Breast cancer: initial workup and staging with FDG PET/CT

Area of Science:

• Oncology
• Nuclear Medicine
• Radiology

Background:

• Accurate breast cancer staging is crucial for effective treatment planning.
• 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) demonstrates high sensitivity for detecting extra-axillary lymph nodes and distant metastases.

Purpose of the Study:

• To determine patient groups who would benefit from FDG-PET/CT for breast cancer staging.
• To provide guidance on incorporating tumor biology and subtype into FDG-PET/CT interpretation.

Main Methods:

• A comprehensive literature review and appraisal of relevant research studies.
• Development of clinical practice recommendations by a French Society of Nuclear Medicine working group in collaboration with oncological societies.

Main Results:

• FDG-PET/CT is valuable for initial breast cancer staging across all tumor phenotypes and grades.
• The imaging modality is particularly effective for invasive ductal carcinoma and helpful for invasive lobular carcinoma.
• FDG-PET/CT demonstrates utility for staging starting from clinical stage IIB, with possible utility in stage IIA, but no added value in stage I.

Conclusions:

• FDG-PET/CT is a recommended tool for staging breast cancer patients from clinical stage IIB.
• The interpretation of FDG-PET/CT scans should consider breast cancer subtypes and tumor biology.