PDF herunterladen
Der Nuklearmediziner 2004; 27(4): 295-303
DOI: 10.1055/s-2004-836235
© Georg Thieme Verlag Stuttgart · New York

PET und PET/CT - Stellenwert beim Mammakarzinom

PET and PET/CT - Relevance in Breast Cancer PatientsH. Palmedo1
  • 1Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
14. Februar 2005 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Das Mammakarzinom ist der häufigste maligne Tumor der Frau in Deutschland. Trotz steigender Inzidenz ist die Mortalität leicht gesunken, was unter anderem auf Verbesserungen in der Diagnostik und Therapie zurückgeführt wird. Die FDG-PET besitzt insbesondere beim Nachweis von Lymphknoten- und Fernmetastasen eine hohe Treffsicherheit beim Nachweis von Tumorgewebe. Da die Sensitivität der FDG-PET bei kleinen Lymphknotenmetastasen limitiert ist, stellt sie keine Alternative zur axillären Dissektion oder zur Sentinel-Node-Biopsie dar. Beim N-Staging kann die PET relevante Zusatzinformationen liefern, wenn eine Mammaria-interna- oder mediastinale Lymphknotenmetastasierung nachgewiesen werden soll (1 b-Indikation). In Einzelfällen kann die FDG-PET zur Detektion von Fernmetastasen bei fortbestehendem Tumorverdacht trotz negativer konventioneller Bildgebung beitragen (2-Indikation). Die FDG-PET zeigt hervorragende Eigenschaften zum frühen Therapiemonitoring bei präoperativer Chemotherapie, die mit keinem anderen bildgebenden Verfahren möglich sind. Hierzu stehen noch größere Studien aus.

Abstract

Breast cancer is the most frequent malignant tumor of women in Germany. In spite of an increasing incidence mortality has slightly declined most likely due to improvements in diagnosis and therapy of the disease. FDG-PET has a high diagnostic accuracy for the detection of lymph node and distant metastases. However, PET is no alternative to axillary dissection or sentinel node biopsy because sensitivity for small lymph node metastases is limited. For N-staging, FDG-PET delivers valuable information if mammaria-interna or mediastinal lymph node disease has to be proven (1 b-indication). Individually, PET can add important diagnostic information in patients with suspected distant metastases but unsuspicious or equivocal conventional imaging (2-indication). FDG-PET shows unique and favourable properties for early therapy monitoring during preoperative chemotherapy. Larger studies have to confirm these results.

Schlüsselwörter

Mammakarzinom - FDG - PET - PET/CT

Key words

Breast cancer - F-18 Fluordeoxyglucose - positron emission tomography - PET - integrated PET/CT

Literatur

  • 1 Adler L P, Crowe J P, Al Kaisi N K, Sunshine J L. Evaluation of breast masses and axillary lymph nodes with F-18 deoxy-2-fluoro-D-glucose PET.  Radiology. 1993;  187 743-750
    PubMedGoogle Scholar
  • 2 Antoch G, Freudenberg L S, Beyer T, Bockisch A, Debatin J F. To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT.  J Nucl Med. 2004;  45 (Suppl 1) 56-65
    PubMedGoogle Scholar
  • 3 Avril N, Rose C A, Schelling M, Dose J, Kuhn W, Bense S, Weber W, Ziegler S, Graeff H, Schwaiger M. Breast imaging with positron emission tomography and fluorine-18 fluorodeoxyglucose: use and limitations.  J Clin Oncol. 2000;  18 3495-3502
    PubMedGoogle Scholar
  • 4 Avril N, Dose J, Jänicke F. et al . Metabolic characterization of breasts tumors with PET using F-18 fluorodeoxyglucose.  J Clin Oncol. 1996;  14 1848-1856
    PubMedGoogle Scholar
  • 5 Avril N, Dose J, Janicke F, Ziegler S, Romer W, Weber W, Herz M, Nathrath W, Graeff H, Schwaiger M. Assessment of axillary lymph node involvement in breast cancer patients with positron emission tomography using radiolabeled 2-(fluorine-18)-fluoro-2-deoxy-D-glucose.  J Natl Cancer Inst. 1996;  88 1204-1209
    PubMedGoogle Scholar
  • 6 Bender H, Kirst J, Palmedo H, Schomburg A, Wagner U, Ruhlmann J, Biersack H J. Value of 18fluoro-deoxyglucose positron emission tomography in the staging of recurrent breast carcinoma.  Anticancer Res. 1997;  17 1687-1692
    PubMedGoogle Scholar
  • 7 Biersack H J, Bender H, Palmedo H. FDG-PET in monitoring therapy of breast cancer.  Eur J Nucl Med Mol Imaging. 2004;  31 (Suppl 1) 112-117
    CrossrefPubMedGoogle Scholar
  • 8 Bos R, van Der Hoeven J J, van Der Wall E, van Der Groep P, van Diest P J, Comans E F, Joshi U, Semenza G L, Hoekstra O S, Lammertsma A A, Molthoff C F. Biologic correlates of (18)fluorodeoxyglucose uptake in human breast cancer measured by positron emission tomography.  J Clin Oncol. 2002;  20 379-387
    CrossrefPubMedGoogle Scholar
  • 9 Brown R S, Leung J Y, Fisher S J, Frey K A, Ethier S P, Wahl R L. Intratumoral distribution of tritiated fluorodeoxyglucose in breast carcinoma: I. Are inflammatory cells important?.  J Nucl Med. 1995;  36 1854-1861
    PubMedGoogle Scholar
  • 10 Buck A, Wahl A, Eicher U. et al . Combined morphological and functional imaging with FDG PET/CT for restaging breast cancer: additional value for diagnostic imaging and patient management.  J Nucl Med. 2003;  44 78
    PubMedGoogle Scholar
  • 11 Cook G J, Houston S, Rubens R, Maisey M N, Fogelman I. Detection of bone metastases in breast cancer by 18FDG PET: differing metabolic activity in osteoblastic and osteolytic lesions.  J Clin Oncol. 1998;  16 3375-3379
    PubMedGoogle Scholar
  • 12 Eubank W B, Mankoff D A, Takasugi J, Vesselle H, Eary J F, Shanley T J, Gralow J R, Charlop A, Ellis G K, Lindsley K L, Austin-Seymour M M, Funkhouser C P, Livingston R B. 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer.  J Clin Oncol. 2001;  19 3516-3523
    PubMedGoogle Scholar
  • 13 Fisher B, Redmond C, Fisher E R. et al . Ten-year result of randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation.  New Engl J Med. 1985;  312 674
    PubMedGoogle Scholar
  • 14 Fisher B, Bryant J, Wolmark N. et al . Effect of präoperative chemotherapy on the outcome of women with operable breast cancer.  J Clin Oncol. 1998;  16 2672-2685
    CrossrefPubMedGoogle Scholar
  • 15 Greco M, Crippa F, Agresti R, Seregni E, Gerali A, Giovanazzi R, Micheli A, Asero S, Ferraris C, Gennaro M, Bombardieri E, Cascinelli N. Axillary lymph node staging in breast cancer by 2-fluoro-2-deoxy-D-glucose-positron emission tomography: clinical evaluation and alternative management.  J Natl Cancer Inst. 2001;  93 630-635
    CrossrefPubMedGoogle Scholar
  • 16 Hoh C K, Hawkins R H, Glaspy J A, Dahlbom M, Tse N Y, Hoffmann E J, Schiepers C, Choi Y, Rege S, Nitzsche E. Cancer detection with whole body PET using 18F-deoxyglucose.  J Comput Assist Tomogr. 1993;  17 582-589
    PubMedGoogle Scholar
  • 17 Kim T S, Moon W K, Lee D S, Chung J K, Lee M C, Youn Y K, Oh S K, Choe K J, Noh D Y. Fluorodeoxyglucose positron emission tomography for detection of recurrent or metastatic breast cancer.  World J Surg. 2001;  25 829-834
    CrossrefPubMedGoogle Scholar
  • 18 Koscielny S, Tubiana M, Le M G, Valleron A J, Mouriesse H, Contesso G, Sarrazin D. Breast cancer: relationship between the size of the primary tumour and the probability of metastatic dissemination.  Br J Cancer. 1984;  49 709-715
    PubMedGoogle Scholar
  • 19 Kuerer H M, Newman L A, Smith T L. et al . Clinical course of breast cancer patients with complete pathologic primary tumor and axillary lymph node response to doxorubicin-based neoadjuvant chemotherapy.  J Clin Oncol. 1999;  17 460-469
    CrossrefPubMedGoogle Scholar
  • 20 Levi F, La Vecchia C, Lucchini F, Negri E. Cancer mortality in Europe 1990-92.  Eur J Cancer Prev. 1995;  4 389-417
    PubMedGoogle Scholar
  • 21 Lind P, Igerc I, Beyer T, Reinprecht P, Hausegger K. Advantages and limitations of FDG PET in the follow-up of breast cancer.  Eur J Nucl Med Mol Imaging. 2004;  31 (Suppl 1) 125-134
    CrossrefPubMedGoogle Scholar
  • 22 Masood S, Chiao J. Pathology of breast cancer. In: Taillefer R, Khalkhali I, Waxman AD, Biersack HJ (eds). Radionuclide imaging of the breast. Marcel Dekker, New York, Basel, Hong Kong 1998
    Google Scholar
  • 23 Moon D H, Maddahi J, Silverman D H, Glaspy J A, Phelps M E, Hoh C K. Accuracy of whole-body fluorine-18-FDG PET for the detection of recurrent or metastatic breast carcinoma.  J Nucl Med. 1998;  39 431-435
    PubMedGoogle Scholar
  • 24 Palmedo H, Meyka S, Jaeger U E, Hortling N, Manka-Waluch A, Ezziddin S, Biersack H J. PET-CT for restaging of differentiated thyroid cancer: coregistered imaging in comparison with PET alone.  Eur J Nucl Med. 2004;  31 225
    PubMedGoogle Scholar
  • 25 Palmedo H, Bender H, Grünwald F. et al . FDG-PET and scintimammography with Tc-99m MIBI in breast tumors.  Eur J Nucl Med. 1997;  24 1138-1145
    PubMedGoogle Scholar
  • 26 Palmedo H, Hensel J, Reinhardt M, Von Mallek D, Matthies A, Biersack H J. Breast cancer imaging with PET and SPECT agents: an in vivo comparison.  Nucl Med Biol. 2002;  29 809-815
    PubMedGoogle Scholar
  • 27 Palmedo H, Textor J, Ko Y, Grohé C, von Mallek D, Bender H, Ezziddin S, Biersack H J. PET With 18f Fluoride Compared To Bone Scintigraphy In The Diagnosis Of Bone Metastases: Results Of A Prospective Study.  Eur J Nucl Med. 2002;  29 4
    PubMedGoogle Scholar
  • 28 Pelosi E, Messa C, Sironi S, Picchio M, Landoni C, Bettinardi V, Gianolli L, Del Maschio A, Gilardi M C, Fazio F. Value of integrated PET/CT for lesion localisation in cancer patients: a comparative study.  Eur J Nucl Med Mol Imaging. 2004;  31 932-939
    CrossrefPubMedGoogle Scholar
  • 29 Reske S N, Kotzerke J. FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, “Onko-PET III”, 21 July and 19 September 2000.  Eur J Nucl Med. 2001;  28 1707-1723
    Google Scholar
  • 30 Riddell C, Carson R E, Carrasquillo J A, Libutti S K, Danforth D N, Whatley M, Bacharach S L. Noise reduction in oncology FDG PET images by iterative reconstruction: a quantitative assessment.  J Nucl Med. 2001;  42 1316-1323
    PubMedGoogle Scholar
  • 31 Schaefer N G, Hany T F, Taverna C, Seifert B, Stumpe K D, von Schulthess G K, Goerres G W. Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging - do we need contrast-enhanced CT?.  Radiology. 2004;  232 823-829
    CrossrefPubMedGoogle Scholar
  • 32 Scheidhauer K, Scharl A, Pietrzyk U. et al . Qualitative F-18 FDG positron emission tomography in primary breast cancer: clinical relevance and practicability.  Eur J Nucl Med. 1996;  23 618-623
    PubMedGoogle Scholar
  • 33 Schelling M, Avril N, Nahrig J, Kuhn W, Romer W, Sattler D, Werner M, Dose J, Janicke F, Graeff H, Schwaiger M. Positron emission tomography using [(18)F]Fluorodeoxyglucose for monitoring primary chemotherapy in breast cancer.  J Clin Oncol. 2000;  18 1689-1695
    PubMedGoogle Scholar
  • 34 Schirrmeister H, Kuhn T, Guhlmann A, Santjohanser C, Horster T, Nussle K, Koretz K, Glatting G, Rieber A, Kreienberg R, Buck A C, Reske S N. Fluorine-18 2-deoxy-2-fluoro-D-glucose PET in the präoperative staging of breast cancer: comparison with the standard staging procedures.  Eur J Nucl Med. 2001;  28 351-358
    CrossrefPubMedGoogle Scholar
  • 35 Schirrmeister H, Guhlmann A, Kotzerke J, Santjohanser C, Kuhn T, Kreienberg R, Messer P, Nussle K, Elsner K, Glatting G, Trager H, Neumaier B, Diederichs C, Reske S N. Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography.  J Clin Oncol. 1999;  17 2381-2389
    PubMedGoogle Scholar
  • 36 Smart C R, Myers M H, Gloeckler L A. Implications from SEER data on breast cancer management.  Cancer. 1978;  41 787
    PubMedGoogle Scholar
  • 37 Smith I C, Welch A E, Hutcheon A W. et al . Positron emission tomography using [(18)F]-fluorodeoxy-D-glucose to predict the pathologic response of breast cancer to primary chemotherapy.  J Clin Oncol. 2000;  18 1676-1688
    PubMedGoogle Scholar
  • 38 Tse N Y, Hoh C K, Hawkins R H, Zinner M J, Dahlbom M, Choi Y, Maddahi J, Brunicardi F C, Phelps M E, Glaspy J A. The application of positron emission tomographic imaging with FDG to the evaluation of breast disease.  Ann Surg. 1992;  216 27-34
    PubMedGoogle Scholar
  • 39 van der Hoeven J J, Hoekstra O S, Comans E F, Pijpers R, Boom R P, van Geldere D, Meijer S, Lammertsma A A, Teule G J. Determinants of diagnostic performance of [F-18]fluorodeoxyglucose positron emission tomography for axillary staging in breast cancer.  Ann Surg. 2002;  236 619-624
    CrossrefPubMedGoogle Scholar
  • 40 Wahl R L, Henry C A, Ethier S P. Serum glucose: effects on tumor and normal tissue accumulation of 2-[F-18]-fluoro-2-deoxy-D-glucose in rodents with mammary carcinoma.  Radiology. 1992;  183 643-647
    PubMedGoogle Scholar
  • 41 Wahl R L, Cody R L, Hutchins G D, Mudgett E E. Primary and metastatic breast carcinoma: initial clinical evaluation with PET with the radiolabeled glucose analogue F-18 fluoro-2-deoxy-D-glucose.  Radiology. 1991;  179 765-770
    PubMedGoogle Scholar
  • 42 Wang Y, Yu J, Liu J. et al . PET-CT in the diagnosis of primary breast cancer and axillary lymph node metastases.  Int J Radiat Oncol Biol Phys. 2003;  57 362-363
    CrossrefPubMedGoogle Scholar
  • 43 Yim J H, Barton P, Weber B. et al . Mammographically detected breast cancer.  Ann Surg. 1996;  223 688-700
    CrossrefPubMedGoogle Scholar

Priv. Doz. Dr. med. Holger Palmedo

Klinik und Poliklinik für Nuklearmedizin · Universitätsklinikum Bonn

Sigmund-Freud-Str. 25

53127 Bonn

eMail: holger.palmedo@ukb.uni-bonn.de