Fueger et al. (2005)

Fueger et al. (2005)
Design: Retrospective case series (diagnosis, screening), evidence level: 3
Country: United States
Inclusion criteria:
Patients with breast cancer and about whom there is sufficient clinical information to verify the disease status.
Exclusion criteria:
None stated.
Population:
Number of patients = 58, age range 29 to 80 years, mean age = 53 years.
Interventions:
Patients fasted for 6hr before being given 740MBq 18F FDG followed 60min later by PET scan using a Reveal PET/CT scanner. PET in 3D mode and whole body CT images were obtained. Images were taken from the base of skull to mid thigh. CT images were subsequently matched to PET data and the images were reconstructed.
Outcomes:
A comparison between PET alone and in combination with CT imaging to determine if the latter adds more information towards the successful staging of cancer in the breast.

PET/CT findings were verified by clinical follow-up, serum markers, independently acquired CT images, plain radiography, bone scans and mammography.
Follow up:
9 months +/− 4.4 months
Results:
33/58 patients had confirmed breast disease as determined by elevated tumour markers and positive imaging and/or an increase in the number and/or size of lesions during the follow-up period.

PET:
Correct disease status = 46/58 (79.3%)
Incorrect disease status = 12/58 (20.7%) with 7 false +ve results and 5 false -ve results.
Sensitivity = 84.8% specificity = 72% and accuracy = 79.3%

PET/CT:
Correct disease status = 52/58 (89.7%)
Incorrect disease status = 6/58 (18.3%) with 7 false +ve results and 5 false −ve results.
Sensitivity = 93.9% specificity = 84% and accuracy = 89.7%

The statistical significance between sensitivity PET vs PET/CT P = 0.32 (nsd)

The statistical significance between specificity PET vs PET/CT P = 0.32 (nsd)

The statistical significance between accuracy PET vs PET/CT P = 0.06 (nsd)
General comments:
This paper describes a retrospective case series of 58 breast cancer patients who received both conventional PET scan and PET/CT between August 2002 and November 2003.

Two nuclear medicine physicians evaluated the PET images and the same reviewers also interpreted the PET/CT results. These reviewers knew the patient diagnosis but not the disease status.

Reasons for false positives with either imaging modality include benign hyperplasia, pneumonia, fat necrosis and post-surgical changes. False negatives occurred in some cases of axillary lymph node metastasis and local recurrence of breast cancer.

It was concluded that FDG-PET alone was not a good technique for osteoblastic lesions but CT had an accuracy of 75% therefore the combination imaging should improve this overall.

Authors state that PET-CT can only be successfully evaluated after a careful interpretation of the CT data set.

From: Chapter 2, Presentation and diagnosis

Cover of Advanced Breast Cancer
Advanced Breast Cancer: Diagnosis and Treatment.
NICE Clinical Guidelines, No. 81.
National Collaborating Centre for Cancer (UK).
Copyright © 2009, National Collaborating Centre for Cancer.

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