Detection of metastases in breast cancer patients

Summary

Distant metastases at primary diagnosis are a prognostic key factor in breast cancer patients and play a central role in therapeutic decisions. To detect them, chest X-ray, abdominal ultrasound, and bone scintigraphy are performed as standard of care in Germany and many centers worldwide. Although FDG PET detects metastatic disease with high accuracy, its diagnostic value in breast cancer still needs to be defined. The aim of this study was to compare the diagnostic performance of FDG PET with conventional imaging. Patients, methods: A retrospective analysis of 119 breast cancer patients who presented for staging was performed. Whole-body FDG-PET (n=119) was compared with chest X-ray (n=106) and bone scintigraphy (n=95). Each imaging modality was independently assessed and classified for metastasis (negative, equivocal and positive. The results of abdominal ultrasound (n=100) were classified as negative and positive according to written reports. Imaging results were compared with clinical follow-up including follow-up imaging procedures and histopathology. Results: FDG-PET detected distant metastases with a sensitivity of 87.3% and a specificity of 83.3%. In contrast, the sensitivity and specificity of combined conventional imaging procedures was 43.1% and 98.5%, respectively. Regarding so-called equivocal and positive results as positive, the sensitivity and specificity of FDG-PET was 93.1% and 76.6%, respectively, compared to 61.2% and 86.6% for conventional imaging. Regarding different locations of metastases the sensitivity of FDG PET was superior in the detection of pulmonary metastases and lymph node metastases of the mediastinum in comparison to chest x-ray, whereas the sensitivity of FDG PET in the detection of bone and liver metastases was comparable with bone scintigraphy and ultrasound of the abdomen. Conclusions: FDG-PET is more sensitive than conventional imaging procedures for detection of distant breast cancer metastases and should be considered for additional staging especially in patients with high risk primary breast cancer.

Zusammenfassung

Fernmetastasen zum Zeitpunkt der Primärdiagnose bei Patientinnen mit Mammakarzinom sind der wichtigste Prognosefaktor mit wesentlichen Einfluss auf Therapieentscheidungen. Zum Nachweis dienen Röntgenuntersuchung des Thorax, Ultraschall vom Abdomen und Skelettszintigraphie als Standarduntersuchungen in Deutschland und vielen Zentren weltweit. Für viele Tumorentitäten wurde gezeigt, dass mittels FDG-PET Metastasen mit hoher diagnostischer Genauigkeit erkannt werden. Ziel dieser Studie war es, die diagnostische Genauigkeit der FDG-PET mit der konventionellen Diagnostik zum Nachweis von Metastasen bei Patientinnen mit Mammakarzinom zu vergleichen. Patientinnen, Methoden: Bei 119 Patientinnen mit Mammakarzinom wurden Staging-Untersuchungen durchgeführt. 119 FDG-PET-Untersuchungen in Ganzkörpertechnik sowie 106 Röntgen-Thorax und 95 Skelettszintigraphien wurden retrospektiv verblindet analysiert und die Befunde in drei Gruppen (kein Nachweis – Verdacht – Nachweis von Metastasen) eingeteilt. 100 Oberbauchsonographien wurden retrospektiv ausgewertet und anhand der schriftlichen Befunde in zwei Gruppen (kein Nachweis – Nachweis von Metastasen) eingeteilt. Die Beurteilung des Metastasierungstatus erfolgte anhand aller Befunde (ohne FDG-PET-Ergebnisse) sowie weiterer bildgebender Diagnostik (CT und NMR), dem klinischen Verlauf und histologischer Befunde. Ergebnisse: Sensitivität und Spezifität zum Nachweis der Metastasierung betrugen 87,3% und 83,3% für FDG-PET, 43,1% und 98,5% für die konventionelle Diagnostik. Wurden auch suspekte Befunde als Nachweis von Metastasen gewertet, so betrugen Sensitivität und Spezifität 93,1% und 76,6% für FDG-PET, verglichen mit 61,2% und 86,6% für die konventionelle Diagnostik. Bezogen auf einzelne Lokalisationen war die Sensitivität der FDGPET deutlich höher im Nachweis von pulmonalen und mediastinalen Lymphknotenmetastasen im Vergleich zum Röntgen-Thorax und ähnlich gut im Nachweis von ossären und hepatischen Metastasen verglichen mit Skelettszintigraphie und Oberbauchsonographie. Schlussfolgerung: Die FDG-PET ist sensitiver im Nachweis von Metastasen als die konventionelle Diagnostik und für Patientinnen mit hohem Metastasierungsrisiko zusätzlich zum Staging sinnvoll.

Keywords

Breast cancer - staging - FDG-PET - metastasis

Schlüsselwörter

Mammakarzinom - FDG-PET - Staging - Metastasen

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