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© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserve PET in PET in Breast Cancer Breast Cancer Early detection of disease Early detection of disease Precise Staging of Disease Precise Staging of Disease Progression Progression Accurate Assessment of Therapy Accurate Assessment of Therapy

Breast Cancer

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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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Page 1: Breast Cancer

© 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

Page 2: Breast Cancer

© 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

Page 3: Breast Cancer

© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.

PET in Breast CancerPET in Breast Cancer

• Diagnosis

• Staging

• Restaging

Page 4: Breast Cancer

© 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

Page 5: 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.

Page 6: Breast Cancer

© 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

Page 7: Breast Cancer

© Copyright 2003 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.

PET in Breast CancerPET in Breast Cancer

• Diagnosis

• Staging

• Restaging

Page 8: Breast Cancer

© 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

Page 9: Breast Cancer

© 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.

Page 10: Breast Cancer

© 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

Page 11: Breast Cancer

© 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

Page 12: Breast Cancer

© 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

Page 13: Breast Cancer

© 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

Page 14: Breast Cancer

© 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.

Page 15: Breast Cancer

© 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

Page 16: Breast Cancer

© 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.

Page 17: Breast Cancer

© 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