Top Line: Is FDG-PET useful in staging patients with locally advanced breast cancer?
The Study: Body imaging plays a limited role in the standard workup of breast cancer. In general, the NCCN Guidelines don’t recommend systemic imaging without signs or symptoms of metastasis, and they’re lukewarm on the use of CT and especially PET/CT for patients with more locoregionally advanced disease. In this multicenter Canadian trial, 369 patients with stage III or cT3N0 breast cancer were randomized to systemic imaging with CT and bone scan or FDG-PET/CT. The primary endpoint was the proportion of patients upstaged to stage IV. More than twice as many patients in the PET/CT arm were found to have stage IV disease (23% v 11%). These findings resulted in significantly fewer patients in the PET/CT arm receiving combined modality therapy (81% v 89.2%). PET/CT also did a better job of identifying regional lymph node metastasis than conventional imaging (22.7% v 7.1%).
TBL: PET/CT is more sensitive than conventional imaging at detecting occult metastatic disease in patients with stage III or T3N0 disease. Nearly a quarter of patients in this study had distant metastases on PET/CT. | Dayes, J Clin Oncol 2023
The Study: Body imaging plays a limited role in the standard workup of breast cancer. In general, the NCCN Guidelines don’t recommend systemic imaging without signs or symptoms of metastasis, and they’re lukewarm on the use of CT and especially PET/CT for patients with more locoregionally advanced disease. In this multicenter Canadian trial, 369 patients with stage III or cT3N0 breast cancer were randomized to systemic imaging with CT and bone scan or FDG-PET/CT. The primary endpoint was the proportion of patients upstaged to stage IV. More than twice as many patients in the PET/CT arm were found to have stage IV disease (23% v 11%). These findings resulted in significantly fewer patients in the PET/CT arm receiving combined modality therapy (81% v 89.2%). PET/CT also did a better job of identifying regional lymph node metastasis than conventional imaging (22.7% v 7.1%).
TBL: PET/CT is more sensitive than conventional imaging at detecting occult metastatic disease in patients with stage III or T3N0 disease. Nearly a quarter of patients in this study had distant metastases on PET/CT. | Dayes, J Clin Oncol 2023