Joint EANM-SNMMI guideline on the role of 2-[18F]FDG PET/CT in no special type breast cancer
(endorsed by the ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA)
Sofia C. Vaz (Leiden University Medical Center, Champalimaud Clinical Center)
John Patrick Pilkington Woll (Clinica Delgado AUNA)
Gary J.R. Cook (King’s College London)
Gary A. Ulaner (Hoag Family Cancer Institute, University of Southern California)
Heather Jacene (Dana-Farber Cancer Institute, Boston, Harvard Medical School)
Jan W. Schoones (Leiden University Medical Center)
Marie Jeanne Vrancken Peeters (Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis, Universiteit van Amsterdam)
Ritse M. Mann (Radboud University Medical Center)
Elizabeth H. Dibble (Brown University)
Lioe Fee de Geus-Oei (University of Twente, TU Delft - RST/Radiation, Science and Technology, Leiden University Medical Center)
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Abstract
Introduction: There is much literature about the role of 2-[18F]FDG PET/CT in patients with breast cancer (BC). However, there exists no international guideline with involvement of the nuclear medicine societies about this subject. Purpose: To provide an organized, international, state-of-the-art, and multidisciplinary guideline, led by experts of two nuclear medicine societies (EANM and SNMMI) and representation of important societies in the field of BC (ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA). Methods: Literature review and expert discussion were performed with the aim of collecting updated information regarding the role of 2-[18F]FDG PET/CT in patients with no special type (NST) BC and summarizing its indications according to scientific evidence. Recommendations were scored according to the National Institute for Health and Care Excellence (NICE) criteria. Results: Quantitative PET features (SUV, MTV, TLG) are valuable prognostic parameters. In baseline staging, 2-[18F]FDG PET/CT plays a role from stage IIB through stage IV. When assessing response to therapy, 2-[18F]FDG PET/CT should be performed on certified scanners, and reported either according to PERCIST, EORTC PET, or EANM immunotherapy response criteria, as appropriate. 2-[18F]FDG PET/CT may be useful to assess early metabolic response, particularly in non-metastatic triple-negative and HER2+ tumours. 2-[18F]FDG PET/CT is useful to detect the site and extent of recurrence when conventional imaging methods are equivocal and when there is clinical and/or laboratorial suspicion of relapse. Recent developments are promising. Conclusion: 2-[18F]FDG PET/CT is extremely useful in BC management, as supported by extensive evidence of its utility compared to other imaging modalities in several clinical scenarios.
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