Breast cancer tailored staging using molecular imaging

Part 1 of this thesis focuses on the additional value of prone position PET/CT for loco-regional staging. Chapter 2 addresses the additional value of PET/CT imaging in prone position for the visualization of the primary tumour and regional lymph node metastases compared to supine position PET/CT imaging. In Chapter 3 we analyse the effect on 3-year survival outcome of discovering additional lymph node metastases by prone position PET/CT.
In part 2 we explore the individual and additional value of FDG PET/CT for response monitoring of the primary tumour and axillary lymph node metastases during PST. Chapter 4 shows the comparison of response monitoring of the primary tumour during PST by MRI alone, PET/CT alone and by a combination of both modalities. In Chapter 5 the FDG uptake of the primary tumour in the breast and axillary lymph node metastases were compared before and during PST to find the best prediction for a complete response in the final pathology per subgroup.
Part 3 presents the possibilities and consequence for daily clinical practice of introducing dedicated breast PET and PET-guided biopsy. Chapter 6 shows the comparison of MAMMI-PET with supine position PET/CT for visualization of histologically proven primary breast cancer lesions. In chapter 7 we assessed the expected additional radiation dose for the nuclear medicine technologists when MAMMI-PET would be implemented as an addition to the PET/CT protocol. In Chapter 8 the results of the first technical feasibility study of a MAMMI-PET inspired PET-guided biopsy device is presented: the MammoCare.