Diagnostic Value of FDG PET/CT in Surveillance after Curative Resection of Breast Cancer

SIMPLE SUMMARY: With increasing incidence of breast cancer and improvement in treatment, the concern about surveillance management after curative treatment in patients with breast cancer also has increased. However, there is a debate regarding routine surveillance follow-up examinations in clinical practice. This retrospective study was designed to evaluate the diagnostic value of routine surveillance FDG PET/CT in patients with breast cancer. A total of 2121 scans in 1681 women with breast cancer in surveillance were included in the study. The frequency of positive surveillance PET/CT findings was 5.0% (105 of 2121 scans) and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detecting clinically unsuspected recurrent breast cancer or second primary malignancy were 100%, 98.5%, 70.5%, 100% and 98.5%, respectively. In conclusion, surveillance fluorodeoxyglucose PET/CT showed superior diagnostic performance and comparable rate of positive findings with conventional imaging modality in the detection of clinically unexpected recurrent breast cancer after curative treatment. ABSTRACT: With increasing incidence of breast cancer and improvement in treatment, the concern about surveillance management also has increased. This retrospective study was designed to evaluate the diagnostic value of routine surveillance FDG PET/CT in patients with breast cancer. The diagnostic performance of surveillance PET/CT was analyzed regarding sensitivity, specificity, positive predictive value, negative predictive value and accuracy. The diagnostic accuracy was defined as the ability to differentiate recurrence and no-disease correctly and the proportion of true results, either true positive or true negative, in the population. Findings from pathologic examination; other imaging modalities such as CT, MRI and bone scan; or clinical follow-up were used as the reference standard. In this study of 1681 consecutive patients with breast cancer who underwent curative surgery, surveillance fluorodeoxyglucose PET/CT showed good diagnostic performance in the detection of clinically unexpected recurrent breast cancer or other malignancy, with a sensitivity of 100%, specificity of 98.5%, positive predictive value of 70.5%, negative predictive value of 100% and accuracy of 98.5%. In conclusion, surveillance fluorodeoxyglucose PET/CT showed good diagnostic performance in the detection of clinically unexpected recurrent breast cancer after curative surgery.