Padrões de disseminação do câncer de mama identificados no estadiamento por PET-CT

Abstract

Breast cancer is the most frequent malignant neoplasm among women worldwide, representing a significant public health problem that requires precise and individualized staging according to the aggressiveness and extent of the disease. This study aimed to analyze the main patterns of breast cancer dissemination identified in staging by positron emission tomography combined with X-ray computed tomography (PET/CT), highlighting the method's ability to detect metastases and its impact on disease stage reclassification. The methodology employed in this work was an integrative literature review on breast cancer dissemination patterns by PET/CT, in journals from the BVS, PubMed, Scielo, Scopus, and Web of Science databases. Twenty articles published between 2015 and 2025 were selected. The results obtained revealed four main patterns of metastatic dissemination identified by PET/CT: bone metastases, extra-axillary lymph node metastases, liver metastases, and lung metastases. In locally advanced and metastatic cases, PET/CT labeled with Fluorine-18-fluorodeoxyglucose (18F-FDG) remains a valuable complementary tool, particularly due to its high specificity in detecting bone metastases and occult lymph nodes, offering greater staging reclassification capabilities compared to conventional methods. Furthermore, new specific radiopharmaceuticals still under study, such as 68Ga-DOTATATE, show promise for tumors with defined molecular profiles, although 18F-FDG continues to be the standard used in the vast majority of clinical indications. In cases of aggressive subtypes, such as triple-negative and HER2-positive, PET/CT approaches with 18F-FDG play a central role, being highly effective in detecting occult metastases and enabling therapeutic changes. Simultaneously, innovations such as artificial intelligence and radiomics are still under development for predicting treatment response and prognosis. Finally, the integration of 18FFDG PET/CT with traditional imaging methods, combined with clinical and histopathological data, is fundamental for accurate staging and improving the quality of life of patients.