Prospective study comparing positron emission tomography/computed tomography (PET/CT) with conventional staging workup T3, T4 breast carcinoma

ABSTRACT Background: The staging workup for T3/T4 breast carcinoma requires multiple imaging sessions. Using 18F-FDG PET/CT (18F-fluorodeoxyglucose positron emission tomography/computed tomography) as a single modality may streamline diagnosis, reduce hospital visits, expedite treatment initiation, and facilitate early disease staging, improving overall patient management efficiency. Objectives: The primary objective was to determine whether PET/CT results in a higher stage assignment compared to conventional imaging (CI) in T3/T4 breast cancer. The secondary objectives were to compare the duration of workup and the number of radiology visits at Yenepoya Medical College, Mangalore, Karnataka, India. Materials and Methods: Forty-two women aged 18–70 years with biopsy-confirmed T3/T4 breast cancer underwent CI (contrast-enhanced computed tomography + bone scan) and PET/CT. Outcomes included differences in TNM staging, detection of metastases, and number of radiological visits. Results: PET/CT showed staging advancements for 21.4% ( n = 9) and downgraded stage for 9.5% ( n = 4) of cases. It detected distant metastases in 45.2% ( n = 19) compared with 47.6% ( n = 20) using CI, and identified more nodal involvement [N2/N3: 40.5% ( n = 17) vs. 33.4% ( n = 14)]. The mean workup duration was similar between PET/CT and CI (3.07 ± 1.2 days vs. 3.26 ± 0.66 days; P, 0.382). PET/CT required fewer radiological visits (1.24 ± 0.43 vs. 2.62 ± 0.66; P < 0.0001). Conclusion: PET/CT improved staging refinement in T3/T4 breast cancer and substantially reduced the hospital visits, while the overall workup duration remained similar. These findings support integrating it into the staging pathway for T3/T4 breast carcinoma.