Current clinical use of the [¹⁸F]FDG PET/CT in breast cancer patients: an audit of local referral patterns

Introduction

[¹⁸F]FDG PET/CT scanning has been shown to be an established, accurate method of detecting many primary and metastatic tumours. However, widespread use of PET/CT scanning in the UK remains generally limited, as it is expensive and restricted to a few tertiary centres. Cheltenham General Hospital receives referrals for patients from across the southwest of England and Wales for [¹⁸F]FDG PET/CT. We looked at the referral patterns of patients with breast cancer to see whether they reflected current indications for [¹⁸F]FDG PET/CT and to see whether the findings impacted on clinical decision-making.

Methods

Ninety-five [¹⁸F]FDG PET/CT scans from 2006 to 2010 were requested for breast cancer patients. The indications and results of these were recorded and analysed.

Results

The following indications were found - staging scans in patients with locoregional disease: 22%; equivocal radiology: 17%; specific concern of recurrent disease: 17%; diagnostic/therapeutic conflict with second primary: 15%; staging of locally advanced disease: 11%; response to endocrine or chemotherapy: 9%; stability/speed of progression of metastatic disease: 8%. On reviewing clinical records/follow-up, the results of [¹⁸F]FDG PET/ CT in many circumstances gave information about metastatic disease in locoregional recurrence, resolved issues surrounding equivocal radiology and ensured that patients with second operable cancers were not subjected to major surgery only to succumb to their breast metastasis.

Conclusions

[¹⁸F]FDG PET/CT can give valuable information in patients with breast cancer, particularly in scenarios with equivocal findings on other imaging and regarding disease progression. The technique often contributed to management decisions in complex cases.