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PET in Breast Cancer Early detection of disease Precise Staging of Disease Progression Accurate Assessment of Therapy. Breast Cancer. 31% of all new malignancies in women, 7% in men Mammographic screening improves early detection and survival Types Ductal85% Lobular 10% - PowerPoint PPT Presentation
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© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
PET in PET in Breast CancerBreast Cancer
Early detection of diseaseEarly detection of diseasePrecise Staging of Disease ProgressionPrecise Staging of Disease Progression
Accurate Assessment of TherapyAccurate Assessment of Therapy
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Breast CancerBreast Cancer
• 31% of all new malignancies in women, 7% in men
• Mammographic screening improves early detection and survival
• Types Ductal 85% Lobular 10%
• TNM staging is used
• Combined modality treatment is common
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
PET in Breast CancerPET in Breast Cancer
• Diagnosis
• Staging
• Restaging
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Diagnosing Breast CancerDiagnosing Breast Cancer
History • 50 YOF• Palpable (barely) mass in left
breast; doctor not concerned• Dense breasts, mammogram
normal
PET Findings• Hyper-metabolic breast focus in
left breast
Outcome • Surgical resection• Stage I breast cancer
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
PET in the PET in the Diagnosis of Breast CancerDiagnosis of Breast Cancer
• 117 patients with suspected breast cancer
• PET compared with histopathology
PET Sensitivity 93% Specificity 75%
• PET detected multi-focal cancer better than mammography
PET Mammo Multi-focal 63% 32% Detection
Schirrmeister H EJNM 2001; 28:351.
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Why PET for diagnosis?Why PET for diagnosis?
• Dense breast tissue on mammogram
• Multiple abnormalities
• Equivocal biopsy results
• Breast implant
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
PET in Breast CancerPET in Breast Cancer
• Diagnosis
• Staging
• Restaging
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Staging Breast CancerStaging Breast Cancer
History • 57 YOF• Right breast cancer• Elevated tumor markers
PET Findings• Hyper-metabolic right breast
cancer and axillary nodes
Outcome • Primary chemotherapy• Surgery deferred
mets
primary
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Axillary Node StagingAxillary Node Staging
• 167 patients with biopsy proven breast cancer
• Pre-operative PET compared to results of axillary node resection
PET Sensitivity 94% Specificity 86%
• Greatest sensitivity in patients with tumor >2cm
Greco M Natl Cancer Inst 200; 93;630.
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Why stage with PET?Why stage with PET?
• Locally advanced cancers anticipating primary chemotherapy
• Breast cancers arising medially drain into internal mammary nodes
• Suspected multi-focal cancers
• Indeterminant clinical, imaging or pathologic findings
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
PET in Breast CancerPET in Breast Cancer
• Diagnosis
• Staging
• Restaging Recurrence detection
Recurrence extent
Therapy assessment
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Detecting RecurrenceDetecting Recurrence
History • 57 YOF • Breast cancer 5 years ago, primary
is gone• Presented with elevated markers• Mammo negative• CT negative• Bone scan negative
PET Findings• Left supraclavicular node uptake
Outcome • Biopsy proven metastasis• XRT & chemotherapy
normal GI
activity
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Detecting the Extent of RecurrenceDetecting the Extent of Recurrence
History • 49 YOF• Breast cancer 7 years ago• Presented with elevated
markers• Asymptomatic
PET Findings• Numerous skeletal and liver
foci
Outcome • Biopsy proven mets• High dose chemotherapy• Stem cell replacement
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Detection of Recurrent or Detection of Recurrent or Metastatic Breast CancerMetastatic Breast Cancer
• 27 patients suspected recurrence
• PET compared with biopsy
PET Sensitivity 94% Specificity 80%
• Lesion detection rate 94%
• 13 of 27 PET results altered treatment
KimTS World J Surg. 2001;25;829.
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
PET in Breast CancerPET in Breast Cancer
History • 55 YOF• Left breast cancer
PET Findings• Marked improvement with
primary chemotherapy
Outcome • Complete response to
treatment
Before Treatment
After Treatment
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Response to Primary ChemotherapyResponse to Primary Chemotherapy
• 30 patients with advanced stage breast cancer
• Primary chemotherapy & serial PET scans
• Prediction (before surgery) of pathologic CR (complete remission)
PET Sensitivity 90% Specificity 74%
• PET predicted CR after single cycle of chemotherapy
Smith IC J Clin Oncol 2000; 18:1676.
© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
• PET is an important adjunct in the diagnosis and staging of breast cancer
• PET is superior to all imaging modalities in the restaging of breast cancer
• Difficult patient management problems can often be solved with the unique information PET provides
PET in Breast CancerPET in Breast Cancer