A recent study of 196 subjects [134] tested the utility of PET/CT in breast cancer and found the overall yield of unsuspected distant metastases was 14% (n = 27), including 0% for stage IIA, 13% for stage IIB (10/79), 22% for stage IIIA (9/41), 17% for stage IIIB (5/30), and 37% for stage IIIC (3/8). In another study of 303 patients, PET/CT demonstrated unknown metastatic disease in 4.9% (15/303), 0.8% in stage IIA, and 9.8% in stage IIB [135]. Finally, Groheux et al [136] performed a prospective study of 254 women with breast cancer, and PET/CT found unsuspected metastatic disease in 2.3% of stage IIA and 10.7% in stage IIB [128]. The performance of PET/CT was independent of cancer subtype, as shown in other studies on stage IIB disease [137]. Finally, a recent meta-analysis of 4,276 patients (29 studies) also found 11% (95% CI, 3%-22%) of patients with stage I and 20% (95% CI, 16%-24%) of patients with stage II breast cancer changed disease stage or management plan (including up or downstaging) with PET/CT [13]. Thus, there is some evidence to consider this test, even in early breast cancer, if the immunohistochemical subtype is HER2+/TN or the disease is locally advanced as described above. Mammography Diagnostic There is no evidence to support the use of diagnostic mammography to evaluate distant disease. Mammography With IV Contrast There is no evidence to support the use of diagnostic mammography with IV contrast to evaluate distant disease. MRI Breast Without and With IV Contrast There is no evidence to support the use of MRI breast to evaluate distant disease. MRI Breast Without IV Contrast There is no evidence to support the use of noncontrast breast MRI in evaluating extent of disease. US Axilla There is no evidence to support the use of US axilla to evaluate distant disease. US Breast There is no evidence to support the use of US breast to evaluate distant disease. Variant 3: Newly diagnosed. Clinical stage IIB-III (late stage) breast cancer at presentation.
Imaging of Invasive Breast Cancer. A recent study of 196 subjects [134] tested the utility of PET/CT in breast cancer and found the overall yield of unsuspected distant metastases was 14% (n = 27), including 0% for stage IIA, 13% for stage IIB (10/79), 22% for stage IIIA (9/41), 17% for stage IIIB (5/30), and 37% for stage IIIC (3/8). In another study of 303 patients, PET/CT demonstrated unknown metastatic disease in 4.9% (15/303), 0.8% in stage IIA, and 9.8% in stage IIB [135]. Finally, Groheux et al [136] performed a prospective study of 254 women with breast cancer, and PET/CT found unsuspected metastatic disease in 2.3% of stage IIA and 10.7% in stage IIB [128]. The performance of PET/CT was independent of cancer subtype, as shown in other studies on stage IIB disease [137]. Finally, a recent meta-analysis of 4,276 patients (29 studies) also found 11% (95% CI, 3%-22%) of patients with stage I and 20% (95% CI, 16%-24%) of patients with stage II breast cancer changed disease stage or management plan (including up or downstaging) with PET/CT [13]. Thus, there is some evidence to consider this test, even in early breast cancer, if the immunohistochemical subtype is HER2+/TN or the disease is locally advanced as described above. Mammography Diagnostic There is no evidence to support the use of diagnostic mammography to evaluate distant disease. Mammography With IV Contrast There is no evidence to support the use of diagnostic mammography with IV contrast to evaluate distant disease. MRI Breast Without and With IV Contrast There is no evidence to support the use of MRI breast to evaluate distant disease. MRI Breast Without IV Contrast There is no evidence to support the use of noncontrast breast MRI in evaluating extent of disease. US Axilla There is no evidence to support the use of US axilla to evaluate distant disease. US Breast There is no evidence to support the use of US breast to evaluate distant disease. Variant 3: Newly diagnosed. Clinical stage IIB-III (late stage) breast cancer at presentation.