Detection of breast cancer in an FDG-PET cancer screening program: results of a nationwide Japanese survey

Abstract

Background: The [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) cancer screening program is defined as cancer screening for asymptomatic subjects using FDG-PET/computed tomography with or without combination of other screening tests. The aim of this study was to analyze the detection rate and effectiveness of the FDG-PET cancer screening program for breast cancer between 2006 and 2009 in Japan.

Patients and methods: A total of 62,054 asymptomatic female subjects underwent FDG-PET cancer screening. We analyzed 473 cases with findings of possible breast cancer in any screening tests.

Results: Among 473 possible cases, 161 were verified as breast cancer. The relative sensitivity and positive predictive value (PPV) of FDG-PET for breast cancer were 83.9% and 41.7%, respectively. The relative sensitivity and PPV of mammography (MMG) for breast cancer was less than for FDG-PET; results for breast ultrasonography (US) were close to FDG-PET. The combination of FDG-PET with MMG and US might contribute to increased sensitivity but does not improve PPV. Most breast cancer cases (83.0%) detected using the FDG-PET cancer screening program were stage 0 or I based on the Union for International Cancer Control criteria.

Conclusion: The FDG-PET screening program in Japan detected breast cancer at an early stage. A combination of FDG-PET and MMG and/or breast US yields the best results for detecting breast cancer. The FDG-PET cancer-screening program alone cannot detect all breast cancers.

Keywords: Asymptomatic subjects; Breast ultrasound; Cancer staging; Mammography; PET/CT.