Current status and future prospects in breast carcinoma of positron emission tomography

Abstract

In this communication, we explore the current status and future prospects of positron emission tomography (PET) imaging in breast carcinoma. While the use of FDG-PET in the evaluation and management of cancer patients continues to increase, its precise role in the management of breast carcinoma is not yet clearly defined. Currently the most useful applications are in monitoring response to therapy (especially neoadjuvant chemotherapy for locally advanced breast cancer), diagnosis of recurrent and metastatic disease, and defining tumor biology based upon FDG uptake in the lesion. PET has a limited role in diagnosing the primary malignancy, especially in patients with small tumors and those with lobular carcinoma, but can prove useful in certain specific and difficult situations (e.g., in patients with dense breast tissue, significant fibrocystic changes, fibrosis after radiotherapy, and inconclusive results from MR imaging and other imaging modalities). FDG-PET has a relatively low sensitivity for detection of diseased axillary nodes, but the predictive value of a positive PET is very high. We have found that quantitative FDG-PET parameters help define and predict tumor biology. FDG uptake in the index lesion correlates well with tumor aggressiveness, and partial volume correction of the standardized uptake value substantially improves its accuracy especially in lesions less than 2.5∈cm in diameter. In this review, we discuss the clinical utility of PET vis-à-vis existing modalities. © 2010 Springer-Verlag US.