Positron emission tomography in breast disease

Functional imaging techniques including positron emission tomography/computed tomography (PET/CT) are now increasingly being used for oncological patient management. Knowledge of the strengths and weaknesses of this evolving technique is critical for appropriate and optimal patient management. A state of the art presentation is provided to demonstrate the role of PET/CT in breast cancer, with a literature review and practical clinical patient examples from our very extensive experience of imaging in breast cancer.

Current PET/CT does not have a sufficiently high accuracy for the diagnosis of primary breast cancer or for routine axillary nodal staging. Worldwide literature and our own experience show the converse to be true for metastatic breast cancer, PET/CT now being recognised as the most accurate single imaging modality to define/stage metastatic breast disease. The role of PET/CT in the patient pathway, with specific comparison with triple assessment, CT, magnetic resonance imaging and MDP bone scan is addressed. The accuracy of PET/CT for evaluation of nodal, visceral (including liver disease, brachial plexopathy and for pre/post-radio-frequency ablation evaluation) and bony disease is discussed. The important use of PET/CT for response assessment, specifically for bone disease, and its use in guiding management (re. hormone therapy, chemotherapy and radiotherapy) are highlighted. The development of more specific PET tracers, targeting the oestrogen receptor, is also discussed.