Evolving role of positron emission tomography in breast cancer imaging

18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has been used for detection, staging, and response monitoring in breast cancer patients. Although studies have proven its accuracy in detection of the primary tumor and axillary staging, its most important current clinical application is in detection and defining the extent of recurrent or metastatic breast cancer and for monitoring response to therapy. PET is complementary to conventional methods of staging in that it provides better sensitivity in detecting nodal and lytic bone metastases; however, it should not be considered a substitute for conventional staging studies, including computed tomography and bone scintigraphy. FDG uptake in the primary tumor carries prognostic information, but the underlying biochemical mechanisms responsible for enhanced glucose metabolism have not been completely elucidated. Future work using other PET tracers besides FDG will undoubtedly help our understanding of tumor biology and help tailor therapy to individual patient by improving our ability to quantify the therapeutic target, identify drug resistance factors, and measure and predict early response.