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12 - Application of positron emission tomography – computerized tomography in breast cancer

Published online by Cambridge University Press:  06 July 2010

By
Iain D. Lyburn  and
Elizabeth F. Brown
Edited by
Michael J. Michell
Michael J. Michell
Affiliation:
King's College Hospital, London
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Summary

Introduction

At present there is no clinical role for whole or half body imaging with 18F-fluoro-2-deoxy-D-glucose (FDG)–positron emission tomography (PET) in detecting breast cancer, but this technique has been shown to be useful in staging and restaging breast cancer, in the evaluation of response to therapy, and in problem solving when conventional imaging results are equivocal. In these scenarios FDG–PET often demonstrates loco-regional or unsuspected distant disease that affects clinical management.

Positron emission tomography

PET is an imaging technique increasingly used in oncology. It may map functional activity before structural changes have taken place. The most commonly used isotope is FDG, a glucose analogue which, like normal glucose, is taken up by cells via the membrane glucose transporter system and phosphorylated by hexokinase. Unlike glucose, the metabolic product FDG-6-phosphate does not cross the cell membrane and is trapped in cells. FDG accumulation is dependent on the rate of transport through the cell membrane mediated by glucose transporters (GLUT). Many malignancies, including breast cancers, show increased expression of GLUT-1, contributing to increased FDG accumulation. FDG may also accumulate in non-malignant areas of infection or inflammation leading to false-positive findings.

Technique

An intravenous injection of 300 to 400 megabecquerels (MBq) of FDG is used in most institutions and the patient imaged at least one hour after injection. Delaying the time of imaging may improve the tumor-to-background ratio.

Type
Chapter
Information
Breast Cancer , pp. 218 - 240
Publisher: Cambridge University Press
Print publication year: 2010

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References

Hodgson, NC, Gulenchyn, KY. Is there a role for positron emission tomography in breast cancer staging?J Clin Oncol 2008; 26: 712–20.CrossRefGoogle Scholar
Fletcher, JW, Djulbegovic, B, Soares, HP, et al. Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med 2008; 49: 480–508.CrossRefGoogle Scholar
Bar-Shalom, R, Valdivia, A y, Blaufox, MD. PET imaging in oncology. Semin Nucl Med 2000; 30: 150–85.CrossRefGoogle Scholar
Shreve, PD, Anzai, Y, Wahl, RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics 1999; 19: 61–77.CrossRefGoogle ScholarPubMed
Chen, YM, Huang, G, Sun, XG, et al. Optimizing delayed scan time for FDG PET: comparison of the early and late delayed scan. Nucl Med Commun 2008; 29: 425–30.CrossRefGoogle ScholarPubMed
Zytoon, AA, Murakami, K, El-Kholy, MR, et al. Breast cancer with low FDG uptake: Characterization by means of dual-time point FDG-PET/CT. Eur J Radiol 2009; 70: 530–8.CrossRefGoogle ScholarPubMed
Turcotte, E, Benard, F, Boucher, L, et al. Use of IV insulin to reduce blood glucose levels before FDG-PET scanning in diabetic patients. J Nucl Med 2000; 41: 294P.Google Scholar
Thie, JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med 2004; 45: 1431–4.Google ScholarPubMed
Visvikis, D, Turzo, A, Bizais, Y, et al. Technology related parameters affecting quantification in positron emission tomography imaging. Nucl Med commun 2004; 25: 637–41.CrossRefGoogle ScholarPubMed
Lardinois, D, Weder, W, Hany, TF, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med 2003; 348: 2500–7.CrossRefGoogle ScholarPubMed
Cerfolio, RJ, Ojha, B, Bryant, AS, et al. The accuracy of integrated PET-CT compared with dedicated PET alone for the staging of patients with nonsmall cell lung cancer. Ann Thorac Surg 2004; 78: 1017–23.CrossRefGoogle ScholarPubMed
Casneuf, V, Delrue, L, Kelles, A, et al. Is combined 18F-fluorodeoxyglucose-positron emission tomography/computed tomography superior to positron emission tomography or computed tomography alone for diagnosis, staging and restaging of pancreatic lesions?Acta Gastroenterol Belg 2007; 70: 331–8.Google ScholarPubMed
Sung, YM, Lee, KS, Kim, BT, et al. (18)F-FDG PET versus (18)F-FDG PET/CT for adrenal gland lesion characterization: a comparison of diagnostic efficacy in lung cancer patients. Korean J Radiol 2008; 9: 19–28.CrossRefGoogle ScholarPubMed
Kumar, R, Chauhan, A, Zhuang, H, et al. Clinicopathological factors associated with false negative FDG-PET in primary breast cancer. Breast cancer Res Treat 2006; 98: 267–74.CrossRefGoogle Scholar
Samson, DJ, Flamm, CR, Pisano, ED, et al. Should FDG PET be used to decide whether a patient with an abnormal mammogram or breast finding at physical examination should undergo biopsy? Acad Radiol 2002; 9: 773–83.CrossRefGoogle ScholarPubMed
Effectiveness of Noninvasive Diagnositic Tests for Breast Abnormalities: Comparative Effectivenes Review No.2. (Prepared by ECRI Evidence-Based Practice Center Under Contract No. 290–02–0019) (computer program). Rockville, MD: Agency for Healthcare Research, 2006.
Dehdashti, F, Seigel, BA. Evaluation of breast and gynaecologic cancers by positron emission tomography. Semin Roentgenol 2002; 37: 151–68.CrossRefGoogle Scholar
Boerner, AR, Weckesser, M, Herzog, H, et al. Optimal scan time for fluorine-18 fluorodeoxyglucose positron emission tomographyin breast cancer. Eur J Nucl Med 1999; 26: 226–30.CrossRefGoogle ScholarPubMed
Vranjesevic, D, Schiepers, C, Silverman, DH, et al. Relationship between 18F-FDG uptake and breast density in women with normal breast tissue. J Nucl Med 2003; 44: 1238–42.Google ScholarPubMed
Bakheet, SM, Powe, J, Kandil, A, et al. F-18 FDG uptake in breast infection and inflammation. Clin Nucl Med 2000; 25: 100–3.CrossRefGoogle ScholarPubMed
Murthy, K, Aznar, M, Thompson, CJ, et al. Results of preliminary clinical trials of the positron emission mammography system PEM-I: a dedicated breast imaging system producing glucose metabolic images using FDG. J Nucl Med 2000; 41: 1851–8.Google ScholarPubMed
Rosen, EL, Turkington, TG, Soo, MS, et al. Detection of primary breast carcinoma with a dedicated, large-field-of-view FDG PET mammography device: initial experience. Radiology 2005; 234: 527–34.CrossRefGoogle ScholarPubMed
Berg, WA, Weinberg, IN, Narayanan, D, et al. Positron Emission Mammography Working Group. High resolution fluorodeoxyglucose positron emission tomography with compression (“positron emission mammography”) is highly accurate in depicting primary breast cancer. Breast J 2006; 12: 309–23.CrossRefGoogle Scholar
Raylman, RR, Majewski, S, Smith, MF, et al. The positron emission mammography/tomography breast imaging and biopsy system (PEM/PET): design, construction and phantom-based measurementsPhys Med Biol 2008; 53: 637–53.CrossRefGoogle ScholarPubMed
Rieber, A, Schirrmeister, H, Gabelmann, A, et al. Pre-operative staging of invasive breast cancer with MR mammography and/or PET: boon or bunk?Br J Radiol 2002; 75: 789–98.CrossRefGoogle ScholarPubMed
Heinisch, M, Gallowitsch, HJ, Mikosch, P, et al. Comparison of FDG-PET and dynamic contrast-enhanced MRI in the evaluation of suggestive breast lesions. Breast J 2003; 12: 17–22.CrossRefGoogle ScholarPubMed
Uematsu, T, Kasami, M, Yuen, S. Comparison of FDG PET and MRI for evaluating the tumor extent of breast cancer and the impact of FDG PET on the systemic staging and prognosis of patients who are candidates for breast-conserving therapy. Breast Cancer 2009; 16: 307–14.CrossRefGoogle ScholarPubMed
Utech, CI, Young, CS, Winter, PF. Prospective evaluation of fluorine-18 fluorodeoxyglucose positron emission tomography in breast cancer for staging of the axilla related to surgery and immunocytochemistry. Eur J Nucl Med 1996; 23: 1588–93.CrossRefGoogle ScholarPubMed
Smith, IC, Ogston, KN, Whitford, P, et al. Staging of the axilla in breast cancer: accurate in vivo assessment using positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose. Ann Surg 1998; 228: 220–7.CrossRefGoogle ScholarPubMed
Wahl, RL, Siegel, BA, Coleman, RE, et al. PET Study Group. 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: 277–85.CrossRefGoogle Scholar
Barranger, E, Grahek, D, Antoine, M, et al. Evaluation of fluorodeoxyglucose positron emission tomography in the detection of axillary lymph node metastases in patients with early-stage breast cancer. Ann Surg Oncol 2003; 10: 622–7.CrossRefGoogle ScholarPubMed
Fehr, MK, Hornung, R, Varga, Z, et al. Axillary staging using positron emission tomography in breast cancer patients qualifying for sentinel lymph node biopsy. Breast J 2004; 10: 89–93.CrossRefGoogle ScholarPubMed
Gil-Rendo, A, Zornoza, G, Garcia-Velloso, MJ, et al. Flurodeoxyglucose positron emission tomography with sentinel lymph node biopsy for evaluation of axillary involvement in breast cancer. Br J Surg 2006; 93: 707–12.CrossRefGoogle Scholar
Rosen, EL, Eubank, WB, Mankoff, DA. FDG PET, PET/CT, and Breast Cancer Imaging. Radiographics. 2007; 27(Suppl 1): S215–29.CrossRefGoogle ScholarPubMed
Veronesi, U, Cicco, C, Galimberti, VE, at al. Comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol 2007; 18: 473–8.CrossRefGoogle ScholarPubMed
Hoeven, JJ, Hoekstra, OS, Comans, EF, et al. Determinants of diagnostic performance of {F-18}fluorodeoxyglucose positron emission tomography for axillary staging in breast cancer. Ann Surg 2002; 236: 619–24.CrossRefGoogle ScholarPubMed
Zornoza, G, Garcia-Velloso, MJ, Sola, J, et al. 18F-FDG PET complemented with sentinel lymph node biopsy in the detection of axillary involvement in breast cancer. Eur J Surg Oncol 2004; 30: 15–9.CrossRefGoogle ScholarPubMed
Eubank, WB, Mankoff, DA. Evolving role of positron emission tomography in breast cancer imaging. Semin Nucl Med 2005; 35: 84–99.CrossRefGoogle ScholarPubMed
Eubank, WB, Mankoff, DA, Takasugi, J, et al. 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J Clin Oncol 2001; 19: 3516–23.CrossRefGoogle ScholarPubMed
Bellon, JR, Livingston, RB, Eubank, WB, et al. Evaluation of the internal mammary lymph nodes by FDG-PET in locally advanced breast cancer (LABC). Am J Clin Oncol 2004; 27: 407–10.CrossRefGoogle Scholar
Eubank, WB, Mankoff, D, Bhattacharya, M, et al. Impact of FDG PET on defining the extent of disease and on the treatment of patients with recurrent or metastatic breast cancer. Am J Roentgenol 2004; 183: 479–86.CrossRefGoogle ScholarPubMed
,The GIVIO Investigators: Impact of follow-up testing on survival is health – related quality of life in breast cancer patients: A multicenter randomized controlled trial. JAMA 1994; 271: 1587–92.CrossRefGoogle Scholar
Cancer UK website: Breast Cancer incidence statistics., accessed 27th August 2008.
Haug, A, Tiling, R, Sommer, HL. FDG-PET and FDG-PET/CT in breast cancer. Recent Results. Cancer Res 2008; 170: 125–40.Google Scholar
Mahner, S, Schirrmacher, S, Brenner, W, et al. Comparison between position emission tomography using 2 – {fluorine – 18} fluoro – 2 – deoxy – D – glucose, conventional imaging and computed tomography for staging of breast cancer. Ann Oncol 2008; 19: 1249–54.CrossRefGoogle Scholar
Schmidt, GP, Baur-Melnyk, A, Haug, A, et al. Comprehensive imaging of tumour recurrence in breast cancer patients using whole – body MRI at 1.5 and 3T compared to FDG – PET – CT. Eur J Radiol 2008; 65: 47–58.CrossRefGoogle ScholarPubMed
Bombardieri, E, Gianni, L. The choice of the correct imaging modality in Breast Cancer management. Eur J Nucl Med Mol Imag 2004; 31(Suppl 1): 5179–86.CrossRefGoogle ScholarPubMed
Cook, GJ, Huston, S, Rubens, R, et al. Detection of bone metastases in Breast cancer by 18 FDG PET: differing metabolic activity in osteoblastic and osteolytic lesions. J Clin Oncol 1998; 16: 3375–9.CrossRefGoogle ScholarPubMed
Radan, L, Ben-Haim, S, Bar-Shalom, R, et al. The role of FDG-PET/CT in suspected recurrence of breast cancer. Cancer 2006; 107: 2545–51.CrossRefGoogle ScholarPubMed
Biersack, H-J, Bender, H, Palmedo, H. FDG – PET in Monitoring therapy of breast cancer. Eur J Nucl Med Mol Imag 2004; 31(Suppl 1): S112s–7.CrossRefGoogle ScholarPubMed
Smith, IC, Welch, AE, Hutcheon, AW, et al. Positron Emission Tomography using {18F} fluorodeoxyglucose for monitoring primary chemotherapy in breast cancer. J Clin Oncol 2000; 18: 1689–95.CrossRefGoogle Scholar
Krak, NC, Hoekstra, OS, Lammertsma, AA. Measuring response to chemotherapy in locally advanced breast cancer:methodological considerations. Eur J Nucl Med Mol Imag 2004; 31(Suppl 1): S103–11.CrossRefGoogle ScholarPubMed
Mankoff, DA, Dunnwald, LK, Gralow, JR, et al. Changes in blood flow and metabolism in locally advanced breast cancer treated with neoadjuvant chemotherapy. J Nucl Med 2003; 44: 1806–14.Google ScholarPubMed
Chen, X, Moore, MO, Lehman, CD, et al. Combined use of MRI and PET to monitor response and assess residual disease for locally advanced breast cancer treated with neoadjuvant chemotherapy. Acad Radiol 2004; 11: 1115–24.CrossRefGoogle ScholarPubMed
Tateishi, U, Gamez, C, Dawood, S, et al. Bone metastases in patients with metastatic breast cancer: morphologic and metabolic monitoring of response to systemic therapy with integrated PET/CT. Radiology 2008; 247: 189–96.CrossRefGoogle ScholarPubMed
Mortimer, JE, Dehdashti, F, Siegel, BA, et al. Metabolic flare: Indicator of hormone responsiveness in advanced breast cancer. J Clin Oncol 2001; 19: 2797–803.CrossRefGoogle ScholarPubMed
Linden, HM, Stekhora, SA, Link, JM, et al. Quantitative fluoroestradiol position emission tomography imaging predicts response to endocrine treatment in breast cancer. J Clin Oncol 2006: 24: 2793–9.CrossRefGoogle Scholar
Jonson, SD, Welch, MJ. PET imaging of breast cancer with fluorine -18 radiolabelled estrogens and progestins. Q J Nucl Med 1998; 42: 8–17.Google Scholar

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