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Breast Cancer

PET in Breast Cancer Early detection of disease Precise Staging of Disease Progression Accurate Assessment of Therapy. Breast Cancer. 31% of all new malignancies in women, 7% in men Mammographic screening improves early detection and survival Types Ductal 85% Lobular 10%

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Breast Cancer

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  1. PET in Breast CancerEarly detection of diseasePrecise Staging of Disease ProgressionAccurate Assessment of Therapy

  2. Breast Cancer • 31% of all new malignancies in women, 7% in men • Mammographic screening improves early detection and survival • Types • Ductal 85% • Lobular 10% • TNM staging is used • Combined modality treatment is common

  3. PET in Breast Cancer • Diagnosis • Staging • Restaging

  4. Diagnosing Breast Cancer History • 50 YOF • Palpable (barely) mass in left breast; doctor not concerned • Dense breasts, mammogram normal PET Findings • Hyper-metabolic breast focus in left breast Outcome • Surgical resection • Stage I breast cancer

  5. PET in the Diagnosis of Breast Cancer • 117 patients with suspected breast cancer • PET compared with histopathology PET • Sensitivity 93% • Specificity 75% • PET detected multi-focal cancer better than mammography PETMammo • Multi-focal 63% 32% Detection Schirrmeister H EJNM 2001; 28:351.

  6. Why PET for diagnosis? • Dense breast tissue on mammogram • Multiple abnormalities • Equivocal biopsy results • Breast implant

  7. PET in Breast Cancer • Diagnosis • Staging • Restaging

  8. Staging Breast Cancer History • 57 YOF • Right breast cancer • Elevated tumor markers PET Findings • Hyper-metabolic right breast cancer and axillary nodes Outcome • Primary chemotherapy • Surgery deferred mets primary

  9. Axillary Node Staging • 167 patients with biopsy proven breast cancer • Pre-operative PET compared to results of axillary node resection PET • Sensitivity 94% • Specificity 86% • Greatest sensitivity in patients with tumor >2cm Greco M Natl Cancer Inst 200; 93;630.

  10. Why stage with PET? • Locally advanced cancers anticipating primary chemotherapy • Breast cancers arising medially drain into internal mammary nodes • Suspected multi-focal cancers • Indeterminant clinical, imaging or pathologic findings

  11. PET in Breast Cancer • Diagnosis • Staging • Restaging • Recurrence detection • Recurrence extent • Therapy assessment

  12. Detecting Recurrence History • 57 YOF • Breast cancer 5 years ago, primary is gone • Presented with elevated markers • Mammo negative • CT negative • Bone scan negative PET Findings • Left supraclavicular node uptake Outcome • Biopsy proven metastasis • XRT & chemotherapy normal GI activity

  13. Detecting the Extent of Recurrence History • 49 YOF • Breast cancer 7 years ago • Presented with elevated markers • Asymptomatic PET Findings • Numerous skeletal and liver foci Outcome • Biopsy proven mets • High dose chemotherapy • Stem cell replacement

  14. Detection of Recurrent or Metastatic Breast Cancer • 27 patients suspected recurrence • PET compared with biopsy PET • Sensitivity 94% • Specificity 80% • Lesion detection rate 94% • 13 of 27 PET results altered treatment KimTS World J Surg. 2001;25;829.

  15. PET in Breast Cancer Before Treatment History • 55 YOF • Left breast cancer PET Findings • Marked improvement with primary chemotherapy Outcome • Complete response to treatment After Treatment

  16. Response to Primary Chemotherapy • 30 patients with advanced stage breast cancer • Primary chemotherapy & serial PET scans • Prediction (before surgery) of pathologic CR (complete remission) PET • Sensitivity 90% • Specificity 74% • PET predicted CR after single cycle of chemotherapy Smith IC J Clin Oncol 2000; 18:1676.

  17. PET in Breast Cancer • PET is an important adjunct in the diagnosis and staging of breast cancer • PET is superior to all imaging modalities in the restaging of breast cancer • Difficult patient management problems can often be solved with the unique information PET provides

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