Role of [18F]FDG PET/CT in patients with invasive breast carcinoma of no special type: Literature review and comparison between guidelines

David Groheux; Sofia C Vaz; Philip Poortmans; Ritse M Mann; Gary A Ulaner; Gary J R Cook; Elif Hindié; John Patrick Pilkington Woll; Heather Jacene; Isabel T Rubio; Marie-Jeanne Vrancken Peeters; Elizabeth H Dibble; Lioe-Fee de Geus-Oei; Stephanie L Graff; Fatima Cardoso

doi:10.1016/j.breast.2024.103806

Role of [¹⁸F]FDG PET/CT in patients with invasive breast carcinoma of no special type: Literature review and comparison between guidelines

Breast. 2024 Dec:78:103806. doi: 10.1016/j.breast.2024.103806. Epub 2024 Sep 12.

Authors

Affiliations

¹ Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM, U976, Paris, France; Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France. Electronic address: [email protected].
² Department of Nuclear Medicine and Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
³ Department of Radiation Oncology, Iridium Netwerk, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium.
⁴ Department of Radiology, Radboud umc, Nijmegen, the Netherlands.
⁵ Department of Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, United States; Departments of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, United States.
⁶ Department of Cancer Imaging, King's College London, London, UK; King's College London and Guy's & St Thomas' PET Centre, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
⁷ Department of Nuclear Medicine, Bordeaux University Hospital, Bordeaux, France.
⁸ Department of PET-CT, Clinica Delgado AUNA, Lima, Peru.
⁹ Dana-Farber Cancer Institute/Brigham and Women's Hospital, and Harvard Medical School, United States.
¹⁰ Department of Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Cancer Center Clinica Universidad de Navarra, Spain.
¹¹ Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.
¹² Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI, United States.
¹³ Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands; Department of Radiation Science & Technology, Delft University of Technology, Delft, the Netherlands.
¹⁴ Lifespan Cancer Institute, Providence, RI, United States; Legorreta Cancer Center at Brown University, Providence, RI, United States.
¹⁵ Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal.

Abstract

Purpose: The recently released EANM/SNMMI guideline, endorsed by several important clinical and imaging societies in the field of breast cancer (BC) care (ACR, ESSO, ESTRO, EUSOBI/ESR, EUSOMA), emphasized the role of [¹⁸F]FDG PET/CT in management of patients with no special type (NST) BC. This review identifies and summarizes similarities, discrepancies and novelties of the EANM/SNMMI guideline compared to NCCN, ESMO and ABC recommendations.

Methods: The EANM/SNMMI guideline was based on a systematic literature search and the AGREE tool. The level of evidence was determined according to NICE criteria, and 85 % agreement or higher was reached regarding each statement. Comparisons with NCCN, ESMO and ABC guidelines were examined for specific clinical scenarios in patients with early stage through advanced and metastatic BC.

Results: Regarding initial staging of patients with NST BC, [¹⁸F]FDG PET/CT is the preferred modality in the EANM-SNMMI guideline, showing superiority as a single modality to a combination of contrast-enhanced CT of thorax-abdomen-pelvis plus bone scan in head-to-head comparisons and a randomized study. Its use is recommended in patients with clinical stage IIB or higher and may be useful in certain stage IIA cases of NST BC. In NCCN, ESMO, and ABC guidelines, [¹⁸F]FDG PET/CT is instead recommended as complementary to conventional imaging to solve inconclusive findings, although ESMO and ABC also suggest [¹⁸F]FDG PET/CT can replace conventional imaging for staging patients with high-risk and metastatic NST BC. During follow up, NCCN and ESMO only recommend diagnostic imaging if there is suspicion of recurrence. Similarly, EANM-SNMMI states that [¹⁸F]FDG PET/CT is useful to detect the site and extent of recurrence only when there is clinical or laboratory suspicion of recurrence, or when conventional imaging methods are equivocal. The EANM-SNMMI guideline is the first to emphasize a role of [¹⁸F]FDG PET/CT for assessing early metabolic response to primary systemic therapy, particularly for HER2+ BC and TNBC. In the metastatic setting, EANM-SNMMI state that [¹⁸F]FDG PET/CT may help evaluate bone metastases and determine early response to treatment, in agreement with guidelines from ESMO.

Conclusions: The recently released EANM/SNMMI guideline reinforces the role of [¹⁸F]FDG PET/CT in the management of patients with NST BC supported by extensive evidence of its utility in several clinical scenarios.

Keywords: ABC guidelines; Breast cancer; EANM-SNMMI guidelines; ESMO guidelines; FDG-PET/CT; NCCN guidelines.

Publication types

Comparative Study
Review

MeSH terms

Breast Neoplasms* / diagnostic imaging
Breast Neoplasms* / pathology
Female
Fluorodeoxyglucose F18*
Humans
Neoplasm Staging*
Positron Emission Tomography Computed Tomography* / methods
Practice Guidelines as Topic*
Radiopharmaceuticals

Substances

Fluorodeoxyglucose F18
Radiopharmaceuticals