18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

Area of Science:

• Nuclear Medicine
• Oncology
• Radiology

Background:

• Current guidelines lack systematic recommendations for 18F-FDG PET/CT in breast cancer staging.
• Evidence and recommendations for its use vary across patient groups.

Purpose of the Study:

• To review the evidence on 18F-FDG PET/CT for breast cancer staging.
• To assess its therapeutic and prognostic impact over the last decade.
• To provide evidence-based recommendations for its clinical application.

Main Methods:

• Systematic MEDLINE search using PICO framework for studies with ≥30 patients.
• Critical review of selected articles and evidence table elaboration.
• Summarization of evidence levels and recommendation grades.

Main Results:

• Level III evidence supports 18F-FDG PET/CT for initial staging in recently diagnosed breast cancer (weak recommendation).
• Level II evidence supports its use in locally advanced breast cancer (strong recommendation).
• Baseline 18F-FDG PET/CT metabolic information correlates with tumor biology and prognosis (Level II evidence).

Conclusions:

• 18F-FDG PET/CT is not recommended for all early breast cancer staging.
• Its use is supported for locally advanced breast cancer due to improved staging accuracy.
• Baseline tumor glycolytic activity predicts tumor biology and prognosis.