Potencial papel de la tomografía por emisión de positrones con fluorodesoxiglucosa (18F-FDG PET/TC) en la estadificación inicial del cáncer de mama

Objective

Multiple studies have evaluated the usefulness of ¹⁸F-FDG-PET/CT in the initial staging of breast cancer, demonstrating an important clinical impact with a change in therapeutic management. However, its role in current clinical practice is controversial and its use remains optional for major guidelines. Our objective is to assess the usefulness of PET/CT in this context.

Material and method

The results of PET/CT in patients recently diagnosed with breast cancer (2021–2022) have been analyzed visually and semiquantitatively using SUVmax. Positive findings were confirmed by specific imaging procedures.

Results

We prospectively evaluated 166 patients (59.8 ± 12.08 years). The primary tumor was detected by PET/CT in all cases. At diagnosis, 58 patients had axillary lymph node involvement by PET/CT. Axillary ultrasound detected lymph node involvement in 79% (46/58). Furthermore, in the 46 patients with lymph node involvement detected by both tests, PET/CT increased the number of lymph node lesions, thus modifying the stage. Unsuspected distant metastases were diagnosed by PET/CT in 12 patients, 10 had axillary lymph node involvement. The variables significantly associated with a higher probability of axillary or distant metastases in PET/CT were: histological grade 2–3 (p = 0.03), elevated Ki67 (p = 0.002) and higher SUVmax of the primary lesion (p = 0.02).

Conclusions

Our results suggest a potential usefulness of PET/CT in the initial staging of patients with breast cancer, particularly in those with axillary involvement, for the detection of unsuspected distant metastases.