1 / 12

Diagnosis and Treatment of Breast Cancer. Is there a place for PET scan ?

Diagnosis and Treatment of Breast Cancer. Is there a place for PET scan ?. Professeur Alain Brémond Centre Régional de Lutte Contre le Cancer Université Claude Bernard – Lyon I Lyon - France. The two steps of diagnosis. Perception: «  Is there any abnormality on the mammography ?“

mayten
Download Presentation

Diagnosis and Treatment of Breast Cancer. Is there a place for PET scan ?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diagnosis and Treatment of Breast Cancer.Is there a place for PET scan ? Professeur Alain Brémond Centre Régional de Lutte Contre le Cancer Université Claude Bernard – Lyon I Lyon - France

  2. The two steps of diagnosis • Perception: « Is there any abnormality on the mammography ?“ • Analysis: « Which of the abnormalities is a cancer?”

  3. Sensitivity of mammography • Overall: 80% • Fatty breasts: • 95% • Lower limit in the size of a detectable tumor: 5 mm • Dense breasts • 70% • Lower limit: 10 to 20 mm (sometimes more).

  4. What could be the role of PET scan ? • The sensitivity of the PET scan does not depend on the breast density. • Issues: • Localization of tumors otherwise not seen on mammography or ultrasonography. • Is core biopsy directed by PET scan possible ?

  5. Evaluation of the lymph nodes invasion . • Axillary dissection is the standard • But side effects are frequent • Lymphoedema: 6% • Arm swelling: 25 to 40% • Pain in axilla and/or shoulder: 50 to 60% • No benefit for the patient if there are no invaded nodes in the axilla.

  6. What about Sentinel node biopsy? • SNB is an alternative to axillary dissection for small tumors (less than 2.5 cm in diameter). • But patients with invaded nodes have to be operated on a second time (That is in about 45% of the cases). • Could PET scan of the axilla select the patients with invaded nodes ?

  7. Reference Number of axillae evaluated Sensitivity (%) Specificity (%) Minn 18 75 89 Tse 14 57 100 Hoh 14 67 100 Adler 25 90 93 Bassa 16 77 100 Avril 51 79 96 Scheidhauer 18 100 89 Utech 124 100 75 Adler 52 95 66 Noh 27 93 100 Total 359 89.8 84.3 PET studies to evaluate axillary lymph-node status.Adapted from I.C. Smith (Eur J Surg Oncol) Adapted from I.C. Smith (Eur J Surg ). Sensitivity and specificity of PET scan to assess the axilla.

  8. Selection for axillary node dissectionAND (tumours < 2,5 Cm in diameter)

  9. Pet scan as a selection tool? • Suspicion of the involvement of the axillary lymph nodes. In this goal PET studies have shown a sensitivity which varies from 57 to 100% and a specificity going from 66 to 100% with means of 89.8 and 84.3%. • SNB would be indicated for negative PET scans. This would reduce the number of unnecessary SNB. With these values the table has shown than among 100 patients, 46 would have a positive axillary PET scan. Axillary dissection would be performed in these patients but in 10 patients the axilla would be free from cancer. Is this acceptable ?

  10. Other indications • Patients with large tumours can benefit from primary chemotherapy. In 50% of these cases a conservative treatment can be performed instead of a radical mastectomy. This is usually offered to the patient. Knowing the risk of having positive nodes in the axilla could be useful in the treatment choice.

  11. Economic clues. •  The costs of SNB is being measured in our institution. • The costs of PET scan should be evaluated in comparison with SNB in a combined modality of evaluation of the axilla

  12. Conclusions • PET scan can be of interest in: • Screening in dense breast. • Preoperative evaluation of the axilla • Sensitivity and specificity of PET scan have to be improved for these indications.

More Related