Positron emission tomography/computed tomography in the management of recurrent/metastatic breast cancer: a large retrospective study from the Royal Marsden Hospital.

BACKGROUND Despite the increasing use of positron emission tomography/computed tomography (PET/CT) in the management of patients with breast cancer, its role is yet to be defined. PATIENTS AND METHODS We reviewed PET/CT scans carried out in breast cancer patients, the indication, concordance/discordance with other imaging and whether their use had altered patient management. RESULTS PET/CT scans (233) were carried out in 122 patients between July 2004 and October 2008. Indications were as follows: staging (S) (91), response assessment (RA) (87), clarification (C) of findings on other imaging (32) and reassurance (ASS) (23). In the S group, positive scans were helpful in accurately defining the extent of disease and guided localised or systemic treatment. PET/CT was particularly useful for detecting lytic bone metastases. One-third of the scans was carried out for RA. PET/CT allowed early RA and in some cases appropriate discontinuation of ineffective treatment. PET/CT was used effectively for the clarification of indeterminate lesions on CT (18), magnetic resonance imaging (15) and bone scan (13). In the ASS group, all scans were negative. CONCLUSIONS PET/CT is useful in accurately staging metastatic disease, assessing response to systemic treatment and clarifying equivocation on other imaging. Incorporation of PET/CT in these areas contributes to breast cancer management optimisation.