• Kuruva Manohar, Bhagwant R Mittal, Amit Bhoil, Anish Bhattacharya, and Gurpreet Singh.
• Department of Nuclear Medicine and PET and General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
• Nucl Med Commun. 2013 Jun 1; 34 (6): 557-61.

ObjectivesThis study was conducted to evaluate the role of (18)F-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography (CT) in identifying missed distant metastases in patients with locally advanced breast cancer (LABC) who were assessed by conventional imaging methods.Materials And MethodsForty-three consecutive patients with histopathologically proven LABC with negative conventional imaging results for distant metastases were included in the study. All of them underwent (18)F-FDG PET/CT within a week after conventional imaging.Results(18)F-FDG PET/CT findings suggestive of distant metastases were noted in 11/43 patients, and 10 of them were confirmed to have true-positive distant metastatic disease on clinical follow-up of 6 months. None of the patients with negative (18)F-FDG PET/CT for distant metastases developed distant metastases during the follow-up. (18)F-FDG PET/CT had a sensitivity, specificity, positive predictive value, and negative predictive value of 100, 96.8, 91, and 100%, respectively, for identifying distant metastases missed by conventional imaging. In addition, (18)F-FDG PET/CT suggested previously unknown lymph nodal metastases in 16/43 (37%) patients. Change in stage was noticed in 17/43 (39.5%) patients.Conclusion(18)F-FDG PET/CT is a sensitive and specific imaging modality for identifying distant metastases in patients with LABC missed by conventional imaging. In addition, it detects unknown lymph nodal metastases in a significant proportion of patients and hence can be used routinely in staging of patients with LABC.

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