FDG-PET and PET/CT in Breast Cancer Staging

Positron emission tomography (PET) using the glucose analogue F-18 fluorodeoxyglucose (FDG) enables the visualisation of increased glucose metabolism in cancer. Whole-body FDG-PET can be used for staging patients with breast cancer to identify metastatic disease. The metabolic information from FDG-PET is more sensitive than conventional structural imaging for the detection of loco-regional and distant metastases. FDG-PET is superior in detecting tumour-involved lymph nodes, particularly those which are normal in size radiologically and is superior in characterising enlarged lymph nodes as positive or negative. The overall sensitivity for bone scintigraphy and FDG-PET have been reported as comparable, but bone scintigraphy seems to be superior in the detection of osteoblastic disease and FDG-PET in osteolytic metastases, suggesting a complementary role for both imaging procedures. Due to its ability to more accurately stage patients with locally advanced breast cancer, FDG-PET may have a significant impact on patient management especially in combination with computed tomography (CT). Combined FDG-PET/CT provides both metabolic information from FDG-PET and the anatomical information from CT. FDG-PET/CT could potentially replace currently used imaging modalities and consolidate the diagnostic work-up of breast cancer patients with locally advanced or suspected locally recurrent or metastatic disease.