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Abstract
Breast-specific positron imaging systems provide higher sensitivity than whole-body PET for breast cancer detection. The clinical applications for breast-specific positron imaging are similar to breast MRI including preoperative local staging and neoadjuvant therapy response assessment. Breast-specific positron imaging may be an alternative for patients who cannot undergo breast MRI. Further research is needed in expanding the field-of-view for posterior breast lesions, increasing biopsy capability, and reducing radiation dose. Efforts are also necessary for developing appropriate use criteria, increasing availability, and advancing insurance coverage.
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Affiliation(s)
- Amy M Fowler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA; Department of Medical Physics, University of Wisconsin-Madison; University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
| | - Kanae K Miyake
- Department of Advanced Medical Imaging Research, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, Kyoto, Japan
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Sunassee ED, Jardim-Perassi BV, Madonna MC, Ordway B, Ramanujam N. Metabolic Imaging as a Tool to Characterize Chemoresistance and Guide Therapy in Triple-Negative Breast Cancer (TNBC). Mol Cancer Res 2023; 21:995-1009. [PMID: 37343066 PMCID: PMC10592445 DOI: 10.1158/1541-7786.mcr-22-1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/07/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
After an initial response to chemotherapy, tumor relapse is frequent. This event is reflective of both the spatiotemporal heterogeneities of the tumor microenvironment as well as the evolutionary propensity of cancer cell populations to adapt to variable conditions. Because the cause of this adaptation could be genetic or epigenetic, studying phenotypic properties such as tumor metabolism is useful as it reflects molecular, cellular, and tissue-level dynamics. In triple-negative breast cancer (TNBC), the characteristic metabolic phenotype is a highly fermentative state. However, during treatment, the spatial and temporal dynamics of the metabolic landscape are highly unstable, with surviving populations taking on a variety of metabolic states. Thus, longitudinally imaging tumor metabolism provides a promising approach to inform therapeutic strategies, and to monitor treatment responses to understand and mitigate recurrence. Here we summarize some examples of the metabolic plasticity reported in TNBC following chemotherapy and review the current metabolic imaging techniques available in monitoring chemotherapy responses clinically and preclinically. The ensemble of imaging technologies we describe has distinct attributes that make them uniquely suited for a particular length scale, biological model, and/or features that can be captured. We focus on TNBC to highlight the potential of each of these technological advances in understanding evolution-based therapeutic resistance.
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Affiliation(s)
- Enakshi D. Sunassee
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | | | - Megan C. Madonna
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Bryce Ordway
- Department of Cancer Physiology, Moffitt Cancer Center, Tampa, FL 33612, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27708, USA
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Evaluation of a High-Sensitivity Organ-Targeted PET Camera. SENSORS 2022; 22:s22134678. [PMID: 35808181 PMCID: PMC9269056 DOI: 10.3390/s22134678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/05/2023]
Abstract
The aim of this study is to evaluate the performance of the Radialis organ-targeted positron emission tomography (PET) Camera with standardized tests and through assessment of clinical-imaging results. Sensitivity, count-rate performance, and spatial resolution were evaluated according to the National Electrical Manufacturers Association (NEMA) NU-4 standards, with necessary modifications to accommodate the planar detector design. The detectability of small objects was shown with micro hotspot phantom images. The clinical performance of the camera was also demonstrated through breast cancer images acquired with varying injected doses of 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (18F-FDG) and qualitatively compared with sample digital full-field mammography, magnetic resonance imaging (MRI), and whole-body (WB) PET images. Micro hotspot phantom sources were visualized down to 1.35 mm-diameter rods. Spatial resolution was calculated to be 2.3 ± 0.1 mm for the in-plane resolution and 6.8 ± 0.1 mm for the cross-plane resolution using maximum likelihood expectation maximization (MLEM) reconstruction. The system peak noise equivalent count rate was 17.8 kcps at a 18F-FDG concentration of 10.5 kBq/mL. System scatter fraction was 24%. The overall efficiency at the peak noise equivalent count rate was 5400 cps/MBq. The maximum axial sensitivity achieved was 3.5%, with an average system sensitivity of 2.4%. Selected results from clinical trials demonstrate capability of imaging lesions at the chest wall and identifying false-negative X-ray findings and false-positive MRI findings, even at up to a 10-fold dose reduction in comparison with standard 18F-FDG doses (i.e., at 37 MBq or 1 mCi). The evaluation of the organ-targeted Radialis PET Camera indicates that it is a promising technology for high-image-quality, low-dose PET imaging. High-efficiency radiotracer detection also opens an opportunity to reduce administered doses of radiopharmaceuticals and, therefore, patient exposure to radiation.
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Miyake KK, Kataoka M, Ishimori T, Matsumoto Y, Torii M, Takada M, Satoh Y, Kubota K, Satake H, Yakami M, Isoda H, Ikeda DM, Toi M, Nakamoto Y. A Proposed Dedicated Breast PET Lexicon: Standardization of Description and Reporting of Radiotracer Uptake in the Breast. Diagnostics (Basel) 2021; 11:diagnostics11071267. [PMID: 34359350 PMCID: PMC8306936 DOI: 10.3390/diagnostics11071267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Dedicated breast positron emission tomography (dbPET) is a new diagnostic imaging modality recently used in clinical practice for the detection of breast cancer and the assessment of tumor biology. dbPET has higher spatial resolution than that of conventional whole body PET systems, allowing recognition of detailed morphological attributes of radiotracer accumulation within the breast. 18F-fluorodeoxyglucose (18F-FDG) accumulation in the breast may be due to benign or malignant entities, and recent studies suggest that morphology characterization of 18F-FDG uptake could aid in estimating the probability of malignancy. However, across the world, there are many descriptors of breast 18F-FDG uptake, limiting comparisons between studies. In this article, we propose a lexicon for breast radiotracer uptake to standardize description and reporting of image findings on dbPET, consisting of terms for image quality, radiotracer fibroglandular uptake, breast lesion uptake.
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Affiliation(s)
- Kanae K. Miyake
- Department of Advanced Medical Imaging Research, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan
- Correspondence: ; Tel.: +81-75-751-3760; Fax: +81-75-771-9709
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.K.); (T.I.); (Y.N.)
| | - Takayoshi Ishimori
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.K.); (T.I.); (Y.N.)
| | - Yoshiaki Matsumoto
- Department of Breast Surgery, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (Y.M.); (M.T.); (M.T.)
- Preemptive Medicine and Lifestyle Related Disease Research Center, Kyoto University Hospital, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.Y.); (H.I.)
| | - Masae Torii
- Department of Breast Surgery, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama-City 640-8558, Wakayama, Japan;
| | - Masahiro Takada
- Department of Breast Surgery, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (Y.M.); (M.T.); (M.T.)
| | - Yoko Satoh
- Yamanashi PET Imaging Clinic, 3046-2 Shimokato, Chuo-City 409-3821, Yamanashi, Japan;
| | - Kazunori Kubota
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-City 343-8555, Saitama, Japan;
| | - Hiroko Satake
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-City 466-8550, Aichi, Japan;
| | - Masahiro Yakami
- Preemptive Medicine and Lifestyle Related Disease Research Center, Kyoto University Hospital, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.Y.); (H.I.)
| | - Hiroyoshi Isoda
- Preemptive Medicine and Lifestyle Related Disease Research Center, Kyoto University Hospital, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.Y.); (H.I.)
| | - Debra M. Ikeda
- Department of Radiology, Stanford University School of Medicine, Breast Imaging, 875 Blake Wilbur Drive, Stanford, CA 94305-5826, USA;
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (Y.M.); (M.T.); (M.T.)
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto-City 606-8507, Kyoto, Japan; (M.K.); (T.I.); (Y.N.)
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Narayanan D, Berg WA. Dedicated Breast Gamma Camera Imaging and Breast PET: Current Status and Future Directions. PET Clin 2018; 13:363-381. [PMID: 30100076 DOI: 10.1016/j.cpet.2018.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recent advances in nuclear medicine instrumentation have led to the emergence of improved molecular imaging techniques to image breast cancer: dedicated gamma cameras using γ-emitting 99mTc-sestamibi and breast-specific PET cameras using 18F-fluorodeoxyglucose. This article focuses on the current role of such approaches in the clinical setting including diagnosis, assessing local extent of disease, monitoring response to therapy, and, for gamma camera imaging, possible supplemental screening in women with dense breasts. Barriers to clinical adoption and technologies and radiotracers under development are also discussed.
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Affiliation(s)
- Deepa Narayanan
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.
| | - Wendie A Berg
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213
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Narayanan D, Berg WA. Use of Breast-Specific PET Scanners and Comparison with MR Imaging. Magn Reson Imaging Clin N Am 2018; 26:265-272. [PMID: 29622131 DOI: 10.1016/j.mric.2017.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The goals of this article are to discuss the role of breast-specific PET imaging of women with breast cancer, compare the clinical performance of positron emission mammography (PEM) and MR imaging for current indications, and provide recommendations for when women should undergo PEM instead of breast MR imaging.
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Affiliation(s)
- Deepa Narayanan
- SBIR Development Center, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.
| | - Wendie A Berg
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213, USA
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