DOI: | Full Text: [PDF]

The value of 18F-FDG PET/CT imaging in breast cancer staging

Ulkem Yararbas, Neslihan Cetin Avci, Levent Yeniay, Aziz Murat Argon


The National Comprehensive Cancer Network (NCCN) guidelines recommend assessment with positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) in staging of breast cancer, starting from the stage IIIA. Previously, PET/CT contributed to the accurate staging from the stage IIB. Our aim is to evaluate the contribution of 18F-FDG PET/CT in staging of breast cancer patients. A total of 234 patients were retrospectively evaluated. PET/CT was performed preoperatively in 114/234 and postoperatively in 120/234 patients. Initial staging was performed based on histopathological results in 125/234 and clinical results in 109/234 patients, according to the American Joint Committee on Cancer (AJCC) classification. All patients had a normal abdominal ultrasound and chest x-ray. Following PET/CT imaging, modification in the staging was performed in patients with the metastatic findings. In 42/234 (17.9%) patients hypermetabolic extra-axillary regional lymph nodes and in 65/234 patients (27.7%) distant metastatic involvement were detected with PET/CT. Modification in the staging was applied in 82/234 (35%) patients. Patient management was changed in 69/234 (29.4%) cases. The percentage of patients with upstaging, according to each stage, was as follows: IIA: 18.6%, IIB: 30%, IIIA: 46.3%, IIIB: 68.8%, and IIIC: 20.8%. In 43/43 patients, 99mTc-methylene diphosphonate (MDP) bone scan did not show additional bone metastasis. In 5/32 patients, metastatic involvement was detected with sentinel lymph node biopsy (SLNB), but preoperative PET/CT scan did not reveal hypermetabolic lymph nodes. Although our study was limited by the referral bias and lack of homogeneity in the referral group, PET/CT still significantly contributed to the accurate staging and management of our breast cancer patients, starting from the stage IIA.


Breast cancer; Breast cancer staging; 18F-FDG; 18F-FDG PET/CT

Full Text:



Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59(4):225-49.

Groheux D, Espié M, Giacchetti S, Hindié E. Performance of FDG PET/CT in the clinical management of breast cancer. Radiology 2013;266(2):388-405.

Veronesi U, De Cicco C, Galimberti VE, Fernandez JR, Rotmensz N, Viale G, et al. A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol 2007;18(3):473-8.

Evangelista L, Baretta Z, Vinante L, Cervino AR, Gregianin M, Ghiotto C, et al. Tumour markers and FDG PET/CT for prediction of disease relapse in patients with breast cancer. Eur J Nucl Med Mol Imaging 2011;38(2):293-301.

Aukema TS, Rutgers EJ, Vogel WV, Teertstra HJ, Oldenburg HS, Vrancken Peeters MT, et al. The role of FDG PET/CT in patients with locoregional breast cancer recurrence: A comparison to conventional imaging techniques. Eur J Surg Oncol 2010;36(4):387-92.

NCCN. Clinical Practice Guidelines in Oncology. Breast Cancer. Version 3; 2017. [cited 2017 Aug 10]. Available from:

Groheux D, Giacchetti S, Espié M, Vercellino L, Hamy AS, Delord M, et al. The yield of 18F-FDG PET/CT in patients with clinical stage IIA, IIB, or IIIA breast cancer: A prospective study. J Nucl Med 2011;52(10):1526-34.

Segaert I, Mottaghy F, Ceyssens S, De Wever W, Stroobants S, Van Ongeval C, et al. Additional value of PET-CT in staging of clinical stage IIB and III breast cancer. Breast J 2010;16(6):617-24.

Yararbas U, Argon AM, Yeniay L, Kapkac M. Problematic aspects of sentinel lymph node biopsy and its relation to previous excisional biopsy in breast cancer. Clin Nucl Med 2009;34(12):854-8.

AJCC. Breast Cancer Staging. 8th ed. [cited 2017 Aug 15]. Available from:

Caldarella C, Treglia G, Giordano A. Diagnostic performance of dedicated positron emission mammography using fluorine-18-fluorodeoxyglucose in women with suspicious breast lesions: A meta-analysis. Clin Breast Cancer 2014;14(4):241-8.

Schilling K, Narayanan D, Kalinyak JE, The J, Velasquez MV, Kahn S, et al. Positron emission mammography in breast cancer presurgical planning: Comparisons with magnetic resonance imaging. Eur J Nucl Med Mol Imaging 2011;38(1):23-36.

Gil-Rendo A, Martínez-Regueira F, Zornoza G, García-Velloso MJ, Beorlegui C, Rodriguez-Spiteri N. Association between [18F] fluorodeoxyglucose uptake and prognostic parameters in breast cancer. Br J Surg 2009;96(2):166-70.

Fujii T, Yajima R, Kurozumi S, Higuchi T, Obayashi S, Tokiniwa H, et al. Clinical significance of 18F-FDG-PET in invasive lobular carcinoma. Anticancer Res 2016;36(10):5481-5.

Jung NY, Kim SH, Choi BB, Kim SH, Sung MS. Associations between the standardized uptake value of (18)F-FDG PET/CT and the prognostic factors of invasive lobular carcinoma: In comparison with invasive ductal carcinoma. World J Surg Oncol 2015;13:113.

Soerjomataram I, Louwman MW, Ribot JG, Roukema JA, Coebergh JW. An overview of prognostic factors for long-term survivors of breast cancer. Breast Cancer Res Treat 2008;107(3):309-30.

Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): A phase 3 randomised controlled trial. Lancet Oncol 2013;14(4):297-305.

Reimer T, Hartmann S, Stachs A, Gerber B. Local treatment of the axilla in early breast cancer: Concepts from the national surgical adjuvant breast and bowel project B-04 to the planned intergroup sentinel mamma trial. Breast Care (Basel) 2014;9(2):87-95.

Manca G, Volterrani D, Mazzarri S, Duce V, Svirydenka A, Giuliano A, et al. Sentinel lymph node mapping in breast cancer: A critical reappraisal of the internal mammary chain issue. Q J Nucl Med Mol Imaging 2014;58(2):114-26.

Jatoi I, Hilsenbeck SG, Clark GM, Osborne CK. Significance of axillary lymph node metastasis in primary breast cancer. J Clin Oncol 1999;17(8):2334-40.

Galasko C. The anatomy and pathways of bone metastases. In: Weiss L, Gilbert A, editors. Bone Metastases. Boston: G.K. Hall; 1981. p. 49-63.

Plunkett TA, Smith P, Rubens RD. Risk of complications from bone metastases in breast cancer. Implications for management. Eur J Cancer 2000;36(4):476-82.

Shie P, Cardarelli R, Brandon D, Erdman W, Abdulrahim N. Meta-analysis: Comparison of F-18 fluorodeoxyglucose-positron emission tomography and bone scintigraphy in the detection of bone metastases in patients with breast cancer. Clin Nucl Med 2008;33(2):97-101.

Groheux D, Cochet A, Humbert O, Alberini JL, Hindié E, Mankoff D. 18F-FDG PET/CT for staging and restaging of breast cancer. J Nucl Med 2016;57(Suppl 1):17S-26S. DOI: 10.2967/jnumed.115.157859.

Riedl CC, Slobod E, Jochelson M, Morrow M, Goldman DA, Gonen M, et al. Retrospective analysis of 18F-FDG PET/CT for staging asymptomatic breast cancer patients younger than 40 years. J Nucl Med 2014;55(10):1578-83.

Koolen BB, Vrancken Peeters MJ, Aukema TS, Vogel WV, Oldenburg HS, van der Hage JA, et al. 18F-FDG PET/CT as a staging procedure in primary stage II and III breast cancer: Comparison with conventional imaging techniques. Breast Cancer Res Treat 2012;131(1):117-26.

Cochet A, Dygai-Cochet I, Riedinger JM, Humbert O, Berriolo-Riedinger A, Toubeau M, et al. 18F-FDG PET/CT provides powerful prognostic stratification in the primary staging of large breast cancer when compared with conventional explorations. Eur J Nucl Med Mol Imaging 2014;41(3):428-37.

Groheux D, Hindié E, Delord M, Giacchetti S, Hamy AS, de Bazelaire C, et al. Prognostic impact of (18) FDG-PET-CT findings in clinical stage III and IIB breast cancer. J Natl Cancer Inst 2012;104(24):1879-87.

Jain S, Fisher C, Smith P, Millis RR, Rubens RD. Patterns of metastatic breast cancer in relation to histological type. Eur J Cancer 1993;29A(15):2155-7.

He H, Gonzalez A, Robinson E, Yang WT. Distant metastatic disease manifestations in infiltrating lobular carcinoma of the breast. AJR Am J Roentgenol 2014;202(5):1140-8.

Ferlicot S, Vincent-Salomon A, Médioni J, Genin P, Rosty C, Sigal-Zafrani B, et al. Wide metastatic spreading in infiltrating lobular carcinoma of the breast. Eur J Cancer 2004;40(3):336-41.


  • There are currently no refbacks.

Quick links for Authors:Quick links for Peer Reviewers:

Advanced online | Current Issue | Archives | Submit a manuscript | About the Journal

© Association of Basic Medical Sciences of FBIH, 1998-2018. Credits to Public Knowledge Project