Breast Cancer’s Link to Ovarian Cancer: It’s in Your GenesName : Dr. Dina Hamdy
Affliation : Diagnostic and Interventional Radiologist
University : Menoufia University
Country : Egypt
Breast cancer is the most common cancer type and the leading cause of cancer-related deaths in women worldwide ( J. Ferlay et al.,2010). Many risk factors are well-known , however the exact causes of breast cancer have not been identified .Family history of breast cancer, for example, is a well-known factor that increases risk by a factor of two or three. Also, mutations such as BRCA (1 & 2) and p53 are considered to convey a very strong risk of developing the disease (lacey et al., 2009). Besides these and some environmental risk factors, early detection of breast cancer is considered to be an essential milestone in the control of breast cancer. Early diagnosis is crucial in determining the choice of therapy, as well as a patient’s prognosis and chances for survival (Iagaru et al.,2007).Despite a rising incidence, advances in screening and treatment concepts have contributed to the continuous decrease of breast cancer mortality in the western world since the late 1980s (Lino M.Sawicki et al.,2016). F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT) is widely used in the initial staging, evaluation of the therapeutic response, and detection of recurrent disease. However, with the increasing use of FDG PET/CT sites of increased activity have been occasionally discovered in unexpected locations which may not correlate with the patient’s clinical history or the expected spread of the primary malignancy (Kyung Min Shin et al.,2015). Integrated 18 F-?uordesoxyglucose (18 F-FDG) PET/CT has been successfully introduced in the staging algorithm of a growing number of cancer types (C.D. Collins et al.,2007). In breast cancer patients 18 F FDG PET/CT has been proven superior not only for the detection of distant metastases but also for distinguishing between benign and malignant lesions (M. Tatsumi et al., 2006).
Positron emission tomography (PET) with or without integrated computed tomography (CT) using 18F-fluorodeoxyglucose (FDG) is based on the principle of increased glucose metabolism in malignant tumors and has been investigated frequently in breast cancer (Koolen et al., 2012). The accelerated metabolic activity in oncological cells is the key point when thinking about the usefulness of FDG-PET imaging for detection of malignant tumors. Some researchers have shown very promising results for FDG-PET, with a sensitivity of 80%–96% and specificity of 90%-100% (kumar et al.,2006). Recent studies demonstrated the applicability of 18 F FDG PET/MRI as a promising alternative in cancer staging (K. Beiderwellen et al., 2015). Clinicians usually refer patients for PET/CT scan when conventional imaging studies are equivocal suggestive or considered as high risk according to patient's histological and surgical manifestations. (Segaert et al., 2010). Many studies have pointed to the advantage of PET/CT over conventional imaging modalities in detecting extra-axillary regional lymph nodal involvement, including infraclavicular, supraclavicular, and internal mammary nodes. Detection of such disease involvement may upstage patients to stage III impacts prognosis, and may modify the patient’s initial treatment regimen to include for example, resection of infraclavicular nodes or radiotherapy to extraaxillary nodes(Christopher et al., 2014). Most recently evaluated FDG-PET/CT in comparison to US as the standard of reference of non-invasive imaging techniques in the detection and accuracy of axillary lymph node metastases. The authors determined that though FDG-PET/CT seems to be more accurate than US, it is only as sensitive as US in the detection of axillary lymph node metastases and therefore it is not recommended as a substitute for sentinel lymph node biopsy. On the contrary, FDG-PET/CT was able to detect previously unsuspected loco-regional extra-axillary lymph node metastases (Riegger et al.,2012). Evaluated the sensitivity and specificity of contrast-enhanced CT (ceCT) and PET/CT for re-staging of patients with suspected recurrence of breast cancer and concluded that FDG-PET/CT can improve staging and therefore affect clinical management in patients with suspected breast cancer recurrence and distant metastatic disease (Dirisamer et al.,2010)