Whole-body PET/CT-mammography for staging breast cancer: initial results

The purpose of this study was to evaluate the feasibility and utility of a dedicated positron emission tomography (PET)/CT protocol in breast cancer patients. 40 patients with suspected recurrent breast cancer underwent whole-body PET/CT in the supine position (SP) followed by PET/CT of the breasts and axillae in the prone position (PP) using a special positioning aid. PP and SP images were compared in terms of the tumour-to-thoracic-wall distance, tumour-to-skin distance and tumour volume, diameter, density, maximal standardized uptake value (SUV(max)) and localization. The size of axillary areas, the number of intra-axillary lymph nodes, their transverse diameters, their SUV(max) and the number of distant metastases were compared between PP and SP images. Differences were tested for significance using the Student's t-test. All patients tolerated PP imaging well. Five locally recurrent breast cancers were detected, both in the SP and in the PP. Mean tumour-to-thoracic-wall distances (PP, 19 mm; SP, 8 mm; p = 0.003) and tumour-to-skin distances (PP, 10 mm; SP, 7 mm; p = 0.013) were significantly larger in the PP than in the SP. Potential thoracic wall or skin infiltration, as well as quadrant localization, were determined more easily in PP. The axillary area was wider in the PP when compared with SP (PP, 14.4 cm(2); SP, 10.6 cm(2); p<0.001). No other parameters were significantly different. In conclusion, a dedicated whole-body PET/CT examination, including PET/CT mammography, is feasible for clinical practice and may offer important information on the possible infiltration of a breast lesion into the adjacent thoracic wall and skin. Even though the axilla may be delineated more clearly in the PP, there seems to be no benefit with regard to N-staging.