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Pitfalls and artifacts of FDG PET/CT in recurrent breast cancer patients

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Abstract

Purpose

FDG PET/CT is often indicated in breast cancer patients for the detection of recurrent disease. However, the differential diagnosis between benign and malignant lesions is sometimes difficult to address, especially in organs that are often a potential site of recurrent disease. The present collection of clinical cases aims to provide some information on these likely sites of false-positive findings at FDG PET/CT in breast cancer patients and to give some physiopathological explanations.

Methods

A search of the literature was performed for articles published between 2011 and 2016 that reported data on false-positive findings in patients with suspicious breast recurrence undergoing FDG PET/CT. Moreover, all false-positive findings at FDG PET/CT from a single institutional collection between 2011 and 2016, in the same setting of patients were recovered and singularly described.

Results

From a search of the literature using different keywords, 57 articles reporting false-positive findings at FDG PET in recurrent breast cancer were found. However, from a careful analysis, 10 reports were used for the analysis of data. Mediastinal and loco-regional lymph nodes represent the most common site for false-positive findings at FDG PET/CT (n = 33/74; 44.6% of subjects with available results) in breast cancer patients linked to different benign conditions. Moreover, from an institutional collection of data, 15 cases were carefully described, including explanations about their physiopathological mechanisms.

Conclusions

FDG PET/CT images in recurrent breast cancer patients should be carefully read to avoid over diagnosis of metastatic disease. False-positive findings should be clearly considered, especially in regional lymph nodes. Moreover, correlative CT information and clinical history including recent treatment and procedures are key in avoid false-positive finding.

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Acknowledgements

We are thankful to Christina Drace for her help in English revision.

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Authors and Affiliations

  1. Nuclear Medicine and Molecular Imaging Unit, Veneto Institute of Oncology IOV-IRCCS, Via Gattamelata, 64, 35128, Padua, Italy

    Laura Evangelista, Marta Burei & Giorgio Saladini

  2. Nuclear Medicine Department, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy

    Luigi Mansi

Authors
  1. Laura Evangelista
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  2. Luigi Mansi
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  3. Marta Burei
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  4. Giorgio Saladini
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Contributions

L.E.: Literature search and review, manuscript writing, editing and content planning; L.M.: manuscript writing, editing and content planning; M.B.: literature search and review; G.S.: manuscript writing and editing.

Corresponding author

Correspondence to Laura Evangelista.

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The authors declared that they have no conflict of interests.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

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Evangelista, L., Mansi, L., Burei, M. et al. Pitfalls and artifacts of FDG PET/CT in recurrent breast cancer patients. Clin Transl Imaging 5, 169–182 (2017). https://doi.org/10.1007/s40336-017-0224-0

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  • DOI: https://doi.org/10.1007/s40336-017-0224-0

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