Should fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) staging exams vs. no PET staging exams be used for patients with clinical stage II breast cancer without symptoms suggestive of metastases?

The conditional recommendation for stage IIa, is a result of a balance that favours the comparison (no staging exams) with very low certainty of the evidence, so we are not very certain as to what the benefits are. In addition there are large costs, probably reduced equity and the intervention is probably not feasible. The GDG felt that very few situations would arise that would prompt conducting a PET-CT.

The conditional recommendation for stage IIb, is a result of a balance that does not favour PET-CT, with very low certainty of the evidence. In addition, the same as in stage IIa, there are large costs, probably reduced equity and the intervention is probably not feasible.

The concern about metastases that would not give symptoms in the life of a patient increases as breast cancer stages become lower.

The GDG agreed that for stage IIb there are more scenarios (clinical presentations) that would lead the clinician/patient to opt for doing a PET-CT (tumour grade, age).

The GDG suggested the following:

• More knowledge on determining the probability of metastases that would not give symptoms in the life of a patient would improve describing the conditions for which PET-CT testing is indicated.
• Better characterisation of clinical tumour stages (stage IIa and stage IIb).