Pre-chemotherapy 18F-FDG PET/CT upstages nodal stage in stage II–III breast cancer patients treated with neoadjuvant chemotherapy

• Published in: Breast cancer research and treatment Vol. 141; no. 2; pp. 249 - 254
• Main Authors: Koolen, Bas B., Valdés Olmos, Renato A., Vogel, Wouter V., Vrancken Peeters, Marie Jeanne T. F. D., Rodenhuis, Sjoerd, Rutgers, Emiel J. Th, Elkhuizen, Paula H. M.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-09-2013; Springer; Springer Nature B.V
• Subjects: Adjuvant treatment; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Axilla; Biological and medical sciences; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - drug therapy; Cancer; Cancer patients; Cancer research; Cancer therapies; Care and treatment; Chemotherapy; Clinical Trial; Diagnosis; Female; Fluorodeoxyglucose F18; Gynecology. Andrology. Obstetrics; Humans; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphatic system; Mammary gland diseases; Medical diagnosis; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoadjuvant Therapy; Neoplasm Grading; Neoplasm Staging; Oncology; PET imaging; Positron-Emission Tomography; Radiation therapy; Tomography, X-Ray Computed; Tumors; Young Adult; Neoadjuvant chemotherapy; Breast cancer; Radiotherapy; Locoregional; Lymph nodes; PET/CT; Radionuclide study; Human; 2-deoxy-2-fluoroglucose; Breast disease; Radiodiagnosis; Lymph node; Early stage; Malignant tumor; Neoadjuvant treatment; Mammary gland diseases; Chemotherapy; Treatment; Medical imagery; Computerized axial tomography; Locally advanced stage; Positron emission tomography; Cancer; Emission tomography
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-013-2678-8

In breast cancer patients treated with neoadjuvant chemotherapy (NAC) the number of tumor-positive nodes can no longer reliably be determined. Furthermore, ultrasound (US) seems suboptimal for the detection of N3-disease. Therefore we assessed the proportion of breast cancer patients treated with NAC in which pre-chemotherapy 18F-FDG PET/CT detected ≥4 axillary nodes or occult N3-disease, upstaging nodal status and changing risk estimation for locoregional recurrence (LRR). Conventional regional staging consisted of US with fine needle aspiration and/or sentinel lymph node biopsy. Patients were classified as low-risk (cT2N0), intermediate-risk (cT0N1, cT1N1, cT2N1, cT3N0), or high-risk (cT3N1, cT4, cN2–3) for LRR. The presence and number of FDG-avid nodes were evaluated and the proportion of patients that would be upstaged by PET/CT, based on detection of ≥4 FDG-avid axillary nodes defined as cN2(4+) or occult N3-disease, was calculated. In total, 87 of 278 patients were considered high-risk based on conventional staging. PET/CT detected occult N3-disease in 5 (11 %) of 47 low-risk patients. In 144 intermediate-risk patients, PET/CT detected ≥4 FDG-avid nodes in 24 (17 %) patients and occult N3-disease in 22 (15 %) patients, thereby finally upstaging 38 (26 %) of intermediate-risk patients. Of 43 (23 %) upstaged patients, 18 were ypN0, 12 were ypN1, and 13 were ypN2–3. Pre-chemotherapy PET/CT is valuable for selection of breast cancer patients at high risk for LRR. In our population, 23 % of patients treated with NAC were upstaged to the high-risk group based on PET/CT information, potentially benefiting from regional radiotherapy.