Enhancing precision in bone metastasis diagnosis for lobular breast cancer: reassessing the role of 18F-FDG PET/CT.

PURPOSE: Detection of osseous metastases by imaging can be challenging in patients with invasive lobular breast cancer (ILC). ILC may demonstrate low metabolic rate due to lower tumor cell density, decreased proliferation rate, diffuse infiltration of surrounding tissue, and low level of GLUT-1 expression. The aim of this study is to assess the diagnostic accuracy of 18F-FDG PET/CT in identifying bone metastases in ILC patients. MATERIAL AND METHODS: Out of 52 individuals diagnosed with lobular breast cancer and underwent 18F-FDG PET/CT for evaluation of metastases, 21 patients were included in our study population after applying inclusion and exclusion criteria. The radiological and clinical follow-up of at least 6 months served as the reference standard comparator. RESULTS: Bone metastases were confirmed in six patients. 18F-FDG PET/CT was true positive in two and false negative in four patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG PET/CT were 33.33, 93.33, 66.67, 77.78, and 76.19%, respectively (95% confidence interval). The tendency of ILC osseous metastases to be more sclerotic explains the low diagnostic accuracy of 18F-FDG PET/CT in detection of bone metastases, making it a less suited method of evaluation. CONCLUSION: The results of the present study indicate that 18F-FDG PET/CT has a low diagnostic accuracy in detecting bone metastases in lobular breast cancer and, by inference, new functional modalities can be explored in these patients. The findings contribute valuable insights to optimize the integration of molecular imaging into the diagnostic algorithm for this specific breast cancer subtype.

Assessing variability in breast cancer management across the world: results of a questionnaire survey amongst global international experts in breast cancer management.

Background: Breast cancer is the most common cancer in women worldwide with an estimated 2.3 million breast cancer cases diagnosed annually. The outcome of breast cancer management varies widely across the globe which could be due to a multitude of factors. Hence, a blanket approach in standardisation of care across the world is neither practical nor feasible. Aim: To assess the extent and type of variability in breast cancer management across the globe and to do a gap analysis of patient care pathway. Method: An online questionnaire survey and virtual consensus meeting was carried out amongst 31 experts from 25 countries in the field of breast cancer surgical management. The questionnaire was designed to understand the variability in diagnosis and treatment of breast cancer, and potential factors contributing to this heterogeneity. Result: The questionnaire survey shows a wide variation in breast surgical training, diagnosis and treatment pathways for breast cancer patients. There are several factors such as socioeconomic status, patient culture and preferences, lack of national screening programmes and training, and paucity of resources, which are barriers to the consistent delivery of high-quality care in different parts of the world. Conclusion: On-line survey platforms distributed to global experts in breast cancer care can assess gaps in the diagnosis and treatment of breast cancer patients. This survey confirms the need for an in-depth gap analysis of patient care pathways and treatments to enable the development of personalised plans and policies to standardise high quality care.