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; John Patrick Pilkington Woll; Fatima Cardoso; David Groheux; Gary J R Cook; Gary A Ulaner; Heather Jacene; Isabel T Rubio; Jan W Schoones; Marie-Jeanne Vrancken Peeters; Philip Poortmans; Ritse M Mann; Stephanie L Graff; Elizabeth H Dibble; Lioe-Fee de Geus-Oei

doi:10.1007/s00259-024-06696-9

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)

Eur J Nucl Med Mol Imaging. 2024 Jul;51(9):2706-2732. doi: 10.1007/s00259-024-06696-9. Epub 2024 May 14.

Authors

Sofia C Vaz^{1

2}, John Patrick Pilkington Woll³, Fatima Cardoso⁴, David Groheux^{5

6

7}, Gary J R Cook^{8

9

10}, Gary A Ulaner^{11

12}, Heather Jacene^{13

14}, Isabel T Rubio¹⁵, Jan W Schoones¹⁶, Marie-Jeanne Vrancken Peeters^{17

18}, Philip Poortmans^{19

20}, Ritse M Mann²¹, Stephanie L Graff^{22

23}, Elizabeth H Dibble²⁴, Lioe-Fee de Geus-Oei^{25

26

27}

Affiliations

¹ Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal. sofia.vaz@fundacaochampalimaud.pt.
² Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. sofia.vaz@fundacaochampalimaud.pt.
³ PET-CT Department, Clinica Delgado AUNA, Lima, Peru.
⁴ Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal.
⁵ Nuclear Medicine Department, Saint-Louis Hospital, Paris, France.
⁶ University Paris-Diderot, INSERM U976, Paris, France.
⁷ Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France.
⁸ Department of Cancer Imaging, King's College London, London, UK.
⁹ King's College London and Guy's & St Thomas' PET Centre, London, UK.
¹⁰ School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
¹¹ Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, USA.
¹² University of Southern California, Los Angeles, CA, USA.
¹³ Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA.
¹⁴ Harvard Medical School, Boston, MA, USA.
¹⁵ Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Cancer Center Clinica Universidad de Navarra, Navarra, Spain.
¹⁶ Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands.
¹⁷ Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
¹⁸ Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹⁹ Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium.
²⁰ University of Antwerp, Wilrijk, Antwerp, Belgium.
²¹ Radiology Department, RadboudUMC, Nijmegen, The Netherlands.
²² Lifespan Cancer Institute, Providence, Rhode Island, USA.
²³ Legorreta Cancer Center at Brown University, Providence, Rhode Island, USA.
²⁴ Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. edibble@lifespan.org.
²⁵ Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. l.f.de_geus-oei@lumc.nl.
²⁶ Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands. l.f.de_geus-oei@lumc.nl.
²⁷ Department of Radiation Science & Technology, Technical University of Delft, Delft, The Netherlands. l.f.de_geus-oei@lumc.nl.

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.

Keywords: 2-[18F]FDG; Breast cancer; EANM; No special type; PET/CT; SNMMI.

Publication types

Practice Guideline

MeSH terms

Breast Neoplasms* / diagnostic imaging
Female
Fluorodeoxyglucose F18*
Humans
Nuclear Medicine
Positron Emission Tomography Computed Tomography* / standards
Societies, Medical

Substances

Fluorodeoxyglucose F18