Possibilities of positron emission tomography in the metastatic breast cancer diagnosis

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An analysis of published data on the possibilities of the positron emission tomography method application in complex diagnostic and treatment activities in metastatic breast cancer was performed. The possibilities are described and the method characteristics according to series of studies, in particular with regard to the various localization metastases identification are given. It is noted that, compared with conventional imaging techniques, positron emission tomography is more sensitive and specific method of distant metastases diagnosis. The results of clinical studies on assessment of the method application possibilities in the detection of breast cancer metastases in lymph nodes, various organs and bone metastases are given. It has been shown that the introduction of sodium fluoride into practice allowed to use this agent as bone tissue biomarker, which can be used in positron emission tomography performing. The data that the simultaneous use of positron emission tomography with 18F-fluorodeoxyglucose and computed tomography has a high diagnostic value in relation to the breast cancer distant metastases detection are presented. The method possibilities for the various forms of primary invasive breast cancer identification, including invasive ductal and lobular cancer are considered. The prospects analysis for a further increase of opportunities for positron emission tomography application is performed, in particular, reports on the possibility of so-called hybrid scanning using positron emission tomography and magnetic resonance imaging are considered. It is highlighted that the most important aim of the method use in clinical practice in the prospect may be local-regional recurrence and distant metastasis monitoring after primary treatment for breast cancer.

About the authors

M S Ramazanova

Kirov State Medical Academy

Author for correspondence.
Email: ramazanovam@inbox.ru

A G Kislichko

Kirov State Medical Academy

Email: ramazanovam@inbox.ru

E A Glushkov

Kirov State Medical Academy

Email: ramazanovam@inbox.ru


  1. Abe K., Sasaki M., Kuwabara Y. et at. Comparison of 18FDG-PET with 99mTc-HMDP scintigraphy for the detection of bone metastases in patients with breast cancer. Ann. Nucl. Med. 2005; 19: 573-579. http://dx.doi.org/10.1007/BF02985050
  2. Аukеtа T.S., Straver M.E., Peelers M.J. et al. Detection of extra-axillary lymph node involvement with FDG PET/CT in patients with stage II-III breast cancer. Eur. J. Cancer. 2010; 46: 3205-3210. http://dx.doi.org/10.1016/j.ejca.2010.07.034
  3. Avril N., Dose J., Janicke F. et al. Metabolic characterization of breast tumors with positron emission tomography using F-18 fluorodeoxyglucose. J. Clin. Oncol. 1996; 14: 1848-1857.
  4. Callowitsch H.J., Kresnik E., Gasser J. et at. F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow up of patients with breast carcinoma: a comparison to conventional imaging. Invest. Radiol. 2003; 38: 250-256. http://dx.doi.org/10.1097/01.RLI.0000063983.86229.f2
  5. Catalano O.A., Nicolai E., Rosen B.R. et al. Comparison of CE-FDG-PET/CT with CE-FDG-PET/MR in the evaluation of osseous metastases in breast cancer patients. Br. J. Cancer. 2015; 112 (9): 1452-1460. http://dx.doi.org/10.1038/bjc.2015.112
  6. Coleman R.E. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin. Cancer Res. 2006; 12 (20): 6243-6249. http://dx.doi.org/10.1158/1078-0432.CCR-06-0931
  7. Coleman R.E., Gregory W., Marshall H. et al. The metastatic microenvironment of breast cancer: clinical implications. Breast. 2013; 2: 50-56. http://dx.doi.org/10.1016/j.breast.2013.07.010
  8. Constantinidou A., Martin A., Sharma B., Johnston S.R. Positron emission tomography/computed tomography in the management of recurrent/metastatic breast cancer: a large retrospective study from the Royal Marsden Hospital. Ann. Oncol. 2011; 22: 307-314. http://dx.doi.org/10.1093/annonc/mdq343
  9. Di Gioia D., Stieber P., Schmidt G.P. et al. Early detection of metastatic disease in asymptomatic breast cancer patients with whole-body imaging and defined tumour marker increase. Br. J. Cancer. 2015; 112 (5): 809-818. http://dx.doi.org/10.1038/bjc.2015.8
  10. Dong Y., Hou H., Wang C. et al. The diagnostic value of 18F-FDG PET/CT in association with serum tumor marker assays in breast cancer recurrence and metastasis. Biomed Res. Int. 2015; ID 489021. http://dx.doi.org/10.1155/2015/489021. http://dx.doi.org/10.1155/2015/489021
  11. Door R.K., Muzi M., Peterson L.M. et al. Kinetic analysis of 18E-fluoride PET images of breast cancer bone metastases. J. Nucl. Med. 2010; 51: 521-527. http://dx.doi.org/10.2967/jnumed.109.070052
  12. Ergul N., Kadioglu H., Yildiz S. et al. Assessment of multifocality and axillary nodal involvement in early-stage breast cancer patients using 18F-FDG PET/CT compared to contrast-enhanced and diffusion-weighted magnetic resonance imaging and sentinel node biopsy. Acta Radiol. 2014. 56(8). http://dx.doi.org/10.1177/0284185114539786
  13. Eubank W.B., Mankoff D.A., Takasugi J. et al. 18 fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J. Clin. Oncol. 2001; 19: 3516-3523.
  14. Feriay J., Steliarova-Foucher E., Lortet-Tieulent J. et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur. J Cancer. 2013; 49: 1374-1403. http://dx.doi.org/10.1016/j.ejca.2012.12.027
  15. Fletcher J.W., Djulbegovie B., Soares H.P. et al. Recommendations on the use of 18F-FDG PET in oncology. J. Nucl. Med. 2008; 49: 480-508. http://dx.doi.org/10.2967/jnumed.107.047787
  16. Fujimoto R., Higashi T., Nakamoto Y. et al. Diagnostic accuracy of bone metastases detection in cancer patients: comparison between bone scintigraphy and whole-body FDG-PEY. Ann. Nucl. Med. 2006; 20: 399-408. http://dx.doi.org/10.1007/BF03027375
  17. Greco M., Crippa F., Agresti R. et al. Axillary lymph node staging in breast cancer by 2-F1 uoro-2-deoxy-D-giucose-positron emission tomography: Clinical evaluation and alternative management. J. Natl. Cancer Inst. 2001; 93: 630-635. http://dx.doi.org/10.1093/jnci/93.8.630
  18. Hong S., Li J., Wang S. (18)FDG PET-CT for diagnosis of distant metastases in breast cancer patients. A meta-analysis. Surg. Oncol. 2013; 22: 139-143. http://dx.doi.org/10.1016/j.suronc.2013.03.001
  19. Iagaru A., Mima E., Yaghou M.S et al. Novel strategy for a cocktail 18F-fluoride and 18F-FDG PET/CT scan for evaluation of malignancy: results of the pilot-phase. J. Nucl. Med. 2009; 50: 501-505. http://dx.doi.org/10.2967/jnumed.108.058339
  20. Iagaru A., Mima E., Mosci C. et al. Combined 18F-fluoride and 18F-FDG PET/CT scanning for evaluation of malignancy: results of an international multicenter trial. J. Nucl. Med. 2013; 54: 176-183. http://dx.doi.org/10.2967/jnumed.112.108803
  21. Isasi C.R., Moadel R.M., Blaufox M.D. A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases. Breast Cancer Res. Treat. 2005; 90: 105-112. http://dx.doi.org/10.1007/s10549-004-3291-7
  22. Jambor I., Kuisma A., Ramadan S. et al. Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, (18) F-NaFPET/CT and whole body 1.5T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial. Acta Oncol. 2016; 55 (1): 1-9. http://dx.doi.org/10.3109/0284186X.2015.1027411
  23. Manohar K., Mittal B.R., Senthil R. et al. Clinical utility of F-18 FDG PET/CT in recurrent breast carcinoma. Nucl. Med. Commun. 2012; 33: 591-596. http://dx.doi.org/10.1097/MNM.0b013e3283516716
  24. Morris P.G., Lynch C., Feeney J.N. et at. Integrated positron emission tomography/computed tomography may render bone scintigraphy unnecessary to investigate suspected metastatic breast cancer. J. Clin. Oncol. 2010; 28: 3154-3159. http://dx.doi.org/10.1200/JCO.2009.27.5743
  25. Munoz-Iglesias J., Una-Gorospe J., Allende-Riera A. et al. Unsuspected uterine metastasis of breast carcinoma diagnosed by 18F-FDG PET/CT. Clin. Nucl. Med. 2013; 38 (11): 441-442. http://dx.doi.org/10.1097/RLU.0b013e318292a73b
  26. National Cancer Institute. SEER Star Fact Sheets: Breast (Internet). Available at http://seer.cancer.gov/statfacts/htmi/breast.html [cited on Sep. 9, 2013).
  27. Pan L., Han Y., Sun X. et al. FDG-PET and other imaging modalities for the evaluation of breast cancer recurrence and metastases; a meta-analysis. J. Cancer Res. Clin. Oncol. 2010; 136: 1007-1022. http://dx.doi.org/10.1007/s00432-009-0746-6
  28. Peterson J.J., Kransdorf M.J., O’Connor M.I. Diagnosis of occult bone metastases: positron emission tomography. Clin. Relat. Res. 2003; 123: 8120-8128. http://dx.doi.org/10.1097/01.blo.0000093051.96273.7c
  29. Piccardo A., Altrinetti V., Bacigalupo L. et al. Detection of metastatic bone lesions in breast cancer patients: fused (18)F-Fluoride-PET/MDCT has higher accuracy than MOOT. Preliminary experience. Eur. J. Radiol. 2012; 81: 2632-2638. http://dx.doi.org/10.1016/j.ejrad.2011.12.020
  30. Port E.R., Yeung H., Gonen M. et al. 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography scanning affects surgical management in selected patients with high-risk, operable breast carcinoma. Ann. Surg. Oncol. 2006; 13: 677-684. http://dx.doi.org/10.1245/ASO.2006.03.035
  31. Riedl C.C., Slobod E., Jochelson M. et al. Retrospective analysis of 18F-FDG PET/CT for staging asymptomatic breast cancer patients younger than 40 years. J. Nucl. Med. 2014; 55 (10): 1578-1583. http://dx.doi.org/10.2967/jnumed.114.143297
  32. Riegger C., Koenlnger A., Hartung V. et al. Comparison of the diagnostic value of FDG- PET/CT and axillary ultrasound for the detection of lymph node metastases in breast cancer patients. Acta Radiol. 2012; 53: 1992-1998. http://dx.doi.org/10.1258/ar.2012.110635
  33. Santiago J.E., Gonen M., Yeung H. et al. A retrospective analysis of the impact of 18F-FDG PET scans on clinical management of 133 breast cancer patients. Q. J. Nucl. Med. Mol. Imaging. 2006; 50: 61-67.
  34. Tabouret-Viaud C., Botsikas D., Delattre B.M. et al. PET/MR in Breast Cancer. Semin. Nucl. Med. 2015; 45 (4): 304-321. http://dx.doi.org/10.1053/j.semnuclmed.2015.03.003
  35. Teke F., Teke M., Inal A. et al. Significance of hormone receptor status in comparison of 18F-FDG-PET/CT and 99mTc-MDP bone scintigraphy for evaluating bone metastases in patients with breast cancer: single center experience. Asian. Pac. J. Cancer Prev. 2015; 16 (1): 387-391. http://dx.doi.org/10.7314/APJCP.2015.16.1.387
  36. Treglia G., Paone G., Ceriani L., Giovanella L. Metastatic brachial plexopathy from breast cancer detected by 18F-FDG PET/MRI. Rev. Esp. Med. Nucl. Imagen. Mol. 2014; 33 (1): 54-55. http://dx.doi.org/10.1016/j.remn.2013.06.007
  37. Van der Hoeven J.J., Krak N.C., Hoekstra O.S. et al. 18F-2-fluoro-2-deoxy-d-glucose positron emission tomography in staging of locally advanced breast cancer. J. Clin. Oncol. 2004; 22: 1253-1259. http://dx.doi.org/10.1200/JCO.2004.07.058
  38. Van Kruchten M., Glaudemans A.W., de Vries E.F. et al. Positron emission tomography of tumour [18F] fluoroestradiol uptake in patients with acquired hormone-resistant metastatic breast cancer prior to oestradiol therapy. Eur. J. Nucl. Med. Mol. Imaging. 2015; 42 (11): 1674-1681. http://dx.doi.org/10.1007/s00259-015-3107-5
  39. Veit-Haibach P., Antoch G., Beyer T. et al. FDG-PET/CT in restaging of patients with recurrent breast cancer: possible impact on staging and therapy. Br. J. Radiol. 2007; 80: 508-515. http://dx.doi.org/10.1259/bjr/17395663
  40. Veronesi U., Paganelli G., Galimberti V. et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997; 349: 1864-1867. http://dx.doi.org/10.1016/S0140-6736(97)01004-0
  41. Wahl R.L., Siegel B.A., Coleman R.E., Catsonis C.G. Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J. Clin. Oncol. 2004; 22: 277-285. http://dx.doi.org/10.1200/JCO.2004.04.148
  42. You S., Kang D.K., Jung Y.S. et al. Evaluation of lymph node status after neoadjuvant chemotherapy in breast cancer patients: comparison of diagnostic performance of ultrasound, MRI and (18) F-FDG PET/CT. Br. J. Radiol. 2015. doi: 10.1259/bjr.20150143. http://dx.doi.org/10.1259/bjr.20150143
  43. Zhang X., Wu F., Han P. The role of (18)F-FDG PET/CT in the diagnosis of breast cancer and lymph nodes metastases and micrometastases may be limited. Hell. J. Nucl. Med. 2014; 17 (3): 177-183.

© 2016 Ramazanova M.S., Kislichko A.G., Glushkov E.A.

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