الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 177 |  |  |
| | | from | 177 | | |
Abstract
Globally, women are diagnosed with BC more often than any other malignancy. Accurate staging and restaging of BC
patients are important for proper management decisions.
Update, the efficacy of 18F-FDG PET/CT as an imaging modality for the detection, staging, and restaging of BC is still controversial.
This study aimed to demonstrate the role of 18PET-CT in the staging of breast cancer patients at initial diagnosis and restaging of BC patients in cases of recurrent disease.
This was a prospective study conducted at the Radiodiagnosis Department of Ain Shams University and some private centers. The study included 50 female patients who were referred with histopathologically proven new BC and other 50 females with recurrent BC.
Cases with newly diagnosed breast cancer:
The patients’ ages ranged between 33 to 81 years with a mean ± SD of 57.9 ± 12.97). Most of the patients (36%) were aged from 61 to 70 years.
BC was relatively comparable on both sides with slight predominance on the right side more than the left side (48% vs. 42%, respectively). The majority of patients (72%) at the initial diagnosis had single lesions whereas 20% had multicentric lesions, and 8% had multifocal lesions.
Most of the patients were diagnosed with ductal BC (86%), Grade III BC (62%), and ER +ve, PR +ve, and HER2neu -ve BC (54%) phenotypes.
Regarding nodal deposits, using 18F-FDG PET/CT, multiple axillary lymph nodes were shown in 46 of 50 patients. Other extra-axillary lymph nodes were detected by 18F-FDG PET/CT, including mediastinal and hilar lymph nodes in 12 patients, and internal mammary lymph nodes in 6 patients. Whereas, regarding distant solid organ deposits, osseous metastases were the most common, followed by pulmonary and hepatic deposits.
The staging via other imaging modalities versus after PET- CT scans demonstrated that the total upstaging of PET-CT of BC patients in our work was 42%. PET/CT upstaged 3 patients from stage IIA to stages IIIB, and VI, 3 of 8 patients from stage IIB to stage IV, 3 of 4 patients from stage IIIA to stages IIIC and IV, 5 of 8 patients from stage IIIB to stages IIIC and IV, and finally 6 of 8 patients from stage IIIC to stage IV. PET-CT showed no change in staging in 29 out of 50 cases.
Cases with recurrent breast cancer:
The patients’ ages ranged from 18 to 92 years with a mean
± SD of 55.14 ± 15.52 years. The majority of the patients (30%) were aged 51 to 60 years old.
There was a slight predominance of primary tumors on the left side more than on the right side (52% vs. 46%, respectively) whereas only 2% had bilateral lesions. The majority of BC were
ductal type (88%), and Grade III (84%), as well as both triple- negative tumors and tumors with ER +ve, PR +ve, and HER2neu
-ve were the most frequent phenotypes (44% for both).
All patients in our study underwent surgical management for the primary tumor including modified radical mastectomy (MRM) (62%) and Breast-conserving surgery (BCS) (38%).
As regards the type of recurrence of the tumor, the majority of patients (58%) showed distant deposits recurrence (nodal and solid organs), followed by 28% showing local and distant recurrence, 8% showing contralateral breast, and 6% showing local recurrence. Concerning nodal metastasis, most of the patients had metastatic deposits in mediastinal and hair in (16 patients), internal mammary in (9 patients), and supra-clavicular in (9 patients). Whereas the distant deposits in solid organs were mostly in bone (27 patients), liver (17 patients), and lungs (10 patients).
We found the detections of recurrence via other imaging modalities/serum tumor markers or clinical assessment versus after PET-CT scans were changed in 35 cases as PET-CT showed other metastatic deposits. Compared to the other imaging/clinical/laboratory investigations, 18F FDG-PET/CT showed added deposits in 10 of 17 patients with local recurrence, 13 of 18 patients with distant recurrence, 5 of 5 patients with elevated tumor markers without detected local or distant lesions, and finally, 7 of 10 patients with recurrence diagnosed with clinical assessment. It is worth mentioning that no missed lesion was observed after 18F FDG-PET/CT except for one cerebral lesion.