Evaluation of Diagnostic Accuracy and Impact of Preoperative Positron Emission Tomography/Computed Tomography in the Management of Early Operable Breast Cancers

Piyush Chandra; Senthil Kumar Ravichander; Sridev Maheshwari Babu; Deepti Jain; Satish Nath

doi:10.4103/ijnm.IJNM_140_19

Evaluation of Diagnostic Accuracy and Impact of Preoperative Positron Emission Tomography/Computed Tomography in the Management of Early Operable Breast Cancers

Indian J Nucl Med. 2020 Jan-Mar;35(1):40-47. doi: 10.4103/ijnm.IJNM_140_19. Epub 2019 Dec 31.

Authors

Piyush Chandra¹, Senthil Kumar Ravichander², Sridev Maheshwari Babu², Deepti Jain³, Satish Nath¹

Affiliations

¹ Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India.
² Department of Surgical Oncology, MIOT International, Chennai, Tamil Nadu, India.
³ Department of Pathology, MIOT International, Chennai, Tamil Nadu, India.

Abstract

Aim: Our aim of this study was to evaluate the diagnostic accuracy of staging positron emission tomography/computed tomography (PET/CT) in early breast cancers (EBCs) and to assess its impact on disease management.

Patients and methods: We retrospectively reviewed preoperative PET/CT scans of patients from January 2015 to December 2018 with Stage I/II, clinically T1-T2 N0-N1 breast cancers. The diagnostic performance of PET/CT for nodal (N) and distant metastases (M), its correlation with patient/tumor-specific factors, and its impact on disease management were analyzed using histopathology/clinical follow-up as standards of reference.

Results: Of 158 patients evaluated, 14% of patients were Stage I (T1N0), 60% were Stage IIA (T1N1, T2N0), and 26% were Stage IIB (T2N1). Sensitivity, specificity, and the diagnostic accuracy of PET/CT for axillary staging were 76%, 97%, and 84% and for distant metastasis evaluation were 100%, 98%, and 99%, respectively. The diagnostic accuracy of PET/CT for axillary staging was lower for low-grade, T1 tumors, postmenopausal group, and luminal A pathological subtype (77%, 84%, 81%, and 73%, respectively) compared to high-grade, T2 tumors, premenopausal group, and nonluminal A subtype (88%, 88%, 94%, and 87%, respectively). Distant metastases were detected on PET/CT in overall 16% (n = 25) of the patients (9% in Stage IIA and 27% in Stage IIB). PET/CT also incidentally identified clinically occult internal mammary nodes in 5% (n = 8) and organ-confined synchronous second malignancies in 5% (n = 8) of the patients.

Conclusion: Preoperative PET/CT should be considered in all EBCs> 2 cm as it upstages the disease and alters management in about 24% of these patients. Given its high specificity for axillary staging PET/CT, patients with PET-positive axilla can be subjected to axillary dissection and those with PET-negative axilla to sentinel lymph node biopsy. The yield and diagnostic accuracy of PET/CT is less for low-grade tumors <2 cm and with luminal A subtype.

Keywords: Breast; cancer; early; fluorodeoxyglucose; positron emission tomography/computed tomography.