser U, Hodgson N, Parpia S, Eisen AF, George R, Blanchette P, Cil TD, Arnaout A, Chan A, Levine MN. Impact of 18F-Labeled Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Versus Conventional Staging in Patients With Locally Advanced Breast Cancer. J Clin Oncol 2023; 41:3909-3916. [PMID: 37235845 DOI: 10.1200/jco.23.00249] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Patients with locally advanced breast cancer (LABC) typically undergo staging tests at presentation. If staging does not detect metastases, treatment consists of curative intent combined modality therapy (neoadjuvant chemotherapy, surgery, and regional radiation). Positron emission tomography-computed tomography (PET-CT) may detect more asymptomatic distant metastases, but the evidence is based on uncontrolled studies. METHODS For inclusion, patients had histological evidence of invasive ductal carcinoma of the breast and TNM stage III or IIb (T3N0, but not T2N1). Consenting patients from six regional cancer centers in Ontario were randomly assigned to 18F-labeled fluorodeoxyglucose PET-CT or conventional staging (bone scan, CT of the chest/abdomen and pelvis). The primary end point was upstaging to stage IV. A key secondary outcome was receiving curative intent combined modality therapy (ClinicalTrials.gov identifier: NCT02751710). RESULTS Between December 2016 and April 2022, 184 patients were randomly assigned to whole-body PET-CT and 185 patients to conventional staging. Forty-three (23%) PET-CT patients were upstaged to stage IV compared with 21 (11%) conventional staged patients (absolute difference, 12.3% [95% CI, 3.9 to 19.9]; P = .002). Consequently, treatment was changed in 35 (81.3%) of 43 upstaged PET-CT patients and 20 (95.2%) of the 21 upstaged conventional patients. Subsequently, 149 (81%) patients in the PET-CT group received combined modality treatment versus 165 (89.2%) patients in the conventional staging group (absolute difference, 8.2% [95% CI, 0.1 to 15.4]; P = .03). CONCLUSION In patients with LABC, PET-CT detected more distant metastases than conventional staging, and fewer PET-CT patients received combined modality therapy. Our randomized trial demonstrates the utility of the PET-CT staging strategy.
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Affiliation(s)
- Ian S Dayes
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Juravinski Cancer Centre-Hamilton Health Sciences, Hamilton, ON, Canada
- Ontario Clinical Oncology Group, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- University Health Network Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nicole Hodgson
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Sameer Parpia
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Ontario Clinical Oncology Group, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - Andrea F Eisen
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, ON, Canada
- Ontario Health, Toronto, ON, Canada
| | - Ralph George
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- St Michael's Hospital, Toronto, ON, Canada
| | - Phillip Blanchette
- Department of Oncology, Western University, London, ON, Canada
- London Health Sciences Regional Cancer Program, London, ON, Canada
| | - Tulin D Cil
- University Health Network Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Angel Arnaout
- Department of Surgery, Ottawa University, Ottawa, ON, Canada
- Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Adrien Chan
- Northern Ontario School of Medicine, Thunder Bay ON, Canada
- Thunder Bay Regional Health Sciences Cancer Centre, Thunder Bay, ON, Canada
| | - Mark N Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Juravinski Cancer Centre-Hamilton Health Sciences, Hamilton, ON, Canada
- Ontario Clinical Oncology Group, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
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13
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Groheux D, Ulaner GA, Hindie E. Breast cancer: treatment response assessment with FDG-PET/CT in the neoadjuvant and in the metastatic setting. Clin Transl Imaging 2023; 11:439-452. [DOI: 10.1007/s40336-023-00584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/10/2023] [Indexed: 01/03/2025]
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14
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Ulaner GA. Breast Cancer and Physiologic Avidity From Breast Feeding on FDG PET/CT. Clin Nucl Med 2023; 48:420-421. [PMID: 36800273 DOI: 10.1097/rlu.0000000000004491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
ABSTRACT A 35-year-old woman presented with breast cancer diagnosed during pregnancy. Eleven days after delivery, the patient underwent FDG PET/CT for systemic staging. Avidity was seen diffusely in both breasts, with a more avid focus at the site of a biopsy clip in the right breast. There were no lymph nodes or distant metastases. The patient was actively breast feeding, explaining the diffuse breast avidity. This case demonstrates both malignant and benign FDG avidity in the breasts at the same time, with a focal FDG-avid right breast malignancy identified among bilateral breast parenchyma with elevated physiologic FDG-avid secondary to breast feeding.
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15
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Zhang-Yin J. State of the Art in 2022 PET/CT in Breast Cancer: A Review. J Clin Med 2023; 12:968. [PMID: 36769616 PMCID: PMC9917740 DOI: 10.3390/jcm12030968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
Molecular imaging with positron emission tomography is a powerful and well-established tool in breast cancer management. In this review, we aim to address the current place of the main PET radiopharmaceuticals in breast cancer care and offer perspectives on potential future radiopharmaceutical and technological advancements. A special focus is given to the following: the role of 18F-fluorodeoxyglucose positron emission tomography in the clinical management of breast cancer patients, especially during staging; detection of recurrence and evaluation of treatment response; the role of 16α-18Ffluoro-17β-oestradiol positron emission tomography in oestrogen receptors positive breast cancer; the promising radiopharmaceuticals, such as 89Zr-trastuzumab and 68Ga- or 18F-labeled fibroblast activation protein inhibitor; and the application of artificial intelligence.
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Affiliation(s)
- Jules Zhang-Yin
- Department of Nuclear Medicine, Clinique Sud Luxembourg, Vivalia, B-6700 Arlon, Belgium
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16
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Sapon-Cousineau S, Moldoveanu D, Charpentier D, Gagnon A, Patocskai É. Locally advanced breast cancer arising in the axilla. J Surg Case Rep 2022; 2022:rjac425. [PMID: 36131807 PMCID: PMC9486583 DOI: 10.1093/jscr/rjac425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/25/2022] [Indexed: 11/12/2022] Open
Abstract
Locally advanced breast cancer arising from ectopic axillary breast tissue is an unusual presentation of this malignancy. The work-up and treatment approach pose some unique challenges. We present the case of a 37-year-old female presenting with a left axillary lesion with skin involvement. Radiological studies and biopsy demonstrated an underlying axillary mass compatible with a triple-positive invasive ductal carcinoma of the breast. Following neoadjuvant therapy, the patient underwent nipple-sparing mastectomy with wide local excision of the involved axillary skin and axillary lymph node dissection. Ectopic locally advanced breast cancer can be treated similarly to its orthotopic counterpart, favoring a neoadjuvant therapy approach followed by surgical excision. Special considerations include the local anatomy of the tumor, the extent of surgery and reconstructive options.
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Affiliation(s)
| | | | | | - Alain Gagnon
- Centre Hospitalier de l'Université de Montréal , Montréal, QC , Canada
| | - Érica Patocskai
- Centre Hospitalier de l'Université de Montréal , Montréal, QC , Canada
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17
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Edmonds CE, O'Brien SR, Mankoff DA, Pantel AR. Novel applications of molecular imaging to guide breast cancer therapy. Cancer Imaging 2022; 22:31. [PMID: 35729608 PMCID: PMC9210593 DOI: 10.1186/s40644-022-00468-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
The goals of precision oncology are to provide targeted drug therapy based on each individual’s specific tumor biology, and to enable the prediction and early assessment of treatment response to allow treatment modification when necessary. Thus, precision oncology aims to maximize treatment success while minimizing the side effects of inadequate or suboptimal therapies. Molecular imaging, through noninvasive assessment of clinically relevant tumor biomarkers across the entire disease burden, has the potential to revolutionize clinical oncology, including breast oncology. In this article, we review breast cancer positron emission tomography (PET) imaging biomarkers for providing early response assessment and predicting treatment outcomes. For 2-18fluoro-2-deoxy-D-glucose (FDG), a marker of cellular glucose metabolism that is well established for staging multiple types of malignancies including breast cancer, we highlight novel applications for early response assessment. We then review current and future applications of novel PET biomarkers for imaging the steroid receptors, including the estrogen and progesterone receptors, the HER2 receptor, cellular proliferation, and amino acid metabolism.
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Affiliation(s)
- Christine E Edmonds
- Department of Radiology, Hospital of the University if Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Sophia R O'Brien
- Department of Radiology, Hospital of the University if Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - David A Mankoff
- Department of Radiology, Hospital of the University if Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Austin R Pantel
- Department of Radiology, Hospital of the University if Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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18
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Groheux D. FDG-PET/CT for Primary Staging and Detection of Recurrence of Breast Cancer. Semin Nucl Med 2022; 52:508-519. [PMID: 35636977 DOI: 10.1053/j.semnuclmed.2022.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 12/22/2022]
Abstract
Breast cancer is the most frequent cancer diagnosed in women worldwide. Accurate baseline staging is necessary to plan optimal breast cancer management. Early detection and staging of recurrence are also essential for optimal therapeutic management. Hybrid FDG-PET/CT imaging offers high sensitivity in detecting extra axillary lymph nodes and distant metastases. Although FDG-PET/CT has some limitations for low proliferative tumors, low-grade tumors and for well-differentiated luminal breast cancer, PET/CT is useful for the initial staging of breast cancer, regardless of tumor phenotype (luminal, triple negative, or HER2+) and of tumor grade. Although FDG-PET/CT performs better for invasive ductal carcinoma (invasive carcinoma of no specific subtype), it is also helpful for staging invasive lobular carcinomas. At initial staging, FDG-PET/CT becomes very useful for staging from clinical stage IIB (T2N1 or T3N0). FDG-PET/CT could be useful in patients with clinical stage IIA (T1N1 or T2N0), but there is not enough strong evidence to recommend routine use in this subgroup. For clinical stage I (T1N0) patients, FDG-PET/CT offers no added value. In patients with recurrent breast cancer, FDG-PET/CT is more effective than conventional imaging in detecting locoregional or distant recurrence, whether suspected by clinical examination, conventional imaging, or elevation of a tumor marker (CA 15.3 or CEA). PET/CT is effective even in the presence of normal tumor markers. PET/CT is also a powerful imaging modality for performing a whole-body workup of a known recurrence and for determining whether or not the recurrence is isolated.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM U976, HIPI, Paris, France; Centre d'Imagerie Radio-isotopique, La Rochelle, France.
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19
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Hildebrandt MG, Naghavi-Behzad M, Vogsen M. A role of FDG-PET/CT for response evaluation in metastatic breast cancer? Semin Nucl Med 2022; 52:520-530. [PMID: 35525631 DOI: 10.1053/j.semnuclmed.2022.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/27/2022] [Indexed: 01/19/2023]
Abstract
Breast cancer prognosis is steadily improving due to early detection of primary cancer in screening programs and revolutionizing treatment development. In the metastatic setting, therapy improvements render breast cancer a chronic disease. Although FDG-PET/CT has emerged as a highly accurate method for staging metastatic breast cancer, there has been no change in response evaluation methods for decades. FDG-PET/CT has proven high prognostic values in patients with metastatic breast cancer when using quantitative PET methods. It has also shown a higher predictive value than conventional CT when applying the respective response evaluation criteria, RECIST and PERCIST. Response categorization using FDG-PET/CT is more sensitive in detecting progressive and regressive disease, while conventional imaging such as CT and bone scintigraphy deem stable disease more often. These findings reflect the higher accuracy of FDG-PET/CT for response evaluation in this patient group. But does the higher accuracy of FDG-PET/CT translate into a patient benefit when implementing it for monitoring response to palliative treatment? We have evidence of survival benefit from a retrospective study indicating the superiority of using FDG-PET/CT compared with conventional imaging for response evaluation in metastatic breast cancer patients. The survival benefit seems to result from earlier detection of progression with FDG-PET/CT than conventional imaging, leading to an earlier change in treatment with potentially better efficacy of the subsequent treatment line. FDG-PET/CT can be used semiquantitatively as suggested in PERCIST. However, we still need to improve clinically applicable methods based on neural network modeling to better integrate the quantitative information in a smart and standardized way, enabling relevant comparability between scans, patients, and institutions. Such innovation is warranted to support imaging specialists in diagnostic response assessment. Prospective multicenter studies analyzing patients' survival, quality of life, societal and patient costs of replacing conventional imaging with FDG-PET/CT are needed before firm conclusions can be drawn on which type of scan to recommend in future clinical guidelines.
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Affiliation(s)
- Malene Grubbe Hildebrandt
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Personalized Response Monitoring in Oncology, PREMIO, Odense University Hospital, Odense, Denmark; Center for Innovative Medical Technology, CIMT, Odense University Hospital, Odense, Denmark.
| | - Mohammad Naghavi-Behzad
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Personalized Response Monitoring in Oncology, PREMIO, Odense University Hospital, Odense, Denmark
| | - Marianne Vogsen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Personalized Response Monitoring in Oncology, PREMIO, Odense University Hospital, Odense, Denmark; Department of Oncology, Odense University Hospital, Odense, Denmark
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20
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Sakellis CG, Jacene HA. Imaging for Radiation Planning in Breast Cancer. Semin Nucl Med 2022; 52:542-550. [PMID: 35523601 DOI: 10.1053/j.semnuclmed.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/27/2022] [Indexed: 01/31/2023]
Abstract
Radiation therapy is an integral component of the treatment of breast cancer. The indications and type of radiation therapy vary depending on disease invasiveness and stage. Imaging is the cornerstone for radiation therapy planning. While conventional imaging with CT remains the primary modality for radiation treatment planning locally in the breast, molecular imaging with [18F]FDG-PET/CT identifies additional occult disease that may help alter the local radiation therapy plan or treat oligometastatic disease. The ultimate effects on long-term outcomes remain to be determined. This article reviews the role of imaging in radiation planning for breast cancer.
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Affiliation(s)
- Christopher G Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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21
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Owaki Y, Minamishima K, Nakajima K. Optimization of pediatric FDG-PET/CT examinations based on physical indicators using the SiPM-PET/CT system. Nucl Med Commun 2022; 43:433-441. [PMID: 35045549 DOI: 10.1097/mnm.0000000000001527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the appropriate Silicon photomultiplier -PET/CT acquisition and image reconstruction conditions for each age group. METHODS The original phantom was developed to reflect the thickness and width of the torso in each age group (neonates, 1-year-olds, 5-year-olds, 10-year-olds, 15-year-olds, and adults). The ratio of hot spheres to background radioactivity was 4:1, and the radioactivity concentration was adjusted according to the Japanese consensus guidelines for appropriate implementation of pediatric nuclear medicine examinations. We evaluated the root mean square error (RMSE) as an assessment/function of the standardized uptake value of each hot sphere, the background variability (N10 mm), the % contrast of the hot sphere (QH, 10 mm/N10 mm), and the noise equivalent counts to determine the optimal reconstruction parameters and the appropriate acquisition time. RESULTS The minimum RMSE was obtained by setting the half-width of the Gaussian filter to 0-2 mm for iteration 1 or 2 and to 2-4 mm for iteration 3 or more. The acquisition times that satisfied the image quality equivalent to 120 s acquisitions in the adult phantoms were 30 s in the neonatal and 1-year-old phantoms, 60 s in the 5- and 10-year-old phantoms, and 75 s in the 15-year-old phantoms. CONCLUSION This study demonstrated that good PET images could be obtained with short acquisition times when the examination is performed under appropriate reconstruction conditions.
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Affiliation(s)
- Yoshiki Owaki
- Office of Radiation Technology, Keio University Hospital
- Department of Radiological Sciences, Tokyo Metropolitan University, Japan
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22
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PET imaging in breast cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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23
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Aebi S, Karlsson P, Wapnir IL. Locally advanced breast cancer. Breast 2021; 62 Suppl 1:S58-S62. [PMID: 34930650 PMCID: PMC9097810 DOI: 10.1016/j.breast.2021.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/05/2021] [Accepted: 12/12/2021] [Indexed: 11/28/2022] Open
Abstract
Locally advanced breast cancer (LABC) is defined here as inoperable breast adenocarcinoma without distant metastases. Patients with LABC require a multidisciplinary approach. Given the risk of distant metastasis, staging exams are necessary. The incidence of LABC (stages IIIB and IIIC) has decreased in recent years. LABC has rarely been investigated separately: patients with LABC have participated both in clinical trials of palliative and of neoadjuvant therapy. Most trials did not analyze responses and long-term outcomes independently; thus, the treatment of patients with LABC is extrapolated from studies of patients with less or more advanced disease. Pathologic confirmation and molecular profiling are essential for the choice of neoadjuvant chemotherapy. Preoperative endocrine therapy may be considered in certain clinical situations; the addition of a CDK4/6 inhibitor is being investigated. HER2 positive LABCs are targeted with anti-HER2 agents combined with chemotherapy. PD-1 and PD-L1 antibodies in ‘triple-negative’ LABC are promising. Excellent responses to neoadjuvant therapy enable conservative surgery in many patients; however, inflammatory breast cancer may still indicate mastectomy. Postoperative radiotherapy is usually indicated. Target volumes include breast/chest wall, axillary, supraclavicular and internal mammary nodal basins. Preoperative radiation therapy can be useful in patients without response to systemic therapies. Palliative surgery for poor responders after neoadjuvant systemic and radiation therapy can be considered. Multidisciplinary teams can optimize local control and prevent relapses. However, modest improvement in survival was achieved between 2000 and 2014 underscoring the unmet need in patients with LABC who will benefit from specific research efforts in this disease entity.
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Affiliation(s)
- Stefan Aebi
- Lucerne Cantonal Hospital and University of Bern, Cancer Center, Division of Medical Oncology, 6000, Lucerne 16, Switzerland.
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
| | - Irene L Wapnir
- Stanford University, Stanford Cancer Institute, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA.
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24
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Lenga L, Bernatz S, Martin SS, Booz C, Solbach C, Mulert-Ernst R, Vogl TJ, Leithner D. Iodine Map Radiomics in Breast Cancer: Prediction of Metastatic Status. Cancers (Basel) 2021; 13:2431. [PMID: 34069795 PMCID: PMC8157278 DOI: 10.3390/cancers13102431] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 12/12/2022] Open
Abstract
Dual-energy CT (DECT) iodine maps enable quantification of iodine concentrations as a marker for tissue vascularization. We investigated whether iodine map radiomic features derived from staging DECT enable prediction of breast cancer metastatic status, and whether textural differences exist between primary breast cancers and metastases. Seventy-seven treatment-naïve patients with biopsy-proven breast cancers were included retrospectively (41 non-metastatic, 36 metastatic). Radiomic features including first-, second-, and higher-order metrics as well as shape descriptors were extracted from volumes of interest on iodine maps. Following principal component analysis, a multilayer perceptron artificial neural network (MLP-NN) was used for classification (70% of cases for training, 30% validation). Histopathology served as reference standard. MLP-NN predicted metastatic status with AUCs of up to 0.94, and accuracies of up to 92.6 in the training and 82.6 in the validation datasets. The separation of primary tumor and metastatic tissue yielded AUCs of up to 0.87, with accuracies of up to 82.8 in the training, and 85.7 in the validation dataset. DECT iodine map-based radiomic signatures may therefore predict metastatic status in breast cancer patients. In addition, microstructural differences between primary and metastatic breast cancer tissue may be reflected by differences in DECT radiomic features.
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Affiliation(s)
- Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (L.L.); (S.B.); (S.S.M.); (C.B.); (R.M.-E.); (T.J.V.)
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (L.L.); (S.B.); (S.S.M.); (C.B.); (R.M.-E.); (T.J.V.)
| | - Simon S. Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (L.L.); (S.B.); (S.S.M.); (C.B.); (R.M.-E.); (T.J.V.)
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (L.L.); (S.B.); (S.S.M.); (C.B.); (R.M.-E.); (T.J.V.)
| | - Christine Solbach
- Department of Gynecology and Obstetrics, University Hospital Frankfurt, 60590 Frankfurt, Germany;
| | - Rotraud Mulert-Ernst
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (L.L.); (S.B.); (S.S.M.); (C.B.); (R.M.-E.); (T.J.V.)
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt, Germany; (L.L.); (S.B.); (S.S.M.); (C.B.); (R.M.-E.); (T.J.V.)
| | - Doris Leithner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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25
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Groheux D, Hindie E. Breast cancer: initial workup and staging with FDG PET/CT. Clin Transl Imaging 2021; 9:221-231. [PMID: 33937141 PMCID: PMC8075837 DOI: 10.1007/s40336-021-00426-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022]
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.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
- University Paris-Diderot, INSERM U976, HIPI, Paris, France
| | - Elif Hindie
- Department of Nuclear Medicine, Bordeaux University Hospital, Bordeaux, France
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26
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Weng X, Wei D, Zhu X, Tao L, Guo J, Pang K, Yang Z, Wei X. Real-time monitoring of single circulating tumor cells with a fluorescently labeled deoxy-glucose by in vivo flow cytometry. Cytometry A 2021; 99:586-592. [PMID: 33797159 DOI: 10.1002/cyto.a.24344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/11/2022]
Abstract
Circulating tumor cells (CTCs) play an essential role in metastasis and serve as an important prognostic biomarker. The technology of CTC labeling and detection in vivo can greatly improve the research of cancer metastasis and therapy. However, there is no in vivo technology to detect CTCs in clinic. In this study, we demonstrate that 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl) amino]-2-deoxy-d-glucose (2-NBDG), a 2-deoxy-glucose analog, can work in vivo to indicate CTCs and metastases fluorescently by direct intravenous injection. During the development of an implanted tumor in mice, the spontaneous CTCs released from the primary tumor into blood vessels can be labeled by 2-NBDG due to the abnormal metabolism of CTCs. The green fluorescence of 2-NBDG from CTCs is then noninvasively detected by an in vivo flow cytometry system. Due to the high uptake of glucose by tumor cells, the CTCs in mice can maintain a high 2-NBDG level and thus be distinguished by 2-NBDG fluorescence in vivo efficiently, enabling tumor detection in vivo like positron emission tomography (PET) but at the single-cell resolution. Our results suggest 2-NBDG, a glucose analog with high biosafety, holds promising potential in clinical applications, similar to the widely-used contrast medium 2-F18 -fluorodeoxyglucose in PET.
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Affiliation(s)
- Xiaofu Weng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Dan Wei
- Key Laboratory of Oceanographic Big Data Mining & Application of Zhejiang Province, School of Information Engineering, Zhejiang Ocean University, Zhejiang, China
| | - Xi Zhu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lechan Tao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Peking University Cancer Hospital, Beijing, China
| | - Kai Pang
- School of Instrument Science and Opto Electronics Engineering of Beijing Information Science & Technology University, Beijing, China
| | - Zhangru Yang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xunbin Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Biomedical Engineering Department, Peking University, Beijing, China.,Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Peking University Cancer Hospital, Beijing, China
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27
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Abstract
OPINION STATEMENT Inflammatory breast cancer (IBC) remains the most aggressive type of breast cancer. During the past decade, enormous progress has been made to refine diagnostic criteria and establish multimodality treatment strategies as keys for the improvement of survival outcomes. Multiple genomic studies enabled a better understanding of underlying tumor biology, which is responsible for the complex and aggressive nature of IBC. Despite these important achievements, outcomes for this subgroup of patients remain unsatisfactory compared to locally advanced non-IBC counterparts. Global efforts are now focused on identifying novel strategies that will improve treatment response, prolong survival for metastatic patients, achieve superior local control, and possibly increase the cure rate for locally advanced disease. Genomic technologies constitute the most important tool that will support future clinical progress. Gene-expressing profiling of the tumor tissue and liquid biopsy are important parts of the everyday clinical practice aiming to guide treatment decisions by providing information on tumor molecular drivers or primary and acquired resistance to treatment. The International IBC expert panel and IBC International Consortium made a tremendous effort to define IBC as a distinct entity of BC, and they will continue to lead and support the research for this rare and very aggressive disease. Finally, a uniform platform is now required to develop and lead large, multi-arm, proof-of-concept clinical trials that perform rapid, focused, and cost-effective evaluations of potential novel therapeutics in IBC.
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28
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Han S, Choi JY. Impact of 18F-FDG PET, PET/CT, and PET/MRI on Staging and Management as an Initial Staging Modality in Breast Cancer: A Systematic Review and Meta-analysis. Clin Nucl Med 2021; 46:271-282. [PMID: 33651022 PMCID: PMC7938917 DOI: 10.1097/rlu.0000000000003502] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/28/2020] [Accepted: 11/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We performed a systematic review and meta-analysis to evaluate the impact of 18F-FDG PET, PET/CT, and PET/MRI on staging and management during the initial staging of breast cancer. METHODS We searched the PubMed, Embase, Cochrane Library, and KoreaMed databases until March 2020 to identify studies that reported the proportion of breast cancer patients whose clinical stage or management were changed after PET scans. The proportion of changes was pooled using a random-effects model. Subgroup and metaregression analyses were performed to explore heterogeneity. RESULTS We included 29 studies (4276 patients). The pooled proportions of changes in stage and management were 25% (95% confidence interval [CI], 21%-30%) and 18% (95% CI, 14%-23%), respectively. When stage changes were stratified according to initial stage, the pooled proportions were 11% (95% CI, 3%-22%) in stage I, 20% (95% CI, 16%-24%) in stage II, and 34% (95% CI, 27%-42%) in stage III. The relative proportions of intermodality and intention-to-treat changes were 74% and 70%, respectively. Using metaregression analyses, the mean age and the proportion of initial stage III to IV and histologic grade II to III were significant factors affecting the heterogeneity in changes in stage or management. CONCLUSIONS Currently available literature suggests that the use of 18F-FDG PET, PET/CT, or PET/MRI leads to significant modification of staging and treatment in newly diagnosed breast cancer patients. Therefore, there may be a role for routine clinical use of PET imaging for the initial staging of breast cancer.
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Affiliation(s)
- Sangwon Han
- From the Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Hirata K, Tamaki N. Quantitative FDG PET Assessment for Oncology Therapy. Cancers (Basel) 2021; 13:cancers13040869. [PMID: 33669531 PMCID: PMC7922629 DOI: 10.3390/cancers13040869] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary PET enables quantitative assessment of tumour biology in vivo. Accumulation of F-18 fluorodeoxyglucose (FDG) may reflect tumour metabolic activity. Quantitative assessment of FDG uptake can be applied for treatment monitoring. Numerous studies indicated biochemical change assessed by FDG-PET as a more sensitive marker than morphological change. Those with complete metabolic response after therapy may show better prognosis. Assessment of metabolic change may be performed using absolute FDG uptake or metabolic tumour volume. More recently, radiomics approaches have been applied to FDG PET. Texture analysis quantifies intratumoral heterogeneity in a voxel-by-voxel basis. Combined with various machine learning techniques, these new quantitative parameters hold a promise for assessing tissue characterization and predicting treatment effect, and could also be used for future prognosis of various tumours. Abstract Positron emission tomography (PET) has unique characteristics for quantitative assessment of tumour biology in vivo. Accumulation of F-18 fluorodeoxyglucose (FDG) may reflect tumour characteristics based on its metabolic activity. Quantitative assessment of FDG uptake can often be applied for treatment monitoring after chemotherapy or chemoradiotherapy. Numerous studies indicated biochemical change assessed by FDG PET as a more sensitive marker than morphological change estimated by CT or MRI. In addition, those with complete metabolic response after therapy may show better disease-free survival and overall survival than those with other responses. Assessment of metabolic change may be performed using absolute FDG uptake in the tumour (standardized uptake value: SUV). In addition, volumetric parameters such as metabolic tumour volume (MTV) have been introduced for quantitative assessment of FDG uptake in tumour. More recently, radiomics approaches that focus on image-based precision medicine have been applied to FDG PET, as well as other radiological imaging. Among these, texture analysis extracts intratumoral heterogeneity on a voxel-by-voxel basis. Combined with various machine learning techniques, these new quantitative parameters hold a promise for assessing tissue characterization and predicting treatment effect, and could also be used for future prognosis of various tumours, although multicentre clinical trials are needed before application in clinical settings.
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Affiliation(s)
- Kenji Hirata
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan;
| | - Nagara Tamaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
- Correspondence:
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Hyland CJ, Varghese F, Yau C, Beckwith H, Khoury K, Varnado W, Hirst GL, Flavell RR, Chien AJ, Yee D, Isaacs CJ, Forero-Torres A, Esserman LJ, Melisko ME. Use of 18F-FDG PET/CT as an Initial Staging Procedure for Stage II-III Breast Cancer: A Multicenter Value Analysis. J Natl Compr Canc Netw 2020; 18:1510-1517. [PMID: 33152704 DOI: 10.6004/jnccn.2020.7598] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Metastatic staging imaging is not recommended for asymptomatic patients with stage I-II breast cancer. Greater distant metastatic disease risk may warrant baseline imaging in patients with stage II-III with high-risk biologic subtypes. NCCN Guidelines recommend considering CT of the chest, abdomen, and pelvis (CT CAP) and bone scan in appropriate patients. CT CAP and bone scan are considered standard of care (SoC), although PET/CT is a patient-centered alternative. METHODS Data were available for 799 high-risk patients with clinical stage II-III disease who initiated screening for the I-SPY2 trial at 4 institutions. A total of 564 complete records were reviewed to compare PET/CT versus SoC. Costs were determined from the payer perspective using the national 2018 Medicare Physician Fee Schedule and representative reimbursements to the University of California, San Francisco (UCSF). Incremental cost-effectiveness ratio (ICER) measured cost of using PET/CT per percent of patients who avoided a false-positive (FP). RESULTS The de novo metastatic disease rate was 4.6%. Imaging varied across the 4 institutions (P<.0001). The FP rate was higher using SoC versus PET/CT (22.1% vs 11.1%; P=.0009). Mean time between incidental finding on baseline imaging to FP determination was 10.8 days. Mean time from diagnosis to chemotherapy initiation was 44.3 days with SoC versus 37.5 days with PET/CT (P=.0001). Mean cost per patient was $1,132 (SoC) versus $1,477 (PET/CT) using the Medicare Physician Fee Schedule, with an ICER of $31. Using representative reimbursements to UCSF, mean cost per patient was $1,236 (SoC) versus $1,073 (PET/CT) for Medicare, and $3,083 (SoC) versus $1,656 (PET/CT) for a private payer, with ICERs of -$15 and -$130, respectively. CONCLUSIONS Considerable variation exists in metastatic staging practices. PET/CT reduced FP risk by half and decreased workup of incidental findings, allowing for earlier treatment start. PET/CT may be cost-effective, and at one institution was shown to be cost-saving. Better alignment is needed between hospital pricing strategies and payer coverage policies to deliver high-value care.
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Affiliation(s)
- Colby J Hyland
- 1University of California, San Francisco, San Francisco, California
| | - Flora Varghese
- 1University of California, San Francisco, San Francisco, California
| | - Christina Yau
- 1University of California, San Francisco, San Francisco, California
| | | | | | - William Varnado
- 4University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Gillian L Hirst
- 1University of California, San Francisco, San Francisco, California
| | - Robert R Flavell
- 5Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - A Jo Chien
- 1University of California, San Francisco, San Francisco, California
| | - Douglas Yee
- 2University of Minnesota, Minneapolis, Minnesota
| | | | | | - Laura J Esserman
- 1University of California, San Francisco, San Francisco, California
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Gillman JA, Pantel AR, Mankoff DA, Edmonds CE. Update on Quantitative Imaging for Predicting and Assessing Response in Oncology. Semin Nucl Med 2020; 50:505-517. [PMID: 33059820 PMCID: PMC9788668 DOI: 10.1053/j.semnuclmed.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Molecular imaging has revolutionized clinical oncology by imaging-specific facets of cancer biology. Through noninvasive measurements of tumor physiology, targeted radiotracers can serve as biomarkers for disease characterization, prognosis, response assessment, and predicting long-term response/survival. In turn, these imaging biomarkers can be utilized to tailor therapeutic regimens to tumor biology. In this article, we review biomarker applications for response assessment and predicting long-term outcomes. 18F-fluorodeoxyglucose (FDG), a measure of cellular glucose metabolism, is discussed in the context of lymphoma and breast and lung cancer. FDG has gained widespread clinical acceptance and has been integrated into the routine clinical care of several malignancies, most notably lymphoma. The novel radiotracers 16α-18F-fluoro-17β-estradiol and 18F-fluorothymidine are reviewed in application to the early prediction of response assessment of breast cancer. Through illustrative examples, we explore current and future applications of molecular imaging biomarkers in the advancement of precision medicine.
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Affiliation(s)
- Jennifer A Gillman
- Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Austin R Pantel
- Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David A Mankoff
- Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Christine E Edmonds
- Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
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Vogsen M, Jensen JD, Christensen IY, Gerke O, Jylling AMB, Larsen LB, Braad PE, Søe KL, Bille C, Ewertz M, Hildebrandt MG. FDG-PET/CT in high-risk primary breast cancer-a prospective study of stage migration and clinical impact. Breast Cancer Res Treat 2020; 185:145-153. [PMID: 32920740 DOI: 10.1007/s10549-020-05929-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the clinical impact of FDG-PET/CT for staging and treatment planning in high-risk primary breast cancer. METHODS Women with high-risk primary breast cancer were enrolled between September 2017 and August 2019 at Odense University Hospital, Denmark. Conventional mammography with/without MRI was performed before staging by FDG-PET/CT. We studied the accuracy of FDG-PET/CT for the detection of distant metastases, the effect on the change of treatment, and the prevalence of incidental findings. Biopsy and follow-up were used as a reference standard for the accuracy analysis. RESULTS Of 103 women, 24 (23%) were diagnosed with distant metastases by FDG-PET/CT. Among these, breast surgery was omitted in 18 and could have been spared in six. Another sixteen (16%) patients were upstaged to more advanced loco-regional disease, leading to more extensive radiotherapy. Sensitivity and specificity for diagnosing distant metastases were 1.00 (95% confidence interval: 0.86-1.00) and 0.95 (0.88-0.99), respectively. Twenty-nine incidental findings were detected in 24 women (23%), leading to further examinations in 22 and diagnosis of eight (8/22, 36%) synchronous diseases: cancer (n = 4), thyroiditis (n = 2), aorta aneurysm (n = 1), and meningioma (n = 1). CONCLUSIONS FDG-PET/CT had a substantial impact on staging and change of treatment in women with high-risk primary breast cancer, and further examination of incidental findings was considered clinically relevant. Our findings suggest that FDG-PET/CT should be considered for primary staging in high-risk primary breast cancer to improve treatment planning.
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Affiliation(s)
- Marianne Vogsen
- Department of Oncology, Odense University Hospital, Odense, Denmark.
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
- Centre for Personalized Response Monitoring in Oncology (PREMIO), Odense University Hospital, Odense, Denmark.
- Department of Oncology and Department of Nuclear Medicine, Odense University Hospital, Kloevervaenget 47, 5000, Odense C, Denmark.
| | | | | | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Poul-Erik Braad
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Marianne Ewertz
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Malene Grubbe Hildebrandt
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Personalized Response Monitoring in Oncology (PREMIO), Odense University Hospital, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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Chilwesa PM, Gameldien R, Steyn R, More S, Malherbe F, Human G, Mottay L, Moxley K, Hardy A, Anderson D, Hunter AJ, Parkes J. Comparison of 18F-Fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging for locally advanced breast cancer staging: A prospective study from a tertiary hospital cancer centre in the Western Cape. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2020. [DOI: 10.4102/sajo.v4i0.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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van Es SC, Velleman T, Elias SG, Bensch F, Brouwers AH, Glaudemans AWJM, Kwee TC, Iersel MWV, Maduro JH, Oosting SF, de Vries EGE, Schröder CP. Assessment of Bone Lesions with 18F-FDG PET Compared with 99mTc Bone Scintigraphy Leads to Clinically Relevant Differences in Metastatic Breast Cancer Management. J Nucl Med 2020; 62:177-183. [PMID: 32817140 DOI: 10.2967/jnumed.120.244640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/07/2020] [Indexed: 11/16/2022] Open
Abstract
It is unknown whether assessment of potential bone lesions in metastatic breast cancer (MBC) by 18F-FDG PET instead of 99mTc bone scintigraphy (BS) supports clinically relevant changes in MBC management. Therefore, we retrospectively compared management recommendations based on bone lesion assessment by 18F-FDG PET plus contrast-enhanced CT (ceCT) or BS plus ceCT, for patients with newly diagnosed MBC. Methods: Baseline ceCT, BS, and 18F-FDG PET for all patients included in the IMPACT-MBC study (NCT01957332) at the University Medical Center Groningen were reviewed for bone lesions. If bone lesions were found by any imaging modality, virtual MBC management recommendations were made by a multidisciplinary expert panel, based on either 18F-FDG PET plus ceCT or BS plus ceCT. The panel had access to standard clinicopathologic information and baseline imaging findings outside the skeleton. Clinically relevant management differences between the 2 recommendations were defined either as different treatment intent (curative, noncurative, or unable to determine) or as different systemic or local treatment. If no bone lesions were found by any imaging modality, the patients were included in the analyses without expert review. Results: In total, 3,473 unequivocal bone lesions were identified in 102 evaluated patients (39% by ceCT, 26% by BS, and 87% by 18F-FDG PET). Additional bone lesions on 18F-FDG PET plus ceCT compared with BS plus ceCT led to change in MBC management recommendations in 16% of patients (95% CI, 10%-24%). BS also changed management compared with 18F-FDG PET in 1 patient (1%; 95% CI, 0%-5%). In 26% (95% CI, 19%-36%) of patients, an additional 18F-FDG PET exam was requested, because BS provided insufficient information. Conclusion: In this exploratory analysis of newly diagnosed MBC patients, 18F-FDG PET versus BS to assess bone lesions resulted in clinically relevant management differences in 16% of patients. BS delivered insufficient information in over one fourth of patients, resulting in an additional request for 18F-FDG PET. On the basis of these data, 18F-FDG PET should be considered a primary imaging modality for assessment of bone lesions in newly diagnosed MBC.
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Affiliation(s)
- Suzanne C van Es
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ton Velleman
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frederike Bensch
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Thomas C Kwee
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marleen Woltman-van Iersel
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John H Maduro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carolina P Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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van Uden DJP, Prins MW, Siesling S, de Wilt JHW, Blanken-Peeters CFJM, Aarntzen EHJG. [18F]FDG PET/CT in the staging of inflammatory breast cancer: A systematic review. Crit Rev Oncol Hematol 2020; 151:102943. [PMID: 32416347 DOI: 10.1016/j.critrevonc.2020.102943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/27/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023] Open
Abstract
Up to 78 % of patients with inflammatory breast cancer (IBC) present with axillary lymph node involvement and up to 40 % with distant metastases. Previous studies indicate that 2-deoxy-2-(18F)fluoro-d-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) might be used for initial staging in patients with inflammatory breast cancer (IBC). In other cancer types, [18F]FDG PET/CT has been demonstrated to be a sensitive technique, providing complementary information on locoregional and distant disease to conventional imaging modalities. This systematic review showed that 18F]FDG PET/CT detects additional locoregional lymph node metastases and distant metastases in 10.3 % of patients, that were not detected with standard staging imaging. Compared with conventional imaging procedures, [18F]FDG PET/CT had better diagnostic performance for detection of locoregional and distant metastases and should standardly be used in the diagnostic work-up of IBC patients.
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Affiliation(s)
- D J P van Uden
- Department of Surgery, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands.
| | - M W Prins
- Department of Radiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands
| | - S Siesling
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands
| | - J H W de Wilt
- Department of Surgical Oncology, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | | | - E H J G Aarntzen
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
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Yu P, Lei J, Xu B, Wang R, Shen Z, Tian J. Correlation Between 18F-FDG PET/CT Findings and BI-RADS Assessment Using Ultrasound in the Evaluation of Breast Lesions: A Multicenter Study. Acad Radiol 2020; 27:682-688. [PMID: 31311773 DOI: 10.1016/j.acra.2019.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/26/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the correlation between ultrasound breast imaging reporting and data system (BI-RADS) category and fluorodeoxyglucose [18F] (18F-FDG) positron emission tomography/computed tomography (PET/CT) findings and their value in breast lesion diagnosis. MATERIALS AND METHODS Cases involving hypermetabolic lesions identified by 18F-FDG PET/CT and ultrasound were retrospectively analyzed. The correlation between the maximum standardized uptake values (SUVmax) of the lesions and the BI-RADS grades was calculated. Histologic diagnosis or evidence at the end of a 2-year follow-up as the standard of truth were analyzed to determine the sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the diagnostic methods. Area under the curve (AUC) of BI-RADS, SUVmax, and BI-RADS/SUVmax combined were obtained using receiver-operating characteristic curve (ROC) analysis. RESULTS Of 206 cases, 92 were benign and 114 were malignant. The difference between the SUVmax and the BI-RADS grades was statistically significant (p < 0.001). The critical value of the optimal SUVmax was 2.325, and the accuracy, sensitivity, specificity, PPV, and NPV were 84.5%, 91.2%, 76.1%, 82.5%, and 87.5%, respectively. For diagnosis using BI-RADS, these values were 85.9%, 98.2%, 70.7%, 80.6%, and 97.0%, respectively. ROC analysis of 206 breast lesions for distinguishing benign from malignant lesions yielded AUCs of 0.948, 0.896, and 0.977 for BI-RADS, SUVmax, and BI-RADS/SUVmax combined, respectively. The critical value of the optimal SUVmax in grade 3 and 4 lesions (as determined using BI-RADS) was 2.705, and the accuracy, sensitivity, specificity, PPV, and NPV were 82.6%, 77.8%, 85.7%, 77.8%, and 85.7%, respectively. For diagnosis using BI-RADS in cases with grade 3 and 4 lesions, these values were 68.5%, 94.4%, 51.8%, 55.7%, and 93.5%, respectively. In ROC analysis for distinguishing benign from malignant for BI-RADS grade 3-4 lesions, the AUC of BI-RADS, SUVmax, and BI-RADS/SUVmax combined were 0.731, 0.859, and 0.882, respectively. CONCLUSION Both 18F-FDG PET/CT and ultrasound-dependent BI-RADS grading are effective for diagnosing breast lesions. However, in cases of BI-RADS grades 3 and 4, 18F-FDG PET/CT has better specificity and may be useful for further differential diagnosis.
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Affiliation(s)
- Peng Yu
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China; Department of Nuclear Medicine, Affiliated Hospital of Logistic University of PAP, Tianjin, China
| | - Jixiao Lei
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China; Department of Nuclear Medicine, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Ruimin Wang
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Zhihui Shen
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Jiahe Tian
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
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Arnaout A, Varela NP, Allarakhia M, Grimard L, Hey A, Lau J, Thain L, Eisen A. Baseline staging imaging for distant metastasis in women with stages I, II, and III breast cancer. ACTA ACUST UNITED AC 2020; 27:e123-e145. [PMID: 32489262 DOI: 10.3747/co.27.6147] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background In Ontario, there is no clearly defined standard of care for staging for distant metastasis in women with newly diagnosed and biopsy-confirmed breast cancer whose clinical presentation is suggestive of early-stage disease. This guideline addresses baseline imaging investigations for women with newly diagnosed primary breast cancer who are otherwise asymptomatic for distant metastasis. Methods The medline and embase databases were systematically searched for evidence from January 2000 to April 2019, and the best available evidence was used to draft recommendations relevant to the use of baseline imaging investigation in women with newly diagnosed primary breast cancer who are otherwise asymptomatic. Final approval of this practice guideline was obtained from both the Staging in Early Stage Breast Cancer Advisory Committee and the Report Approval Panel of the Program in Evidence-Based Care. Recommendations These recommendations apply to all women with newly diagnosed primary breast cancer (originating in the breast) who have no symptoms of distant metastasis Staging tests using conventional anatomic imaging [chest radiography, liver ultrasonography, chest-abdomen-pelvis computed tomography (ct)] or metabolic imaging modalities [integrated positron-emission tomography (pet)/ct, integrated pet/magnetic resonance imaging (mri), bone scintigraphy] should not be routinely ordered for women newly diagnosed with clinical stage i or stage ii breast cancer who have no symptoms of distant metastasis, regardless of biomarker status. In women newly diagnosed with stage iii breast cancer, baseline staging tests using either anatomic imaging (chest radiography, liver ultrasonography, chest-abdomen-pelvis ct) or metabolic imaging modalities (pet/ct, pet/mri, bone scintigraphy) should be considered regardless of whether the patient is symptomatic for distant metastasis and regardless of biomarker profile.
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Affiliation(s)
- A Arnaout
- Department of Surgery, The Ottawa Hospital and The University of Ottawa, Ottawa, ON
| | - N P Varela
- Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), and Department of Oncology, McMaster University, Hamilton, ON
| | - M Allarakhia
- Patient Representative, The Ottawa Hospital, Ottawa, ON
| | - L Grimard
- Department of Radiation Medicine, The Ottawa Hospital, Ottawa, ON
| | - A Hey
- Regional Primary Care, Northeast Cancer Centre, Sudbury, ON
| | - J Lau
- Department of Radiology, The University of Ottawa, Ottawa, ON
| | - L Thain
- Ontario Health (Cancer Care Ontario) Regional Imaging, Southlake Regional Health Centre, Newmarket, and Mackenzie Health, Richmond Hill, ON
| | - A Eisen
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
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Groheux D, Hindié E. 18FDG-PET/CT Imaging in Breast Cancer Patients with Clinical Stage IIB or Higher. Ann Surg Oncol 2020; 27:1708-1709. [DOI: 10.1245/s10434-019-08188-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Indexed: 11/18/2022]
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Kowalski ES, Feigenberg SJ, Cohen J, Fellows Z, Vadnais P, Rice S, Mishra MV, Molitoris JK, Nichols EM, Snider JW. Optimal Target Delineation and Treatment Techniques in the Era of Conformal Photon and Proton Breast and Regional Nodal Irradiation. Pract Radiat Oncol 2020; 10:174-182. [DOI: 10.1016/j.prro.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/27/2019] [Accepted: 11/14/2019] [Indexed: 12/16/2022]
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40
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Jacene HA, DiPiro PJ, Bellon J, Hu J, Cheng SC, Warren L, Schlosnagle E, Nakhlis F, Rosenbluth JM, Yeh E, Overmoyer B. Discrepancy between FDG-PET/CT and contrast-enhanced CT in the staging of patients with inflammatory breast cancer: implications for treatment planning. Breast Cancer Res Treat 2020; 181:383-390. [PMID: 32318957 DOI: 10.1007/s10549-020-05631-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/07/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Optimizing treatment strategies for patients with inflammatory breast cancer (IBC) relies on accurate initial staging. This study compared contrast-enhanced computed tomography (ce-CT) and FDG-PET/CT for initial staging of IBC to determine the frequency of discordance between the two imaging modalities and potential impact on management. METHODS 81 patients with IBC underwent FDG-PET/CT and ce-CT prior to starting treatment. FDG-PET/CT and ce-CT scans were independently reviewed for locoregional and distant metastases and findings recorded by anatomic site as negative, equivocal, or positive for breast cancer involvement. Each paired ce-CT and FDG-PET/CT case was classified as concordant or discordant for findings. Discordant findings were subclassified as (a) related to the presence or absence of distant metastases; (b) affecting the locoregional radiation therapy plan; or (c) due to incidental findings not related to IBC. RESULTS There were 47 discordant findings between ce-CT and FDG-PET/CT in 41 of 81 patients (50.6%). Thirty (63.8%) were related to the presence or absence of distant metastases; most commonly disease detection on FDG-PET/CT but not ce-CT (n = 12). FDG-PET/CT suggested alterations of the locoregional radiation therapy plan designed by CT alone in 15 patients. FDG-PET/CT correctly characterized 5 of 7 findings equivocal for metastatic IBC on ce-CT. CONCLUSIONS This study demonstrates differences between ce-CT and FDG-PET/CT for initial staging of IBC and how these differences potentially affect patient management. Preliminary data suggest that FDG-PET/CT may be the imaging modality of choice for initial staging of IBC. Prospective trials testing initial staging with FDG-PET/CT versus important clinical end-points in IBC are warranted.
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Affiliation(s)
- Heather A Jacene
- Department of Imaging and Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Pamela J DiPiro
- Department of Imaging and Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Jennifer Bellon
- Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Jiani Hu
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Su-Chun Cheng
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Laura Warren
- Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Emily Schlosnagle
- Inflammatory Breast Cancer Program, Medical Oncology, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - Faina Nakhlis
- Inflammatory Breast Cancer Program, Medical Oncology, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, USA.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Jennifer M Rosenbluth
- Inflammatory Breast Cancer Program, Medical Oncology, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - Eren Yeh
- Department of Imaging and Radiology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Beth Overmoyer
- Inflammatory Breast Cancer Program, Medical Oncology, Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, USA
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41
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Lopez-Tarruella S, Escudero MJ, Pollan M, Martín M, Jara C, Bermejo B, Guerrero-Zotano A, García-Saenz J, Santaballa A, Alba E, Andrés R, Martínez P, Calvo L, Fernández A, Batista N, Llombart-Cussac A, Antón A, Lahuerta A, de la Haba J, López-Vega JM, Carrasco E. Survival impact of primary tumor resection in de novo metastatic breast cancer patients (GEICAM/El Alamo Registry). Sci Rep 2019; 9:20081. [PMID: 31882586 PMCID: PMC6934456 DOI: 10.1038/s41598-019-55765-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/02/2019] [Indexed: 01/14/2023] Open
Abstract
The debate about surgical resection of primary tumor (PT) in de novo metastatic breast cancer (MBC) patients persists. We explored this approach's outcomes in patients included in a retrospective registry, named El Álamo, of breast cancer patients diagnosed in Spain (1990-2001). In this analysis we only included de novo MBC patients, 1415 of whom met the study's criteria. Descriptive, Kaplan-Meier and Cox regression analyses were carried out. Median age was 63.1 years, 49.2% of patients had single-organ metastasis (skin/soft tissue [16.3%], bone [33.8%], or viscera [48.3%]). PT surgery (S) was performed in 44.5% of the cases. S-group patients were younger, had smaller tumors, higher prevalence of bone and oligometastatic disease, and lower prevalence of visceral involvement. With a median follow-up of 23.3 months, overall survival (OS) was 39.6 versus 22.4 months (HR = 0.59, p < 0.0001) in the S- and non-S groups, respectively. The S-group OS benefit remained statistically and clinically significant regardless of metastatic location, histological type, histological grade, hormone receptor status and tumor size. PT surgery (versus no surgery) was associated with an OS benefit suggesting that loco-regional PT control may be considered in selected MBC patients. Data from randomized controlled trials are of utmost importance to confirm these results.
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Affiliation(s)
- Sara Lopez-Tarruella
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain.
| | - M J Escudero
- GEICAM, Spanish Breast Cancer Research Group, Madrid, Spain
| | - Marina Pollan
- Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - Carlos Jara
- Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain
| | - Begoña Bermejo
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Hospital Clínico Universitario, Valencia. Biomedical Research Institute INCLIVA, Universidad de Valencia, Valencia, Spain
| | | | - José García-Saenz
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Emilio Alba
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Complejo Hospitalario Virgen de la Victoria, Málaga, Spain
| | - Raquel Andrés
- Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Lourdes Calvo
- Complejo Hospitalario Juan Canalejo, A Coruña, Spain
| | | | | | | | - Antonio Antón
- Hospital General Universitario Miguel Servet, Zaragoza, Spain
| | | | - Juan de la Haba
- Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
- Complejo Hospitalario Reina Sofía, Córdoba, Spain
| | | | - E Carrasco
- GEICAM, Spanish Breast Cancer Research Group, Madrid, Spain
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42
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Inflammatory Breast Cancer: Diagnostic, Molecular and Therapeutic Considerations. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00337-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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43
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Ceugnart L, Olivier A, Oudoux A. [Breast cancer: News tools in imaging]. Presse Med 2019; 48:1101-1111. [PMID: 31676215 DOI: 10.1016/j.lpm.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/01/2019] [Indexed: 11/26/2022] Open
Abstract
Breast cancer imaging is always improving for the last 20 years in spite of digitalization and computer development. News tools in mammography (Digital Breast Tomosynthesis, Contrast enhanced mammography), sonography (elastography, Automated echography), MRI (Diffusion, abbreviated MRI) and Nuclear medicine has the great potential to be the future of breats imaging. But true revolution will be to use the huge volume of "hidden" imaging data, by Intelligence Artificial process or Biological progress (in genomics, proteiomics) to purpose to our patient a personalized imaging.
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Affiliation(s)
- Luc Ceugnart
- Centre régional de lutte contre le cancer Oscar-Lambret, pôle imagerie, secteur imagerie, Lille, France.
| | - Anais Olivier
- Centre régional de lutte contre le cancer Oscar-Lambret, pôle imagerie, secteur médecine nucléaire, Lille, France
| | - Aurore Oudoux
- Centre régional de lutte contre le cancer Oscar-Lambret, pôle imagerie, secteur médecine nucléaire, Lille, France
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44
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Abstract
PURPOSE OF REVIEW Inflammatory breast cancer (IBC) is an uncommon but highly aggressive subtype of breast cancer that contributes significantly to breast cancer-related mortality. In this review, we provide an overview of the clinical and molecular characteristics of IBC, and highlight some areas of need for ongoing research. RECENT FINDINGS The disease is characterized by florid tumor emboli that obstruct dermal lymphatics, leading to swelling and inflammation of the affected breast. Recent studies have focused on tumor cell intrinsic features, such as signaling through pathways involved in growth and stem-like behavior, as well as extrinsic features, such as the immune system, that can be leveraged to develop new potential therapies. Key efforts have led to an increase in awareness of the disease as well as new insights into IBC pathogenesis. However, there is a strong need for new therapies designed specifically for IBC, and many unanswered questions remain.
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Affiliation(s)
- Jennifer M Rosenbluth
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Beth A Overmoyer
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
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45
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Jacene HA, Youn T, DiPiro PJ, Hu J, Cheng SC, Franchetti Y, Shah H, Bellon JR, Warren L, Schlosnagle E, Nakhlis F, Rosenbluth J, Yeh E, Overmoyer B. Metabolic Characterization of Inflammatory Breast Cancer With Baseline FDG-PET/CT: Relationship With Pathologic Response After Neoadjuvant Chemotherapy, Receptor Status, and Tumor Grade. Clin Breast Cancer 2019; 19:146-155. [DOI: 10.1016/j.clbc.2018.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/15/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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46
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Dejust S. L’exploration axillaire : un standard du bilan préthérapeutique. ONCOLOGIE 2019. [DOI: 10.3166/onco-2019-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’exploration préthérapeutique axillaire est une étape majeure du bilan initial du cancer du sein. L’échographie associée à un prélèvement est actuellement recommandée en première intention. L’IRM et la TEP/TDM au 18FDG sont utiles dans l’évaluation ganglionnaire axillaire. Les sensibilités et spécificités des examens d’imagerie sont globalement identiques, et leur combinaison permet d’obtenir les meilleures performances. Actuellement, la technique du ganglion sentinelle est indispensable en cas de tumeurs mammaires T1-T2 N0 et en cas d’adénopathie suspecte échographiquement avec cytoponction ou microbiopsie négative.
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47
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Diagnostic and prognostic value of 18F-FDG PET/CT imaging in suspected recurrence of male breast cancer. Nucl Med Commun 2018; 40:63-72. [PMID: 30312217 PMCID: PMC6282661 DOI: 10.1097/mnm.0000000000000928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose Male breast cancer (MBC) is a rare malignancy, with recurrence being one of the main adverse predictors for prognosis. The aim of the study was to evaluate the diagnostic and predictive value of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT in the setting of suspected recurrence of MBC. Patients and methods Retrospective analysis of PET/CT findings was performed in 23 previously treated, histologically proven patients with MBC (mean age: 59.3±10.9 years; range: 36–79 years) with suspected recurrence. Kaplan–Meier disease-specific survival analysis was made with respect to histological, hormonal profile as well as PET/CT findings. Results Of the 23 patients, 19 (82.6%) showed recurrence. Recurrence at primary site with/without regional/distant site recurrence was seen in 12 (52.2%) patients. Only metastatic recurrence without primary site was seen in seven (30.4%) patients. Bone was the most common site of distant metastasis (14/23) followed by lungs (9/23), liver (4/23), brain (2/23), and adrenal (1/23). No recurrence (regional/distant) was noted in 4/23 (17.3%) patients; however, three of them had 18F-FDG-avid soft tissue lesions in esophagus, rectum and tongue, correspondingly, confirmed as second primaries with histopathology. Disease-specific survival analysis yielded nodal (P=0.01) as well as distant metastases (P=0.02) as the main survival predictors on PET/CT. Lung (P=0.001), followed by liver (P=0.009), and skeletal (P=0.01) metastases were the most adverse survival predictive factors. Conclusion 18F-FDG PET/CT showed good diagnostic and prognostic utility in recurrent MBC. It was better than bone scan in evaluation of skeletal metastases. Most importantly, 18F-FDG PET/CT helped in early detection of second malignancy and their clinical management in studied patients.
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48
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Gajjala SR, Hulikal N, Kadiyala S, Kottu R, Kalawat T. Whole-body 18F-fluorodeoxyglucose positron emission tomography-computed tomography ( 18F-FDG PET/CT) for staging locally advanced breast cancer: A prospective study from a tertiary cancer centre in south India. Indian J Med Res 2018; 147:256-262. [PMID: 29923514 PMCID: PMC6022380 DOI: 10.4103/ijmr.ijmr_1368_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background & objectives: Locally advanced breast cancer (LABC) is associated with substantial risk of occult metastases. The patients with LABC have high rate of systemic relapse, suggesting inadequacy of the current conventional staging in detecting the occult metastatic spread. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) is a new modality in the staging of breast cancer patients. Hence, this study was conducted to evaluate the role of 18F-FDG PET/CT in initial staging of LABC and to compare it with conventional methods. Methods: This prospective study included biopsy-confirmed female patients diagnosed with LABC meeting the selection criteria and attending surgical, medical and radiation oncology departments of a tertiary care centre in south India, from April 2013 to December 2014. Conventional workup included serum chemistry, mammogram, bone scan, contrast-enhanced CT (CECT) chest and upper abdomen and ultrasound abdomen and pelvis. All patients following conventional workup underwent 18F-FDG PET/CT. Results: In this study, 61 women with LABC underwent both conventional workup and 18F-FGD PET/CT. The 18F-FDG PET/CT, in comparison to conventional workup, revealed unsuspected N3 nodal disease in 11 more patients, revealed distant metastasis in seven more patients and also detected extra sites of metastasis in five patients. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT to detect distant metastasis were 95, 98, 95, 98 and 97 per cent, respectively, whereas the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional imaging to detect distant metastasis were 65, 93, 81, 84 and 84 per cent, respectively. Interpretation & conclusions: The 18F-FDG PET/CT was found to be more accurate than conventional imaging for staging and modified stage and treatment in 30 and 38 per cent of patients, respectively. It was particularly useful in detecting occult distant metastasis and N3 nodal disease with an added advantage of examining whole body in single session. However, CECT chest was superior over 18F-FDG PET/CT for detecting pulmonary metastasis.
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Affiliation(s)
- Sivanath Reddy Gajjala
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Narendra Hulikal
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Silpa Kadiyala
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Radhika Kottu
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Tekchand Kalawat
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
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49
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Brzezinska M, Dixon JM. Inflammatory breast cancer: no longer an absolute contraindication for breast conservation surgery following good response to neoadjuvant therapy. Gland Surg 2018; 7:520-524. [PMID: 30687625 DOI: 10.21037/gs.2018.08.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Inflammatory breast cancer (IBC) is a rare form of breast cancer characterised by an erythematous swollen breast with extensive oedema and has in the past been associated with a very poor prognosis. After diagnosis by core biopsy of the cancer and any involved nodes patients in the Edinburgh Breast Unit (EBU) are primarily managed with neoadjuvant systemic therapy-chemotherapy or endocrine therapy. If the cancer is localised to one or a few well defined lesions then each of these lesions together with the lowest involved node are clipped. Response during neoadjuvant treatment is monitored clinically and by ultrasound plus mammography +/- magnetic resonance imaging (MRI). Following completion of neoadjuvant therapy, imaging is reviewed at a multidisciplinary meeting and patients with a localised single or multiple areas of cancer where all signs of erythema and oedema have settled are considered as to their suitability for breast conserving surgery and whole breast radiotherapy [breast conserving treatment (BCT)]. Here we discuss the results and outcomes of a selected group of patients with IBC who after obtaining a very good response to neoadjuvant chemotherapy or endocrine therapy were treated by BCT and we compare these with other recent publications on this topic. Our data show that patients treated by BCT did not have worse outcomes than patients treated with mastectomy. Importantly other series published recently support our conclusions. Another important observation is that response in estrogen receptor (ER) rich IBC is seen with neoadjuvant endocrine treatment and so not everyone with IBC needs to have neoadjuvant chemotherapy. In conclusion, patients with one or more well defined and localised breast masses and IBC may be suitable for BCT after a major response to neoadjuvant therapy and for these patients BCT should now be considered a viable option.
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Affiliation(s)
- Monika Brzezinska
- Edinburgh Breast Unit, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - J Michael Dixon
- Edinburgh Breast Unit, NHS Lothian, Western General Hospital, Edinburgh, UK
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50
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Sarikaya I, Sarikaya A. Assessing 18F-FDG Uptake in the Sentinel Lymph Node in Breast Cancer. J Nucl Med Technol 2018; 47:149-153. [PMID: 30413593 DOI: 10.2967/jnmt.118.219758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/03/2018] [Indexed: 01/12/2023] Open
Abstract
18F-FDG PET/CT has limited value in early breast cancer. Sentinel lymph node (SLN) biopsy is the current procedure of choice to search for small metastatic deposits in the axillary lymph nodes in early breast cancer. In this retrospective study, we reevaluated 18F-FDG PET/CT images after locating the SLN on PET/CT with the help of SLN SPECT/CT images and assessed 18F-FDG uptake, particularly in the SLN. Our goal was to understand if combined evaluation of 18F-FDG PET/CT and SLN SPECT/CT could be useful for detecting early lymph node metastasis in the axilla. Methods: 18F-FDG PET/CT images of newly diagnosed breast cancer patients who also had SLN scintigraphy (SPECT/CT) and biopsy results were analyzed to assess 18F-FDG uptake in the SLN. The SLN seen on SPECT/CT images was located on PET/CT images, and its metabolic activity was assessed both visually and semiquantitatively using SUVmax 18F-FDG PET results were compared with the histopathology result for the SLN. Results: Twenty patients among 130 met the inclusion criteria. SLN SPECT/CT images were helpful for locating the SLN on 18F-FDG PET/CT images in all 20 patients. Histopathologic analysis of the SLNs demonstrated metastasis in 7 patients and no metastasis in 13. There was mild (visible) 18F-FDG uptake in the SLN (SUVmax, 1.2-4.1; metastatic deposit size, 6-8 mm) in 6 of 7 patients with SLN metastasis (85.7%). There was no or only faint 18F-FDG uptake in the SLN (SUVmax < 1) in 9 of 13 patients with no SLN metastasis (69.2%). Receiver-operating-characteristic curve analysis indicated that the SUVmax cutoff for differentiating SLN-positive from -negative cases was 0.85 (sensitivity, 85.7%; specificity, 61.5%; area under the curve, 0.747; P < 0.05). Conclusion: Combined evaluation of 18F-FDG PET/CT and SPECT/CT images to assess 18F-FDG uptake, particularly in the SLN, is a new image analysis technique to detect early metastatic disease in the axillary lymph nodes in breast cancer. Although this technique does not currently seem feasible for use in routine practice, mainly because of the limitations of current PET/CT technology in detecting small tumors, it is an interesting image analysis technique to be aware of for possible future use.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait; and
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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