Eur J Nucl Med 2001 Mar;28(3):351-8
Fluorine-18 2-deoxy-2-fluoro-D-glucose PET in the preoperative staging of
breast cancer: comparison with the standard staging procedures.
Schirrmeister H, Kuhn T, Guhlmann A, Santjohanser C, Horster T, Nussle K, Koretz
K, Glatting G, Rieber A, Kreienberg R, Buck AC, Reske SN.
The present study compared the diagnostic accuracy of fluorine-18
2-deoxy-2-fluoro-D-glucose positron emission tomography (FDG-PET) with
conventional staging techniques. The differentiation between malignant and
benign lesions and the detection of multifocal disease, axillary and internal
lymph node involvement, and distant metastases were evaluated. One hundred and
seventeen female patients were prospectively examined using FDG-PET and
conventional staging methods such as chest X-ray, ultrasonography of the breast
and liver, mammography and bone scintigraphy. All patients were examined on a
modern full-ring PET scanner. Histopathological analysis of resected specimens
was employed as the reference method. The readers of FDG-PET were blinded to the
results of the other imaging methods and to the site of the breast tumour. The
sensitivity and specificity of FDG-PET in detecting malignant breast lesions
were 93% and 75% respectively. FDG-PET was twofold more sensitive (sensitivity
63%, specificity 95%) in detecting multifocal lesions than the combination of
mammography and ultrasonography (sensitivity 32%, specificity 93%). Sensitivity
and specificity of FDG-PET in detecting axillary lymph node metastases were 79%
and 92% (41% and 96% for clinical evaluation). FDG-PET correctly indicated
distant metastases in seven patients. False-positive or false-negative findings
were not encountered with FDG-PET. Chest X-ray was false-negative in three of
five patients with lung metastases. Bone scintigraphy was false-positive in four
patients. Three patients were upstaged since FDG-PET detected distant metastases
missed with the standard staging procedure. It is concluded that, compared with
the imaging methods currently employed for initial staging, FDG-PET is as
accurate in interpreting the primary tumour and more accurate in screening for
lymph node metastases and distant metastases. Due to a false-negative rate of
20% in detecting axillary lymph node metastases, FDG-PET cannot replace
histological evaluation of axillary status.
