Fluorodeoxyglucose-PET in the management of breast cancer

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Diagnosis of primary tumor

In the past several years, an enormous amount of effort has been devoted to improving the detection, diagnosis, and local staging of breast cancer. A conventional mammogram along with a thorough physical examination is the most practical method for the early detection of breast cancer. Mammography, however, has a limited value (eg, in distinguishing benign from malignant lesions), and it has a low sensitivity for detecting cancer in women with radiographically dense breasts [3], [4].

Detection of regional lymph node and distant metastases

Metastasis to axillary lymph nodes is one of the most important prognostic factors in breast cancer. There is no effective noninvasive modality for determining the involvement of the axillary lymph nodes; currently histologic examination following dissection is required. Identifying sentinel lymph nodes (SLN) for initial sampling and dissection is a well-established procedure for detecting axillary lymph node metastasis from primary breast cancer [25], [26]. Many investigators have reported

Monitoring treatment response

Neoadjuvant chemotherapy (NACT) is the standard-of-care therapy for the patients with locally advanced breast cancer (LABC). NACT is associated with a good response rate in more than 70% of the patients, including a complete pathologic remission rate of about 10% to 15% [54]. Following successful induction chemotherapy, a variety of options are available, such as surgery alone, surgery and radiotherapy, and radiotherapy alone. Therefore, it is important to assess the residual tumor after

Recurrence and prognosis

Early detection of recurrence or metastasis is essential for instituting local or systemic treatment to prevent further progression and tumor-related symptoms. Whole-body FDG-PET is a sensitive and noninvasive technique in the management of breast cancer. In a retrospective analysis Gallowitsch et al [50] reported that FDG-PET is more accurate than conventional imaging modalities in detecting recurrence. Kamel et al [64] analyzed the role of FDG-PET for detecting relapse in 60 patients and

Summary

FDG-PET can be helpful in the diagnosis of primary breast cancer, especially in patients with dense breast tissue, significant fibrocystic changes, fibrosis after radiotherapy, and inconclusive results from MR imaging and other imaging modalities. PET has a limited role in patients with very small tumors and with well-differentiated and lobular types of breast cancer. In preoperative staging, FDG-PET has a low sensitivity for detection of regional lymph node involvement. Also, current PET

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