Background-aim: To evaluate the impact of PET/CT on man- agement of patients with breast cancer recurrence follow-on the increase of tumor markers with conventional imaging negative or doubt or nullifying and in case of confirmed tumor relapse in order to evaluate the extent of cancer. PET/CT data were compare with Radiology like, in particular, contrast enhanced Computed Tomography (ceCT) for the study of whole body involvement and UltraSonography (US) and/or Magnetic Resonance (MR) for the study of tumor local relapse. We also observed the impact of PET/ CT on patient management. Methods: Between January 2015 to October 2016 we retrospectively observed 85 patients (mean age 62.18 + 4.2 yo) with history of breast cancer with suspect disease relapse. All patients underwent a whole- body PET/CT with the same tomograph. PET/CT findings were compared with radiological techniques. The impact of PET/CT on patient management was evaluated on clinical making decision. Results: In 21 patients (24.7%) PET/CT showed a recurrence of breast cancer in the same site or around the place of primitive tumor; US and MR confirmed a local recurrence disease in 19 patients (22.35%) (p = ns). In 2 cases (2.35%) PET/CT showed a focal uptake in contralateral mammary gland (final histology showed malignant tumor). In 24 cases (28.3%) PET/CT showed lymphnode metastases in the axilla ipsilateral to the site of primary tumor, while radiology showed an ipsilateral axilla lymphnode relapse in 15 cases (17.64%) (p \ 0.35). Furthermore PET/CT showed a lymphnode recovery in other sites in 41 patients (48.23%) while radiology showed a lym- phnode disease relapse in other sites in 23 cases (27.05%) (p \ 0.1). PET/CT detected bone metastases in 32 patients (37.64%) while ceCT showed bone metastases in 12 cases (14.11%) (p \ 0.01). Lung involvement was detected in 19 cases (22.35%) while ceCT showed lung metastases in 15 cases (17.64%) (p = ns). PET/CT showed liver metastases in 9 cases (10.58%) while radiology looks at it in 8 cases (9.41%) (p = ns). PET/CT showed adrenal metastases in 6 cases (7.05%) while radiology looked it in 3 cases (3.52%) (p \ 0.106). In 25 patients (29.41%), PET/CT detected additional lesions not visible on radiology. PET/CT had an impact on clinical management in 37 patients (43.52%) by detecting more extensive locoregional disease or distant metastases. In 21 patients (24.70%) extensive surgery was not ended and treatment was changed. The sensitivity, specificity, accu- racy, positive and negative predictive values of PET/CT were respectively 97, 92, 95, 94 and 96%, while the sensitivity, specificity, accuracy, positive and negative predictive values in particular of ceCT was respectively 87, 81, 90 and 89%. Conclusions: PET/CT plays an central role in the restaging of patients with breast cancer recurrence since its result changed sig- nificantly the management of patients. PET/CT shows breast recurrence particularly contra laterally to the site of primary tumor; it was better for the identification of lymphnodes, bone and adrenal involvement. It was the same of radiology in the identification of lung and liver relapse. US and MR were important for the characterization of suspected breast relapse while they were not so good for the identification of locoregional lymphnodes involvement. PET/CT could potentially replace radiology in patients with breast cancer recurrence to optimize time consuming and costs.

The role of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in suspected recovery of breast cancer disease: comparison with Radiological Imaging and impact on patient management

C. Cittanti;A. Frassoldati;M. Bartolomei
2017

Abstract

Background-aim: To evaluate the impact of PET/CT on man- agement of patients with breast cancer recurrence follow-on the increase of tumor markers with conventional imaging negative or doubt or nullifying and in case of confirmed tumor relapse in order to evaluate the extent of cancer. PET/CT data were compare with Radiology like, in particular, contrast enhanced Computed Tomography (ceCT) for the study of whole body involvement and UltraSonography (US) and/or Magnetic Resonance (MR) for the study of tumor local relapse. We also observed the impact of PET/ CT on patient management. Methods: Between January 2015 to October 2016 we retrospectively observed 85 patients (mean age 62.18 + 4.2 yo) with history of breast cancer with suspect disease relapse. All patients underwent a whole- body PET/CT with the same tomograph. PET/CT findings were compared with radiological techniques. The impact of PET/CT on patient management was evaluated on clinical making decision. Results: In 21 patients (24.7%) PET/CT showed a recurrence of breast cancer in the same site or around the place of primitive tumor; US and MR confirmed a local recurrence disease in 19 patients (22.35%) (p = ns). In 2 cases (2.35%) PET/CT showed a focal uptake in contralateral mammary gland (final histology showed malignant tumor). In 24 cases (28.3%) PET/CT showed lymphnode metastases in the axilla ipsilateral to the site of primary tumor, while radiology showed an ipsilateral axilla lymphnode relapse in 15 cases (17.64%) (p \ 0.35). Furthermore PET/CT showed a lymphnode recovery in other sites in 41 patients (48.23%) while radiology showed a lym- phnode disease relapse in other sites in 23 cases (27.05%) (p \ 0.1). PET/CT detected bone metastases in 32 patients (37.64%) while ceCT showed bone metastases in 12 cases (14.11%) (p \ 0.01). Lung involvement was detected in 19 cases (22.35%) while ceCT showed lung metastases in 15 cases (17.64%) (p = ns). PET/CT showed liver metastases in 9 cases (10.58%) while radiology looks at it in 8 cases (9.41%) (p = ns). PET/CT showed adrenal metastases in 6 cases (7.05%) while radiology looked it in 3 cases (3.52%) (p \ 0.106). In 25 patients (29.41%), PET/CT detected additional lesions not visible on radiology. PET/CT had an impact on clinical management in 37 patients (43.52%) by detecting more extensive locoregional disease or distant metastases. In 21 patients (24.70%) extensive surgery was not ended and treatment was changed. The sensitivity, specificity, accu- racy, positive and negative predictive values of PET/CT were respectively 97, 92, 95, 94 and 96%, while the sensitivity, specificity, accuracy, positive and negative predictive values in particular of ceCT was respectively 87, 81, 90 and 89%. Conclusions: PET/CT plays an central role in the restaging of patients with breast cancer recurrence since its result changed sig- nificantly the management of patients. PET/CT shows breast recurrence particularly contra laterally to the site of primary tumor; it was better for the identification of lymphnodes, bone and adrenal involvement. It was the same of radiology in the identification of lung and liver relapse. US and MR were important for the characterization of suspected breast relapse while they were not so good for the identification of locoregional lymphnodes involvement. PET/CT could potentially replace radiology in patients with breast cancer recurrence to optimize time consuming and costs.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2382582
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