F-18 fluorodeoxyglucose-positron emission tomography imaging for primary breast cancer and loco-regional staging

Breast cancer is the most common female malignancy in Western countries. The limitations of mammography, ultrasound and MRI do not allow reliable identification of primary breast cancer at early stages. Functional breast imaging with positron emission tomography (PET) and F-18 fluorodeoxyglucose (FDG) enables the visualization of increased glucose metabolism of breast cancer. However, despite the successful identification of primary breast cancer, FDG-PET provides a low sensitivity to detect small tumors. Therefore, FDG-PET does not allow screening of asymptomatic women and cannot be used to exclude breast cancer in patients with suspicious breast masses or abnormal mammography. FDG-PET is a powerful tool for staging of breast cancer patients, but does not detect micrometastases and small tumor infiltrated lymph nodes. Nevertheless, in patients with locally advanced breast cancer, PET accurately determines the extent of disease, particularly the loco-regional lymph node status. Advances in technology, for example the development of dedicated breast imaging devices such as positron emission mammography, hold promise to improve the detection of primary tumors in the future.