FDG PET Application for Management of Breast Cancer Patient: A Narrative Review

Background: The application of FDG PET/CT scan for assessment of patients with breast cancer is increasing. The cost effectiveness of the application could be different in a developing country with limited PET scanners and treatment priorities Methods: Open discussions of the PET reviewers from 2 out of 4 PET centers of Tehran, the capital city of Iran, were organized to provide insight into their opinions on the indications of FDG PET in breast cancer patients. Results: The sensitivity of FDG PET scan is high for detection of distant metastases; however, assessment of lymph node pathology and the local extension of the breast cancer are questionable. Considering the cost of the procedure itself and the downstream diagnostic procedures, its application and diagnostic accuracy are hindered for breast cancer screening, staging, and assessment of response to treatment and prognosis. The advantages and disadvantages of FDG PET CT and dedicated breast FDG PET scan have been briefed in different clinical scenarios with a focus on limitations faced by a developing country. Conclusion: We suggest reserving the use of FDG PET for selected cases of suspected but not proven recurrent disease and in patients with high risk of metastasis before high risk surgery.