FDG PET/CT of Breast Cancer

The role of FDG PET/CT is investigated for diagnosis, initial staging, follow-up, and evaluation of response to therapy in breast cancer.

Course ID: Q00375 Category:
Modalities: , , , ,

3.0

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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: 2.00
Patient Care: 1.00
Patient Interactions and Management: 1.00
Image Production: 1.00
Evaluation and Selection of Representative Images: 1.00

Mammography: 2.00
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 1.00
Mammographic Positioning, Special Needs, and Imaging Procedures: 1.00

Nuclear Medicine Technology: 3.00
Procedures: 3.00
Endocrine and Oncology Procedures: 3.00

Registered Radiologist Assistant: 3.00
Procedures: 3.00
Thoracic Section: 3.00

Radiation Therapy: 3.00
Patient Care: 1.50
Patient and Medical Record Management: 1.50
Procedures: 1.50
Treatment Sites and Tumors: 1.50

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