FDG-PET/CT in high-risk primary breast cancer—a prospective study of stage migration and clinical impact

• DOI: 10.1007/s10549-020-05929-3
• Publication Date: 2020-09-12T17:03:19Z
• Authors: Marianne Vogsen; Jeanette Dupont J...; Ivar Yannick Chri...; Oke Gerke; Anne Marie Bak Jy...; Lisbet Brønsro La...; Poul-Erik Braad; Katrine Lydolph Søe; Camilla Bille; Marianne Ewertz; Malene Grubbe Hil...
• Keywords: Clinical impact; Breast Neoplasms; Sensitivity and Specificity; FDG-PET/CT; Incidental findings; 3. Good health; 03 medical and health sciences; Breast cancer; 0302 clinical medicine; Stage migration; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Humans; Female; Prospective Studies; Radiopharmaceuticals; Neoplasm Staging

To investigate the clinical impact of FDG-PET/CT for staging and treatment planning in high-risk primary breast cancer.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.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).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.