Keywords:
Breast, Hybrid Imaging, Oncology, PET-CT, Cost-effectiveness, Molecular imaging, Cancer
Authors:
B. Raghavan1, S. Viswanathan1, G. SIVARAMALINGAM2, S. Singh1, R. Baburaj1, B. Ramakrishnan1; 1Chennai/IN, 2CHENNAI, tamilnadu/IN
DOI:
10.26044/ecr2019/C-2805
Results
In our prospective study,
23 (12.99%) out of 177 unilateral early breast cancer patients were upstaged by PET CT - FIG.
1.
Out of twenty-three upstaged patients two patients (8.69%) were upstaged to stage IIIC and twenty-one (91.30%) to stage IV - FIG. 2.
Two of stage IA patients were upstaged to stage IV,
one of whom was detected with skeletal metastases on PET-CT.
IHC subtype of the patient : Luminal A.
SUVmax of the breast lesion : 6.6 - FIG.
3.
Nine of stage IIA patients were upstaged to stage IV.
One of such patient was detected with prominent metastatic cervical,
mediastinal and retroperitoneal lymph nodes and multiple skeletal metastases after PET-CT imaging.
IHC subtype of the patient : Luminal A.
SUVmax of the breast lesion : 11.3- FIG.
4.
Another stage IIA patient showed FDG positive metastatic hepatic and skleletal metastases.
IHC subtype of the patient : Triple negative.
SUVmax of the breast lesion : 7.6-FIG.
5.
Twelve of stage IIB patients were upstaged,
out of which ten were upstaged to stage IV and two to stage IIIC.
One of the IIB stage was upgraded to stage IV with mediastinal nodes and skeletal metastases.
IHC subtype: Luminal A.
SUV max: 3.4 -FIG. 6.
Vermis metastases was found in another stage IIB patient who was subsequently upgraded to stage IV.
IHC subtype: Luminal A.
SUV max: 3.2-FIG. 7.
Distribution of various metastases detected by PET-CT : FIG.
8. In sixteen newly detected skeletal metastases cases; additional seven hepatic ,
four pulmonary,
one adrenal and one brain metastases were also found in PET-CT imaging which could have gone undetected if patients had undergone only Bone scan and CT chest/abdomen.
One of our case series presented with enlarged axillary nodes with loss of fatty hilum and clinical diagnosis was lymphoma.
PET CT showed a FDG positive subcentimeter heterogenously enhancing nodule in the lower outer quadrant of the right breast (0.8 x 0.6cms-SUV max 4.2) which was later confirmed to be the primary cancer on biopsy. Multiple axillary ,
supraclavicular and cervical lymph nodes and multiple skeletal metastases.
-Fig 9.
Correlation of SUVmax in upstaged tumors with subtypes of breast tumors
Illustrative cases :
- Luminal A -9 cases of Luminal A with median SUVmax value of 6.6 (5.8-10.2) - Fig.10.
- Luminal B - 3 cases of Luminal B with with median SUVmax value of 7.9 (6.7-9.7) -Fig. 11.
- Her 2 neu positive- There was only 1 case of Her 2 neu positive with SUVmax value of 7.6- Fig. 12.
- Triple negative- 5 cases of Triple negative with median SUVmax value of 8.5 (8.2-10.0)- Fig. 13.
Distribution of the various immunohistochemistry subtypes in relation to their SUVmax values : FIG. 14.
Fig. 14: Box and whisker plot showing distribution of SUV max in various IHC types
Addendum
- No immunohistochemistry report was available in 3 patients.
- Equivocal Her 2 neu was reported in 2 patients.