Abstract
Author(s): Riyadh W. AL Esawi*, Huda Mahmood Shakir, Mundher Mudhafar, Afkar Jawad Abed
Background: To establish the optimal treatment for a breast cancer patient, proper staging is required. High sensitivity for identifying extra-axillary lymph nodes and distant metastases is provided by 18F-Fluorodeoxyglucose Positron Emission Tomography coupled with Computed Tomography (FDG-PET/CT). Our study is to evaluate the role of FDG-PET/CT in breast cancer staging and follow-up after treatment in Iraqi women. Aims of the study: This study aims to evaluate the usefulness of Positron Emission Tomography-Computed Tomography (PET-CT) in breast cancer patients for the following: Initial breast cancer staging in Iraqi women in comparison with clinical staging and Follow up PET-CT scan to evaluate treatment response. Patients and methods: A total of 100 female patients, ranging in age from 22 to 80 years, were included in this retrospective analysis. For initial staging with fluorine-18 fluorodeoxyglucose-positron emission tomography-computed tomography, all patients who had been diagnosed with breast cancer through biopsy were referred for a PETCT scan. Out of 100 patients, 15 had undergone a second FDG-PET-CT scan six months after treatment to determine the response. The study was carried out between January 2022 and December 2022, and all patients had undergone a tru-cut biopsy of the lump and clinical staging using a physical, histopathological, and imaging exam, as well as PET staging. The FDG PET/CT scan was carried out at the oncology and nuclear medicine center of the Amir Al-Momineen specialized hospital in Najaf. The results were reported by experienced specialists in nuclear medicine. Results: The median patient age 50 (range: 22-80) years, the majority of the patients aged older than 40 years. The breast lump was the main complaint. 51 percent of lesions are located on the left side, where the upper-outer quadrant was the most common location of lesions. IDC (invasive ductal carcinoma) was the commonest type reported in 79% of cases followed by ILC (invasive lobular carcinoma) in 14%. The mean Standardized Uptake Values was significantly increased with advancing stage, (P. value<0.05). Receiver Operating Characteristic (ROC) curve analysis was performed using the SUV values as a scale parameter for prediction. This analysis revealed that PET scan with an optimal SUV cutoff point of 3.8 had good performance produced an area under the curve of 0.843, sensitivity of 85.7%, specificity of 76.3%, accuracy of 81%, Positive Predictive Value (PPV) of 78.3% and a Negative Predictive Value (NPV) of 84.2% which reflect good performance and validity. Conclusions: PET/CT scan is an indispensable imaging technique had good performance and diagnostic accuracy for initial staging and follow-up of patients with breast cancer. It was effective in the evaluation of response to treatment and outcome of the patients.