Role of 2-[18F] Fluoro-2-Deoxy-D-Glucose-Positron Emission Tomography/Computed Tomography in the Post-Therapy Surveillance of Breast Cancer

• Published in: PloS one Vol. 9; no. 12; p. e115127
• Main Authors: Chang, Hong-Tai, Hu, Chin, Chiu, Yu-Li, Peng, Nan-Jing, Liu, Ren-Shyan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.12.2014; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Biology and Life Sciences; Breast cancer; Breast Neoplasms - metabolism; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Cancer; Cancer diagnosis; Cancer treatment; Carcinoma, Ductal, Breast - metabolism; Carcinoma, Ductal, Breast - secondary; Carcinoma, Ductal, Breast - therapy; Carcinoma, Lobular - metabolism; Carcinoma, Lobular - secondary; Carcinoma, Lobular - therapy; Carcinoma, Medullary - metabolism; Carcinoma, Medullary - secondary; Carcinoma, Medullary - therapy; Care and treatment; Combined Modality Therapy; Computation; Computed tomography; Emission analysis; Emissions; Female; Fluorodeoxyglucose F18 - pharmacokinetics; Follow-Up Studies; Glucose; Health aspects; Humans; Lesions; Lymphatic Metastasis; Mammography; Medical diagnosis; Medical imaging; Medicine and Health Sciences; Middle Aged; Multimodal Imaging; Neoplasm Invasiveness; Neoplasm Recurrence, Local - diagnosis; Neoplasm Staging; Patients; Positron emission; Positron emission tomography; Positron-Emission Tomography - methods; Prognosis; Radiopharmaceuticals - pharmacokinetics; Retrospective Studies; Surveillance; Systematic review; Therapy; Tissue Distribution; Tomography; Tomography, X-Ray Computed - methods
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0115127

To evaluate the usefulness of 2-[18F] fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the early detection of breast cancer tumor recurrences and its role in post-therapy surveillance. FDG-PET/CT was performed on patients with increased serum CA 15-3 levels and/or clinical/radiologic suspicion of recurrence. A group of asymptomatic patients who underwent FDG-PET/CT in the post-therapy surveillance of breast cancer served as the controls. The results were analyzed based on the patients' histological data, other imaging modalities and/or clinical follow-up. Recurrence was defined as evidence of recurrent lesions within 12 months of the FDG-PET/CT scan. Based on elevated serum CA15-3 levels (n = 31) and clinical/radiologic suspicion (n = 40), 71 scans were performed due to suspected recurrence, whereas 69 scans were performed for asymptomatic follow-up. The sensitivity and specificity of FDG-PET/CT were 87.5% and 87.1% in the patients with suspected recurrence and 77.8% and 91.7% in the asymptomatic patients. The positive predictive value in the patients with suspected recurrence (mainly due to elevated serum CA 15-3 levels) was higher than that in asymptomatic patients (P = 0.013). Recurrences were proven in 56.3% (40/71) of the patients with suspected recurrence and in 13% (9/69) of the asymptomatic patients (P < 0.001). FDG-PET/CT resulted in changes in the planned management in 49.3% (35/71) of the patients with suspected recurrence and 10.1% (7/69) of the asymptomatic patients (P < 0.001). After follow-up, 77.5% (55/71) of the patients with suspicious recurrences and 97.1% (67/69) of the asymptomatic patients were surviving at the end of the study (P < 0.001). FDG-PET/CT was able to detect recurrence, and the results altered the intended patient management in the post-therapy surveillance of breast cancer. FDG-PET/CT should be used as a priority in patients with increased serum CA 15-3 levels, or with clinical/radiologic suspicion of recurrence, and might be useful for asymptomatic patients.