PET/CT Beneficial for Younger Breast Cancer Patients

Using PET/CT in younger women with breast cancer may reduce morbidity and cost of unnecessary therapies, according to an article published in the Journal of Nuclear Medicine.

Researchers from the Memorial Sloan Kettering Cancer Center in New York, NY performed a retrospective study of women under age 40 who underwent breast cancer staging with PET/CT after initial staging with physical examination, mammography, ultrasound, and breast MR imaging, but before receiving treatment.

The study included 134 patients with initial breast cancer stage I to IIIC. PET/CT imaging was evaluated to identify unsuspected extraaxillary regional nodal and distant metastases in this group.

The results resulted in upstaging of several patients:

• 28 patients (21%) were upstaged to stage III or IV
• Unsuspected extraaxillary regional nodes were found in 15 patients (11%)
• Distant metastases were found in 20 patients (15%)
• Seven patients (5%) showed both extraaxillary regional nodes and distant metastases

In addition, PET/CT revealed stage IV disease in 1 of 20 (5%) patients with initial clinical stage I, 2 of 44 (5%) stage IIA, 8 of 47 (17%) stage IIB, 4 of 13 (31%) stage IIIA, 4 of 8 (50%) stage IIIB, and 1 of 2 (50%) stage IIIC. All 20 patients upstaged to stage IV were histologically confirmed. Four synchronous thyroid and one rectal malignancies were identified.

"Proper staging right after the breast cancer has first been diagnosed will help doctors make the right treatment decisions. And figuring out which breast cancer patients will benefit most from this 'advanced staging' with FDG PET/CT helps us to improve patient care while avoiding unnecessary tests," one of the lead researchers, Christopher Riedl, MD, said in a release.

The researchers concluded that use of PET/CT in this younger population could be valuable among patients with stage IIB and III disease, despite current National Comprehensive Cancer Network guidelines that recommend against systemic staging in patients with stage II disease. “Use of PET/CT in younger patients has the potential to reduce the morbidity and cost of unnecessary therapies in young breast cancer patients,” the authors wrote.