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Guest Editors: Freeman L. M., Bombardieri E.

The Quarterly Journal of Nuclear Medicine 2002 June;46(2)113-21


language: English

Early diagnosis of recurrent breast cancer with FDG-PET in patients with progressive elevation of serum tumor markers

Suárez M., Pérez-Castejón M. J., Jiménez A., Domper M., Ruiz G., Montz R., Carreras J. L.

PET Institute Carreras, Madrid, Spain


Background. The aim of ­this ­work is to ­assess the diag­nos­tic val­ue of posi­tron emis­sion tomog­ra­phy (PET) ­with 18F-flu­o­rod­e­ox­y­glu­cose (FDG), in the ear­ly detec­tion of ­tumour recur­rence in ­already treat­ed ­breast can­cer ­patients in appar­ent com­plete remis­sion and ­with a pro­gres­sive ele­va­tion of ­tumour mark­ers CEA and/or CA 15.3 with­out any oth­er clin­i­cal or instru­men­tal ­signs of relaps­es.
Methods. The ­author stud­ied 45 wom­en (­mean age 58±12, ­range 35-80 ­years) ­with his­to­log­i­cal diag­no­sis of ­breast can­cer who under­went a ­tumour mark­er-guid­ed ­whole ­body FDG-PET. All ­patients ­were in remis­sion, with­out any oth­er clin­i­cal or instru­men­tal ­signs of relaps­es, ­except for the pro­gres­sive ele­va­tion of CA 15.3 and/or CEA, test­ed dur­ing the fol­low-up. FDG-PET ­results ­were con­trolled by pathol­o­gy ­when his­to­log­i­cal sam­pling was pos­sible, by oth­er con­ven­tion­al imag­ing modal­ities (US, X-­rays, CT, MRI) and/or by clin­i­cal fol­low-up up to 12 ­months at ­least.
Results. FDG-PET find­ings ­were eval­u­at­ed in 38 ­patients: 27 result­ed pos­i­tive. Among ­these 27 PET pos­i­tive ­patients 24 ­were ­true pos­i­tive and 3 ­false pos­i­tive. Tumour mark­er guid­ed FDG-PET was ­also ­able to dis­cov­er 3 ­unknown neo­plasms not vis­u­al­ized by oth­er modal­ities. PET ­revealed 54 ­sites of ­intense ­focal FDG ­uptake. The ana­tom­i­cal dis­tri­bu­tion of ­these ­sites was 19 skele­ton, 18 ­lymph ­node ­basins, 5 liv­er, 5 pel­vic ­region, 1 ­lung, 1 per­i­car­di­um, 1 pleu­ra, 1 con­tra­lat­er­al ­breast, 2 peri­to­ne­um and 1 thy­roid bed. Forty-­eight of ­these 54 ­sites of FDG accu­mu­la­tion ­were con­firmed to be metas­ta­ses. FDG-PET result­ed neg­a­tive in 11 ­patients and ­only in 2 of ­them the oth­er diag­nos­tic modal­ities ­were ­able to dis­cov­er met­a­stat­ic ­lesions; we had 9 ­true neg­a­tive and 2 ­false pos­i­tive ­results. On the ­basis of our inves­ti­ga­tion the per­for­manc­es of ­tumour mark­er guid­ed FDG-PET per ­patient are as fol­lows: sen­si­tiv­ity 92% (24/26), spec­i­fic­ity 75% (9/12), pos­i­tive pre­dic­tive val­ue 89% (24/27), neg­a­tive pre­dic­tive val­ue 82% (9/11), accu­ra­cy 87% (33/38).
Conclusions. This ­study dem­on­strat­ed the clin­i­cal util­ity of ­tumour mark­er-guid­ed PET in the fol­low-up of ­breast can­cer ­patients. This diag­nos­tic ­approach ­allowed to mod­i­fy the clin­i­cal man­age­ment in ­those ­patients in ­whom a ­tumor ­relapse or unex­pect­ed pri­mary neo­plasm was dis­cov­ered.

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