Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM, U976, Paris, France; Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France.
Department of Nuclear Medicine and Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
Breast. 2024 Dec;78:103806. doi: 10.1016/j.breast.2024.103806. Epub 2024 Sep 12.
The recently released EANM/SNMMI guideline, endorsed by several important clinical and imaging societies in the field of breast cancer (BC) care (ACR, ESSO, ESTRO, EUSOBI/ESR, EUSOMA), emphasized the role of [F]FDG PET/CT in management of patients with no special type (NST) BC. This review identifies and summarizes similarities, discrepancies and novelties of the EANM/SNMMI guideline compared to NCCN, ESMO and ABC recommendations.
The EANM/SNMMI guideline was based on a systematic literature search and the AGREE tool. The level of evidence was determined according to NICE criteria, and 85 % agreement or higher was reached regarding each statement. Comparisons with NCCN, ESMO and ABC guidelines were examined for specific clinical scenarios in patients with early stage through advanced and metastatic BC.
Regarding initial staging of patients with NST BC, [F]FDG PET/CT is the preferred modality in the EANM-SNMMI guideline, showing superiority as a single modality to a combination of contrast-enhanced CT of thorax-abdomen-pelvis plus bone scan in head-to-head comparisons and a randomized study. Its use is recommended in patients with clinical stage IIB or higher and may be useful in certain stage IIA cases of NST BC. In NCCN, ESMO, and ABC guidelines, [F]FDG PET/CT is instead recommended as complementary to conventional imaging to solve inconclusive findings, although ESMO and ABC also suggest [F]FDG PET/CT can replace conventional imaging for staging patients with high-risk and metastatic NST BC. During follow up, NCCN and ESMO only recommend diagnostic imaging if there is suspicion of recurrence. Similarly, EANM-SNMMI states that [F]FDG PET/CT is useful to detect the site and extent of recurrence only when there is clinical or laboratory suspicion of recurrence, or when conventional imaging methods are equivocal. The EANM-SNMMI guideline is the first to emphasize a role of [F]FDG PET/CT for assessing early metabolic response to primary systemic therapy, particularly for HER2+ BC and TNBC. In the metastatic setting, EANM-SNMMI state that [F]FDG PET/CT may help evaluate bone metastases and determine early response to treatment, in agreement with guidelines from ESMO.
The recently released EANM/SNMMI guideline reinforces the role of [F]FDG PET/CT in the management of patients with NST BC supported by extensive evidence of its utility in several clinical scenarios.
最近发布的 EANM/SNMMI 指南，得到了乳腺癌（BC）护理领域的几个重要临床和影像学学会的认可（ACR、ESSO、ESTRO、EUSOBI/ESR、EUSOMA），强调了[F]FDG PET/CT 在无特殊类型（NST）BC 患者管理中的作用。本综述确定并总结了 EANM/SNMMI 指南与 NCCN、ESMO 和 ABC 建议相比的相似之处、差异和新颖之处。
EANM/SNMMI 指南基于系统文献检索和 AGREE 工具。证据水平根据 NICE 标准确定，并且对于每个陈述，都达成了 85%的一致或更高的共识。对于早期、晚期和转移性 BC 患者的特定临床情况，检查了与 NCCN、ESMO 和 ABC 指南的比较。
对于 NST BC 患者的初始分期，[F]FDG PET/CT 是 EANM-SNMMI 指南中的首选方法，在头对头比较和随机研究中，作为单一方法，其显示出优于对比增强 CT 联合胸部-腹部-骨盆加骨扫描的优越性。建议在临床分期 IIB 或更高的患者中使用，并且在某些 NST BC 的 IIA 病例中可能有用。在 NCCN、ESMO 和 ABC 指南中，[F]FDG PET/CT 被建议作为常规成像的补充，以解决不确定的发现，尽管 ESMO 和 ABC 也建议[F]FDG PET/CT 可用于分期高危和转移性 NST BC 患者。在随访期间，NCCN 和 ESMO 仅建议在怀疑复发时进行诊断性影像学检查。同样，EANM-SNMMI 指出，只有在临床或实验室怀疑复发时，或当常规影像学方法不确定时，[F]FDG PET/CT 才有助于检测复发的部位和范围。EANM-SNMMI 指南是第一个强调[F]FDG PET/CT 在评估原发性全身治疗早期代谢反应中的作用的指南，特别是对于 HER2+BC 和三阴性 BC。在转移性环境中，EANM-SNMMI 指出，[F]FDG PET/CT 可帮助评估骨转移并确定对治疗的早期反应，与 ESMO 的指南一致。
最近发布的 EANM/SNMMI 指南通过其在多个临床情况下的实用性的广泛证据，加强了[F]FDG PET/CT 在 NST BC 患者管理中的作用。
