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Is 18F-FDG PET/CT an accurate tool for identifying metastases of lobular breast cancer?

Invasive lobular breast cancer (IlBrCa) accounts for only about 8–14% of a heterogeneous group of different histological types of breast cancer (BrCa), but it is still not infrequent due to high overall incidence of BrCa and an increasing rate of this type of tumor in older women since 1977 [1]. BrCa has a well known glycolytic activity due to overexpression of glucose transporters [2] that make F-18-fluorodeoxyglucose (FDG) a suitable tracer, and BrCa one of the frequent indications for PET/CT [3]. significantly lower FDG uptake has been demonstrated in primary IlBrCa versus invasive ductal BrCa (IDBrCa) [4,5], with false negative rates of up to 66% for IlBrCa. a logical resulting extrapolation is that FDG uptake may be also low in metastasis of IlBrCa. This raises an important question regarding the relevance of FDG positron emission tomography/ computerized tomography (PET/CT) for follow-up of IlBrCa. However, despite this common assumption, to the best of our knowledge, little clinical data has been reported to date on this issue. In this study we set out to examine whether metastases of IlBrCa have lower FDG avidity similarly to the primary tumor, and thus whether FDG may be appropriate for systemic evaluation of patients with IlBrCa.