Comparison of [sup.18]F-Fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging for locally advanced breast cancer staging: A prospective study from a tertiary hospital cancer centre in the Western Cape

• Published in: SA journal of oncology Vol. 4; no. 6
• Main Authors: Chilwesa, Paul M, Gameldien, Rufkah, Steyn, Rachelle, More, Stuart, Malherbe, Francois, Human, Gercios, Mottay, Lynelle, Moxley, Karis, Hardy, Anneli, Anderson, David, Hunter, Alistair J, Parkes, Jeannette
• Format: Journal Article
• Language: English
• Published: African Online Scientific Information Systems (Pty) Ltd t/a AOSIS 01.01.2020
• Subjects: Cancer metastasis; Cancer research; Cancer staging; Comparative analysis; Invasive ductal carcinoma (Breast cancer); Positron emission tomography
• ISSN: 2518-8704; 2518-8704
• DOI: 10.4102/sajo.v4i0.106

Background Breast cancer is the second most common cancer in adults and the most frequent cancer diagnosed in women. In South Africa, breast cancer accounts for 38.5% of cancers diagnosed in women. Since the presence, extent and location of distant metastases is one important prognostic factor in locally advanced breast cancer (LABC), accurate staging at diagnosis is crucial to ensure that patients receive the appropriate treatment. Increasing evidence shows that the use of [sup.18]F-Fluorodeoxyglucose positron emission tomography/computed tomography ([sup.18]F-FDG PET/CT) for disease staging of LABC may improve diagnostic sensitivity. Aim The aim of this study was to prospectively assess the difference in diagnostic accuracy between whole-body PET/PET-CT and conventional imaging (CI) for staging LABC. Setting The breast cancer outpatient clinic at Groote Schuur Hospital in Cape Town, South Africa. Methods A total of 42 participants with clinical stage III and a select few stage II breast cancer underwent both [sup.18]F-FDG PET/CT and CI. Results The [sup.18]F-FDG PET/CT found significantly more (p = 0.0077) distant metastatic sites than CI (36% vs. 21%). The [sup.18]F-FDG PET/CT upstaged 9 (21.4%) of patients from clinical stage IIIa to stage IIIc, and changed in management of 54% of patients. Thirty-eight per cent of the patients had their clinical stage unchanged. One of five suspected metastatic sites [sup.18]F FDG PET/CT on biopsy was positive for malignancy. Conclusion The [sup.18]F-FDG PET/CT is useful for staging locally advanced non-inflammatory infiltrating ductal carcinoma of the breast. Use of [sup.18]F-FDG PET/CT was superior to conventional imaging in assessing metastatic mediastinal lymphadenopathy, but with a poor specificity. The use of [sup.18]F-FDG PET/CT in LABC is useful, with the biopsy of isolated suspicious lesions for metastasis increasing its accuracy.