FDG PET/CT of Breast Cancer

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 2.25
Patient Care: 2.25
Patient Interactions and Management: 2.25

Mammography: 2.25
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 1.25
Mammographic Positioning, Special Needs, and Imaging Procedures: 1.25

Nuclear Medicine Technology: 3.50
Procedures: 3.50
Endocrine and Oncology Procedures: 3.50

Registered Radiologist Assistant: 3.50
Procedures: 3.50
Thoracic Section: 3.50

Radiation Therapy: 3.50
Patient Care: 1.75
Patient and Medical Record Management: 1.75
Procedures: 1.75
Treatment Sites and Tumors: 1.75

Outline

1. Introduction
2. Principles of PET/CT
3. FDG Uptake of Breast Cancer Depends on the Histologic and Biologic Characteristics of the Tumor
4. FDG PET/CT Has Little Role in Differentiating Benign from Malignant Breast Lesions
5. Role of FDG PET/CT in Assessment of Multifocality and T Category of Breast Cancer
6. FDG PET/CT Comparison with Sentinel Node Biopsy for Axillary Staging
7. Regional and Distant Staging in Large, Locally Advanced and Inflammatory Breast Cancer (Stages II-III
   1. Detection of Lymph Node Involvement Outside Berg I and Berg II Levels
   2. Detection of Distant Metastases
8. In Which Patient Should FDG PET/CT Be Performed at Initial Staging
9. Performance of PET/CT in Restaging of Breast Carcinoma
10. Performance of PET/CT for Treatment Response Assessment
    1. Early Evaluation of Neoadjuvant Chemotherapy with PET with or without CT
    2. Evaluation of Response of Metastatic Disease with FDG PET/CT
    3. Assessment of Response to Hormonal Therapy: The Paradoxical Metabolic Flare
11. Prognostic Value of FDG PET (/CT
12. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the advantages of combined PET/CT imaging
2. know the currently recommended whole-body imaging modality used for restaging in breast cancer patients with known or suspected recurrence
3. understand the information which CT imaging adds to the PET information in combined PET/CT imaging
4. be familiar with the typical scanning procedure for FDG whole body PET/CT imaging for oncology
5. understand how FDG is metabolized within cells
6. know the factors which affect tumor detection in PET imaging
7. understand the methods of standardized uptake value (SUV) calculation
8. know the most important factor to standardize for an FDG oncology imaging procedure within an institution
9. understand the risk posed in response evaluation due to the partial volume effect in PET imaging
10. identify the factors which correlate with FDG uptake intensity in breast cancer
11. know the term describing the measurement of cell division within a tumor
12. understand what high levels of Ki-67 typically indicate
13. understand the term triple-negative for breast tumors
14. identify the function of the p53 gene
15. know the basis for tumor grading
16. understand the differences in the classification methods of tumors
17. be familiar with the Nottingham grading system for breast cancer
18. identify a procedure cited by some authors for improving specificity of FDG PET imaging for breast cancer
19. understand the role of FDG PET in the assessment of multi-focal breast cancer primary lesions
20. know the gold standard method for axillary staging of breast cancer
21. identify the three methods included in a triple-assessment for breast cancer prior to an axillary clearance procedure
22. be familiar with findings that demonstrate a very high yield of FDG PET uptake
23. understand the TNM Stage Grouping for breast cancer according to the AJCC Cancer Staging Manual
24. be familiar with the Berg categorization method of axillary lymph node classification
25. know the relationship between breast cancer axillary lymph node involvement and the utilization of axillary clearance
26. know what clinical findings constitute an N3 (stage IIIC) lesion
27. be familiar with the results of studies evaluating FDG PET/CT for staging
28. know the types of bone lesions which display with FDG PET imaging
29. know when FDG PET/CT imaging is appropriate for initial staging of breast cancer
30. be familiar with the studies which evaluated FDG PET/CT for breast cancer restaging
31. understand the strengths of PET/CT for breast cancer restaging
32. know the usefulness of PET/CT when a breast cancer recurrence is depicted or suspected
33. be familiar with the two meta-analyses encompassing PET/CT imaging for breast cancer restaging
34. be familiar with adjuvant and neoadjuvant therapies and understand the differences in when they are given
35. be familiar with the factors used by physicians in order to recommend adjuvant therapy for those patients who are at higher risk for recurrence
36. know the factors listed in the article for SUV cutoff value variance for treatment response assessment
37. understand the examination of early FDG PET monitoring of breast cancer and the criteria used to assess breast cancer therapy effectiveness
38. know the deficiencies of CT in response assessment imaging
39. be familiar with the European Organization for Research and Treatment of Cancer’s criteria for partial metabolic response and progressive disease
40. understand the FDG uptake response to hormonal therapy