Clinical Utility of PET Scanning in Breast Cancer Management

The utilization of imaging to stage patients with breast cancer continues to evolve from a reliance on conventional techniques, such as the scintigraphic bone scan and computed tomography (CT), to more advanced hybrid molecular imaging, such as 18F-fluorodeoxyglucose positron-emission tomography-CT (FDG PET-CT). Although FDG PET has proven to be a powerful imaging technique, appropriate usage is critical to optimize healthcare delivery. While FDG PET should not be used routinely for initial detection of breast cancer or for detection of axillary nodal involvement, FDG PET in appropriate higher-risk populations has great value in definitive whole-body initial staging, in the differentiation of recurrent tumor from post-therapy sequela, and in the restaging of patients with recurrent tumors. FDG PET scanning also is emerging as a potent tool in prognostic stratification and for assessing early response to therapy. The use of any advanced imaging technique, including FDG PET, is strongly discouraged for routine surveillance of patients with asymptomatic breast cancer who have achieved a complete response. While more research is under way in other molecular-based radiotracers and imaging techniques, this review will focus on the utility of the most common and available molecular-imaging technique, FDG PET, in the diagnosis, staging, and restaging of breast cancer.