Positron emission tomography in breast disease

Current PET/CT does not have a sufficiently high accuracy for the diagnosis of primary breast cancer or for routine axillary nodal staging. Worldwide literature and our own experience show the converse to be true for metastatic breast cancer, PET/CT now being recognised as the most accurate single imaging modality to define/stage metastatic breast disease. The role of PET/CT in the patient pathway, with specific comparison with triple assessment, CT, magnetic resonance imaging and MDP bone scan is addressed. The accuracy of PET/CT for evaluation of nodal, visceral (including liver disease, brachial plexopathy and for pre/post-radio-frequency ablation evaluation) and bony disease is discussed. The important use of PET/CT for response assessment, specifically for bone disease, and its use in guiding management (re. hormone therapy, chemotherapy and radiotherapy) are highlighted. The development of more specific PET tracers, targeting the oestrogen receptor, is also discussed.