FDG-PET/CT useful for initial staging of inflammatory breast cancer patients
MedWire News: Eighteen-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging provides invaluable information regarding nodal status or distant metastases in inflammatory breast cancer (IBC) patients and should be considered for initial staging, say researchers.
FDG-PET/CT has become a valuable tool to define the extent of disease in several cancers, especially in lung cancer, where it has become a standard for initial staging, note Jean-Louis Alberini (Cancer Research Center Rene Huguenin, Saint-Cloud, France) and colleagues.
To assess its value in the initial staging and prognosis of IBC, Alberini and team scanned 62 women (mean age, 50.7 years) presenting with unilateral inflammatory breast tumors (59 invasive carcinomas, three mastitis) with FDG-PET/CT before biopsy.
As reported in the journal Cancer, PET/CT showed 100% sensitivity for the detection of the primary malignant tumor in the IBC patients but was false positive in two of the three benign mastitis cases.
“This is not unexpected because FDG is not a cancer-specific tracer, [and] may also accumulate in inflammatory and/or infectious lesions,” remark Alberini and co-authors.
Increased FDG uptake nodal foci were detected in axillary (90%) and extra-axillary areas (56%) ipsilateral to the cancer. Compared with clinical examination, the axillary lymph node status by PET/CT was upstaged in 35 patients and downstaged in five patients.
Pathologic postsurgery assessment revealed that the axillary lymph node positivity on PET/CT was correct in seven of nine patients with clinical stage N0 breast cancer. Post surgery data were not available in the remaining two patients.
When the researchers compared PET/CT nodal results with pre-operative fine needle aspiration and/or pathologic surgery findings in 44 patients, there were 38 (86.5%) true–positive, two (4.5%) false-positive, and four (9%) false-negative results.
PET/CT imaging revealed distant lesions in 18 (31%) of the 59 IBC patients. The researchers found that patients with high primary tumor FDG uptake and distant lesions (n=11) had a significantly worse overall survival than those with high primary tumor FDG uptake and no distant lesions (n=17).
Alberini et al conclude that the additional information PET/CT provided regarding lymph node and distant metastases means it should be considered in the initial staging of IBC patients.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009
By Laura Dean