What You Need to Know: While guidelines recommend FDG-PET/CT imaging only for women with stage III breast cancer, PET scan can also help physicians more accurately diagnose young breast cancer patients initially diagnosed with earlier stages of the disease.
Background: Assessing if and how far breast cancer has spread throughout the body is what we refer to as staging. Most women in the USA are diagnosed at earlier stages, meaning stage 1 or 2 of possible 4 stages. Current National Comprehensive Cancer Network (NCCN) guidelines consider systemic FDG-PET/CT staging for only stage III breast cancer patients. More recently it has been debated whether factors other than stage should be considered in this decision. One such factor is patient age, as young breast cancer patients often have more aggressive tumors.
The Study: Researchers from Memorial Sloan Kettering Cancer Center (New York City) evaluated for the first time the impact of FDG PET/CT staging specifically in a young patient cohort. The study suggests that breast cancer patients under the age of 40 may benefit from systemic staging with FDG PET/CT at earlier stages than NCCN guidelines suggest.
Details, details: The study included 134 patients with initial diagnoses of stage I to IIIC breast cancer; those with signs of distant metastases or with prior malignancy were excluded. Here are the findings:
- PET/CT findings lead to upstaging to stage III or IV in 28 patients (21%).
- Unsuspected extra-axillary regional nodes were found in 15/134 (11%) and distant metastases in 20/134 (15%), with 7/134 (5%) demonstrating both.
- PET/CT revealed stage IV disease in 1/20 (5%) patients with initial clinical stage I, 2/44 (5%) stage IIA, 8 /47 (17%) stage IIB, 4/13 (31%) stage IIIA, 4/8 (50%) of IIIB, and 1/2 (50%) of stage IIIC patients. All 20 patients upstaged to stage IV were histologically confirmed.
- Four synchronous thyroid and 1 rectal malignancies were identified.
“Future NCCN guidelines for initial staging of breast cancer patients may need to consider other factors in addition to clinical stage. This study provides further evidence that molecular imaging and nuclear medicine can help us make better cancer staging and treatment decisions,” said Gary Ulaner, MD, PhD, assistant professor at Memorial Sloan Kettering. “Of course, our findings should still be confirmed in a prospective trial,” he added. “Our next step will be to look at factors other than patient age to understand which breast cancer patients benefit most from FDG-PET/CT.”
I’m Dr. Michael Hunter.
The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.
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Reference: Society of Nuclear Medicine. “FDG-PET/CT shows promise for breast cancer patients younger than 40.” ScienceDaily. ScienceDaily, 1 October 2014. <www.sciencedaily.com/releases/2014/10/141001102727.htm>.