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Groheux D, Vaz SC, Poortmans P, Mann RM, Ulaner GA, Cook GJR, Hindié E, Pilkington Woll JP, Jacene H, Rubio IT, Vrancken Peeters MJ, Dibble EH, de Geus-Oei LF, Graff SL, Cardoso F. Role of [ 18F]FDG PET/CT in patients with invasive breast carcinoma of no special type: Literature review and comparison between guidelines. Breast 2024; 78:103806. [PMID: 39303572 PMCID: PMC11440802 DOI: 10.1016/j.breast.2024.103806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/29/2024] [Accepted: 09/07/2024] [Indexed: 09/22/2024] Open
Abstract
PURPOSE The recently released EANM/SNMMI guideline, endorsed by several important clinical and imaging societies in the field of breast cancer (BC) care (ACR, ESSO, ESTRO, EUSOBI/ESR, EUSOMA), emphasized the role of [18F]FDG PET/CT in management of patients with no special type (NST) BC. This review identifies and summarizes similarities, discrepancies and novelties of the EANM/SNMMI guideline compared to NCCN, ESMO and ABC recommendations. METHODS The EANM/SNMMI guideline was based on a systematic literature search and the AGREE tool. The level of evidence was determined according to NICE criteria, and 85 % agreement or higher was reached regarding each statement. Comparisons with NCCN, ESMO and ABC guidelines were examined for specific clinical scenarios in patients with early stage through advanced and metastatic BC. RESULTS Regarding initial staging of patients with NST BC, [18F]FDG PET/CT is the preferred modality in the EANM-SNMMI guideline, showing superiority as a single modality to a combination of contrast-enhanced CT of thorax-abdomen-pelvis plus bone scan in head-to-head comparisons and a randomized study. Its use is recommended in patients with clinical stage IIB or higher and may be useful in certain stage IIA cases of NST BC. In NCCN, ESMO, and ABC guidelines, [18F]FDG PET/CT is instead recommended as complementary to conventional imaging to solve inconclusive findings, although ESMO and ABC also suggest [18F]FDG PET/CT can replace conventional imaging for staging patients with high-risk and metastatic NST BC. During follow up, NCCN and ESMO only recommend diagnostic imaging if there is suspicion of recurrence. Similarly, EANM-SNMMI states that [18F]FDG PET/CT is useful to detect the site and extent of recurrence only when there is clinical or laboratory suspicion of recurrence, or when conventional imaging methods are equivocal. The EANM-SNMMI guideline is the first to emphasize a role of [18F]FDG PET/CT for assessing early metabolic response to primary systemic therapy, particularly for HER2+ BC and TNBC. In the metastatic setting, EANM-SNMMI state that [18F]FDG PET/CT may help evaluate bone metastases and determine early response to treatment, in agreement with guidelines from ESMO. CONCLUSIONS The recently released EANM/SNMMI guideline reinforces the role of [18F]FDG PET/CT in the management of patients with NST BC supported by extensive evidence of its utility in several clinical scenarios.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM, U976, Paris, France; Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France.
| | - Sofia C Vaz
- Department of Nuclear Medicine and Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk-Antwerp, Belgium
| | - Ritse M Mann
- Department of Radiology, Radboud umc, Nijmegen, the Netherlands
| | - Gary A Ulaner
- Department of Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, United States; Departments of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, United States
| | - Gary J R Cook
- Department of Cancer Imaging, King's College London, London, UK; King's College London and Guy's & St Thomas' PET Centre, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Elif Hindié
- Department of Nuclear Medicine, Bordeaux University Hospital, Bordeaux, France
| | | | - Heather Jacene
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, and Harvard Medical School, United States
| | - Isabel T Rubio
- Department of Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Cancer Center Clinica Universidad de Navarra, Spain
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands; Department of Radiation Science & Technology, Delft University of Technology, Delft, the Netherlands
| | - Stephanie L Graff
- Lifespan Cancer Institute, Providence, RI, United States; Legorreta Cancer Center at Brown University, Providence, RI, United States
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
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Rapley M, Freitas V, Weinberg IN, Baldassi B, Poladyan H, Waterston M, Ghai S, Taeb S, Bubon O, Reznik A, Mulligan AM. Case report: Possible role of low-dose PEM for avoiding unneeded procedures associated with false-positive or equivocal breast MRI results. Front Oncol 2024; 14:1405404. [PMID: 39091907 PMCID: PMC11291220 DOI: 10.3389/fonc.2024.1405404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/05/2024] [Indexed: 08/04/2024] Open
Abstract
Contrast-enhanced breast magnetic resonance imaging (MRI) is currently recommended as a screening tool for high-risk women and has been advocated for women with radiologically dense breast tissue. While breast MRI is acknowledged for its high sensitivity (with an exception for lower-grade ductal carcinoma in situ (DCIS) where emerging techniques like diffusion-weighted imaging offer improvement), its limitations include sensitivity to hormonal changes and a relatively high false-positive rate, potentially leading to overdiagnosis, increased imaging uncertainty, and unnecessary biopsies. These factors can exacerbate patient anxiety and impose additional costs. Molecular imaging with breast-targeted Positron Emission Tomography (PET) has shown the capability to detect malignancy independent of breast density and hormonal changes. Furthermore, breast-targeted PET has shown higher specificity when compared with MRI. However, traditional PET technology is associated with high radiation dose, which can limit its widespread use particularly in repeated studies or for undiagnosed patients. In this case report, we present a clinical application of low-dose breast imaging utilizing a breast-targeted PET camera (Radialis PET imager, Radialis Inc). The case involves a 33-year-old female patient who had multiple enhanced lesions detected on breast MRI after surgical removal of a malignant phyllodes tumor from the right breast. A benign core biopsy was obtained from the largest lesion seen in the left breast. One month after the MRI, 18F-fluorodeoxyglucose (18F-FDG) PET imaging session was performed using the Radialis PET Imager. Although the Radialis PET Imager has proven high count sensitivity and the capability to detect breast lesions with low metabolic activity (at a dose similar to mammography), no areas of increased 18F-FDG uptake were visualized in this particular case. The patient underwent a right-sided nipple-sparing mastectomy and left-sided lumpectomy, with bilateral reconstruction. The excised left breast tissue was completely benign, as suggested by both core biopsy and the PET results. The case presented highlights a promising clinical application of low-dose breast-targeted PET imaging to mitigate the uncertainty associated with MRI while keeping radiation doses within the safe range typically used in X-ray mammography.
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Affiliation(s)
- Madeline Rapley
- Department of Physics, Lakehead University, Thunder Bay, ON, Canada
| | - Vivianne Freitas
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Sandeep Ghai
- Temerty Faculty of Medicine, Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Samira Taeb
- Department of Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Oleksandr Bubon
- Department of Physics, Lakehead University, Thunder Bay, ON, Canada
- Radialis Inc., Thunder Bay, ON, Canada
| | - Alla Reznik
- Department of Physics, Lakehead University, Thunder Bay, ON, Canada
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada
| | - Anna Marie Mulligan
- Laboratory Medicine Program, University Health Network – Toronto General Hospital Site, University of Toronto, Toronto, ON, Canada
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Ulaner GA, Vaz SC, Groheux D. Quarter-Century Transformation of Oncology: Positron Emission Tomography for Patients with Breast Cancer. PET Clin 2024; 19:147-162. [PMID: 38177052 DOI: 10.1016/j.cpet.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
PET radiotracers have become indispensable in the care of patients with breast cancer. 18F-fluorodeoxyglucose has become the preferred method of many oncologists for systemic staging of breast cancer at initial diagnosis, detecting recurrent disease, and for measuring treatment response after therapy. 18F-Sodium Fluoride is valuable for detection of osseous metastases. 18F-fluoroestradiol is now FDA-approved with multiple appropriate clinical uses. There are multiple PET radiotracers in clinical trials, which may add utility of PET imaging for patients with breast cancer in the future. This article will describe the advances during the last quarter century in PET for patients with breast cancer.
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Affiliation(s)
- Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Irvine, CA, USA; Departments of Radiology and Translational Genomics, University of Southern California, Los Angeles, CA, USA.
| | - Sofia Carrilho Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - David Groheux
- Nuclear Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France; University Paris-Diderot, INSERM U976, HIPI, Paris, France
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Li X, Johnson JM, Strigel RM, Bancroft LCH, Hurley SA, Estakhraji SIZ, Kumar M, Fowler AM, McMillan AB. Attenuation correction and truncation completion for breast PET/MR imaging using deep learning. Phys Med Biol 2024; 69:045031. [PMID: 38252969 DOI: 10.1088/1361-6560/ad2126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/22/2024] [Indexed: 01/24/2024]
Abstract
Objective. Simultaneous PET/MR scanners combine the high sensitivity of MR imaging with the functional imaging of PET. However, attenuation correction of breast PET/MR imaging is technically challenging. The purpose of this study is to establish a robust attenuation correction algorithm for breast PET/MR images that relies on deep learning (DL) to recreate the missing portions of the patient's anatomy (truncation completion), as well as to provide bone information for attenuation correction from only the PET data.Approach. Data acquired from 23 female subjects with invasive breast cancer scanned with18F-fluorodeoxyglucose PET/CT and PET/MR localized to the breast region were used for this study. Three DL models, U-Net with mean absolute error loss (DLMAE) model, U-Net with mean squared error loss (DLMSE) model, and U-Net with perceptual loss (DLPerceptual) model, were trained to predict synthetic CT images (sCT) for PET attenuation correction (AC) given non-attenuation corrected (NAC) PETPET/MRimages as inputs. The DL and Dixon-based sCT reconstructed PET images were compared against those reconstructed from CT images by calculating the percent error of the standardized uptake value (SUV) and conducting Wilcoxon signed rank statistical tests.Main results. sCT images from the DLMAEmodel, the DLMSEmodel, and the DLPerceptualmodel were similar in mean absolute error (MAE), peak-signal-to-noise ratio, and normalized cross-correlation. No significant difference in SUV was found between the PET images reconstructed using the DLMSEand DLPerceptualsCTs compared to the reference CT for AC in all tissue regions. All DL methods performed better than the Dixon-based method according to SUV analysis.Significance. A 3D U-Net with MSE or perceptual loss model can be implemented into a reconstruction workflow, and the derived sCT images allow successful truncation completion and attenuation correction for breast PET/MR images.
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Affiliation(s)
- Xue Li
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI, United States of America
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Jacob M Johnson
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Roberta M Strigel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medical Physics, University of Wisconsin, Madison, WI, United States of America
- University of Wisconsin Carbone Cancer Center, Madison, WI, United States of America
| | - Leah C Henze Bancroft
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Samuel A Hurley
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - S Iman Zare Estakhraji
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Manoj Kumar
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- ICTR Graduate Program in Clinical Investigation, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Amy M Fowler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medical Physics, University of Wisconsin, Madison, WI, United States of America
- University of Wisconsin Carbone Cancer Center, Madison, WI, United States of America
| | - Alan B McMillan
- Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI, United States of America
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Medical Physics, University of Wisconsin, Madison, WI, United States of America
- University of Wisconsin Carbone Cancer Center, Madison, WI, United States of America
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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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Patel MM, Adrada BE, Fowler AM, Rauch GM. Molecular Breast Imaging and Positron Emission Mammography. PET Clin 2023; 18:487-501. [PMID: 37258343 DOI: 10.1016/j.cpet.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There is growing interest in application of functional imaging modalities for adjunct breast imaging due to their unique ability to evaluate molecular/pathophysiologic changes, not visible by standard anatomic breast imaging. This has led to increased use of nuclear medicine dedicated breast-specific single photon and coincidence imaging systems for multiple indications, such as supplemental screening, staging of newly diagnosed breast cancer, evaluation of response to neoadjuvant treatment, diagnosis of local disease recurrence in the breast, and problem solving. Studies show that these systems maybe especially useful for specific subsets of patients, not well served by available anatomic breast imaging modalities.
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Affiliation(s)
- Miral M Patel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, CPB5.3208, Houston, TX 77030, USA.
| | - Beatriz Elena Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, CPB5.3208, Houston, TX 77030, USA
| | - Amy M Fowler
- Department of Radiology, Section of Breast Imaging and Intervention, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA; Department of Medical Physics, University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Gaiane M Rauch
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1473, Houston, TX 77030, USA; Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1473, Houston, TX 77030, USA
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7
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Groheux D. Breast Cancer Systemic Staging (Comparison of Computed Tomography, Bone Scan, and 18F-Fluorodeoxyglucose PET/Computed Tomography). PET Clin 2023; 18:503-515. [PMID: 37268506 DOI: 10.1016/j.cpet.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
After an overview of the principles of bone scintigraphy, contrast-enhanced computed tomography (CE-CT) and 18F-fluorodeoxyglucose (FDG)-PET/CT, the advantages and limits of these modalities in the staging of breast cancer are discussed in this paper. CT and PET/CT are not optimal for delineating primary tumor volume, and PET is less efficient than the sentinel node biopsy to depict small axillary lymph node metastases. In large breast cancer tumor, FDG PET/CT is useful to show extra-axillary lymph nodes. FDG PET/CT is superior to bone scan and CE-CT in detecting distant metastases, and it results in a change of treatment plan in nearly 15% of patients.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM U976, HIPI, Paris, France; Centre d'Imagerie Radio-isotopique, La Rochelle, France.
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8
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de Andrés Gómez A, Villalba Ferrer F, Ferrer Rebolleda J, Sánchez Jurado R, García García JÁ, García-Vilanova Comas A, Fuster Diana CA. Correlation between MAMMI-PET findings and anatomopathological outcomes in breast cancer patients. Nucl Med Commun 2022; 43:1058-1066. [PMID: 36081401 DOI: 10.1097/mnm.0000000000001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Imaging tests are a key element in the preoperative diagnosis of patients with breast cancer. Whole-body PET-computed tomography (PET/CT) breast studies have a limited spatial resolution, although dedicated breast PET (dbPET) devices such as the Mammography with Molecular Imaging PET (MAMMI-PET), have an increased sensitivity to detect tumor foci, especially those smaller than 2 cm. The purpose of this study is to define the validity and reliability of this new device. METHODS A prospective and analytical observational study was carried out in a sample of patients with histologically confirmed breast cancer who were treated at our hospital between January 2017 and November 2018. The anatomopathological study findings for the surgical pieces were used as gold standards and we calculated their concordance with the findings from the MAMMI-PET as well as the validity and reliability parameters for this test. RESULTS Data from 32 patients and 44 lesions (36 malignant and 8 benign) were evaluated. The mean patient age was 51.50 ± 11.68 years. Twenty patients had received neoadjuvant chemotherapy (NACT). The technique concordance rate was weak ( K = 0.349, P = 0.001) and was 84.3% for benign lesions and 62.6% for malignant ones. The MAMMI-PET sensitivity was 75%, whereas its specificity was 57.1%; the positive predictive value was 81.8% and the negative predictive value was 47.1%, with an overall precision of 70%. The MAMMI-PET sensitivity was higher in patients who had not undergone NACT and was significantly higher in patients with luminal B breast cancer compared to the luminal A subtype. CONCLUSION The MAMMI-PET device had acceptable sensitivity and a high positive predictive value for the preoperative evaluation of patients with breast cancer; it was especially useful for lesions whose diagnosis with other imaging tests had been doubtful.
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Affiliation(s)
| | | | - Jose Ferrer Rebolleda
- Department of Nuclear Medicine, ASCIRES Group, General University Hospital Consortium of Valencia
| | - Raúl Sánchez Jurado
- Department of Nuclear Medicine, ASCIRES Group, General University Hospital Consortium of Valencia
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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: 6] [Impact Index Per Article: 3.0] [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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10
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Groheux D. FDG-PET/CT for Primary Staging and Detection of Recurrence of Breast Cancer. Semin Nucl Med 2022; 52:508-519. [PMID: 35636977 DOI: 10.1053/j.semnuclmed.2022.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 12/22/2022]
Abstract
Breast cancer is the most frequent cancer diagnosed in women worldwide. Accurate baseline staging is necessary to plan optimal breast cancer management. Early detection and staging of recurrence are also essential for optimal therapeutic management. Hybrid FDG-PET/CT imaging offers high sensitivity in detecting extra axillary lymph nodes and distant metastases. Although FDG-PET/CT has some limitations for low proliferative tumors, low-grade tumors and for well-differentiated luminal breast cancer, PET/CT is useful for the initial staging of breast cancer, regardless of tumor phenotype (luminal, triple negative, or HER2+) and of tumor grade. Although FDG-PET/CT performs better for invasive ductal carcinoma (invasive carcinoma of no specific subtype), it is also helpful for staging invasive lobular carcinomas. At initial staging, FDG-PET/CT becomes very useful for staging from clinical stage IIB (T2N1 or T3N0). FDG-PET/CT could be useful in patients with clinical stage IIA (T1N1 or T2N0), but there is not enough strong evidence to recommend routine use in this subgroup. For clinical stage I (T1N0) patients, FDG-PET/CT offers no added value. In patients with recurrent breast cancer, FDG-PET/CT is more effective than conventional imaging in detecting locoregional or distant recurrence, whether suspected by clinical examination, conventional imaging, or elevation of a tumor marker (CA 15.3 or CEA). PET/CT is effective even in the presence of normal tumor markers. PET/CT is also a powerful imaging modality for performing a whole-body workup of a known recurrence and for determining whether or not the recurrence is isolated.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM U976, HIPI, Paris, France; Centre d'Imagerie Radio-isotopique, La Rochelle, France.
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Radionuclide-Based Imaging of Breast Cancer: State of the Art. Cancers (Basel) 2021; 13:cancers13215459. [PMID: 34771622 PMCID: PMC8582396 DOI: 10.3390/cancers13215459] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Breast cancer is one of the most commonly diagnosed malignant tumors, possessing high incidence and mortality rates that threaten women’s health. Thus, early and effective breast cancer diagnosis is crucial for enhancing the survival rate. Radionuclide molecular imaging displays its advantages for detecting breast cancer from a functional perspective. Noninvasive visualization of biological processes with radionuclide-labeled small metabolic compounds helps elucidate the metabolic state of breast cancer, while radionuclide-labeled ligands/antibodies for receptor-targeted radionuclide molecular imaging is sensitive and specific for visualization of the overexpressed molecular markers in breast cancer. This review focuses on the most recent developments of novel radiotracers as promising tools for early breast cancer diagnosis. Abstract Breast cancer is a malignant tumor that can affect women worldwide and endanger their health and wellbeing. Early detection of breast cancer can significantly improve the prognosis and survival rate of patients, but with traditional anatomical imagine methods, it is difficult to detect lesions before morphological changes occur. Radionuclide-based molecular imaging based on positron emission tomography (PET) and single-photon emission computed tomography (SPECT) displays its advantages for detecting breast cancer from a functional perspective. Radionuclide labeling of small metabolic compounds can be used for imaging biological processes, while radionuclide labeling of ligands/antibodies can be used for imaging receptors. Noninvasive visualization of biological processes helps elucidate the metabolic state of breast cancer, while receptor-targeted radionuclide molecular imaging is sensitive and specific for visualization of the overexpressed molecular markers in breast cancer, contributing to early diagnosis and better management of cancer patients. The rapid development of radionuclide probes aids the diagnosis of breast cancer in various aspects. These probes target metabolism, amino acid transporters, cell proliferation, hypoxia, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), gastrin-releasing peptide receptor (GRPR) and so on. This article provides an overview of the development of radionuclide molecular imaging techniques present in preclinical or clinical studies, which are used as tools for early breast cancer diagnosis.
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Groheux D, Hindie E. Breast cancer: initial workup and staging with FDG PET/CT. Clin Transl Imaging 2021; 9:221-231. [PMID: 33937141 PMCID: PMC8075837 DOI: 10.1007/s40336-021-00426-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022]
Abstract
Purpose Precise staging is needed to plan optimal management in breast cancer. 18F-fluorodeoxyglucose positron emission tomography coupled with computed tomography (FDG-PET/CT) offers high sensitivity in detecting extra axillary lymph nodes and distant metastases. This review aims to clarify in which groups of patients staging with FDG-PET/CT would be beneficial and should be offered. We also discuss how tumor biology and breast cancer subtypes should be taken into account when interpreting FDG-PET/CT scans. Methods We performed a comprehensive literature review and rigorous appraisal of research studies assessing indications for FDG-PET/CT in breast cancer. This assessment regarding breast cancer served as a basis for the recommendations set by a working group of the French Society of Nuclear Medicine, in collaboration with oncological societies, for developing good clinical practice recommendations on the use of FDG-PET/CT in oncology. Results FDG-PET/CT is useful for initial staging of breast cancer, independently of tumor phenotype (triple negative, luminal or HER2 +) and regardless of tumor grade. Considering histological subtype, FDG-PET/CT performs better for staging invasive ductal carcinoma, although it is also helpful for staging invasive lobular carcinomas. Based on the available data, FDG-PET/CT becomes useful for staging starting from clinical stage IIB. FDG-PET/CT is possibly useful in patients with clinical stage IIA (T1N1 or T2N0), but there is not enough strong data to recommend routine use in this subgroup. For clinical stage I (T1N0) patients, staging with FDG-PET/CT offers no added value. Conclusion FDG-PET/CT is useful for staging patients with breast cancer, starting from clinical stage IIB.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
- University Paris-Diderot, INSERM U976, HIPI, Paris, France
| | - Elif Hindie
- Department of Nuclear Medicine, Bordeaux University Hospital, Bordeaux, France
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13
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Park CKS, Bax JS, Gardi L, Knull E, Fenster A. Development of a mechatronic guidance system for targeted ultrasound-guided biopsy under high-resolution positron emission mammography localization. Med Phys 2021; 48:1859-1873. [PMID: 33577113 DOI: 10.1002/mp.14768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/20/2021] [Accepted: 02/05/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Image-guided needle biopsy of small, detectable lesions is crucial for early-stage diagnosis, treatment planning, and management of breast cancer. High-resolution positron emission mammography (PEM) is a dedicated functional imaging modality that can detect breast cancer independent of breast tissue density, but anatomical context and real-time needle visualization are not yet available to guide biopsy. We propose a mechatronic guidance system integrating an ultrasound (US)-guided core-needle biopsy (CNB) with high-resolution PEM localization to improve the spatial sampling of breast lesions. This paper presents the benchtop testing and phantom studies to evaluate the accuracy of the system and its constituent components for targeted PEM-US-guided biopsy under simulated high-resolution PEM localization. METHODS A mechatronic guidance system was developed to operate with the Radialis PEM system and a conventional US system. The system includes a user-operated guidance arm and end-effector biopsy device, integrating a US transducer and CNB gun, with its needle focused on a remote center of motion (RCM). Custom software modules were developed to track, display, and guide the end-effector biopsy device. Registration of the mechatronic guidance system to a simulated PEM detector plate was performed using a landmark-based method. Testing was performed with fiducials positioned in the peripheral and central regions of the simulated detector plate and registration error was quantified. Breast phantom experiments were performed under ideal detection and localization to evaluate for bias in the end-effector biopsy device. The accuracy of the complete mechatronic guidance system to perform targeted breast biopsy was assessed using breast phantoms with simulated lesions. Three-dimensional positioning error was quantified, and principal component analysis assessed for directional trends in 3D space within 95% prediction intervals. Targeted breast biopsies with test phantoms were performed and an overall in-plane needle targeting error was quantified. RESULTS The mean registration errors were 0.63 mm (N = 44) and 0.73 mm (N = 72) in the peripheral and central regions of the simulated PEM detector plate, respectively. A 3D 95% prediction ellipsoid shows an error volume <2.0 mm in diameter, centered on the mean registration error. Under ideal detection and localization, targets <1.0 mm in diameter can be sampled with 95% confidence. The complete mechatronic guidance system was able to successfully spatially sample simulated breast lesions, 4 mm and 6 mm in diameter and height (N = 20) in known 3D positions in the PEM image coordinate space. The 3D positioning error was 0.85 mm (N = 20) with 0.64 mm in-plane and 0.44 mm cross-plane component errors. Targeted breast biopsies resulted in a mean in-plane needle targeting error of 1.08 mm (N = 15) allowing for targets 1.32 mm in radius to be sampled with 95% confidence. CONCLUSIONS We demonstrated the utility of our mechatronic guidance system for targeted breast biopsy under high-resolution PEM localization. Breast phantom studies showed the ability to accurately guide, position, and target breast lesions with the accuracy to spatially sample targets <3.0 mm in diameter with 95% confidence. Future work will integrate the developed system with the Radialis PEM system toward combined PEM-US-guided breast biopsy.
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Affiliation(s)
- Claire Keun Sun Park
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A 3K7, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5B7, Canada
| | - Jeffrey Scott Bax
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5B7, Canada
| | - Lori Gardi
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5B7, Canada
| | - Eric Knull
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5B7, Canada.,School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, N6A 3K7, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A 3K7, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5B7, Canada.,School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, N6A 3K7, Canada
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14
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Satoh Y, Motosugi U, Imai M, Omiya Y, Onishi H. Evaluation of image quality at the detector's edge of dedicated breast positron emission tomography. EJNMMI Phys 2021; 8:5. [PMID: 33462645 PMCID: PMC7813900 DOI: 10.1186/s40658-020-00351-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Using phantoms and clinical studies in prone hanging breast imaging, we assessed the image quality of a commercially available dedicated breast PET (dbPET) at the detector's edge, where mammary glands near the chest wall are located. These are compared to supine PET/CT breast images of the same clinical subjects. METHODS A breast phantom with four spheres (16-, 10-, 7.5-, and 5-mm diameter) was filled with 18F-fluorodeoxyglucose solution (sphere-to-background activity concentration ratio, 8:1). The spheres occupied five different positions from the top edge to the centre of the detector and were scanned for 5 min in each position. Reconstructed images were visually evaluated, and the contrast-to-noise ratio (CNR), contrast recovery coefficient (CRC) for all spheres, and coefficient of variation of the background (CVB) were calculated. Subsequently, clinical images obtained with standard supine PET/CT and prone dbPET were retrospectively analysed. Tumour-to-background ratios (TBRs) between breast cancer near the chest wall (close to the detector's edge; peripheral group) and at other locations (non-peripheral group) were compared. The TBR of each lesion was compared between dbPET and PET/CT. RESULTS Closer to the detector's edge, the CNR and CRC of all spheres decreased while the CVB increased in the phantom study. The disadvantages of this placement were visually confirmed. Regarding clinical images, TBR of dbPET was significantly higher than that of PET/CT in both the peripheral (12.38 ± 6.41 vs 6.73 ± 3.5, p = 0.0006) and non-peripheral (12.44 ± 5.94 vs 7.71 ± 7.1, p = 0.0183) groups. There was no significant difference in TBR of dbPET between the peripheral and non-peripheral groups. CONCLUSION The phantom study revealed poorer image quality at < 2-cm distance from the detector's edge than at other more central parts. In clinical studies, however, the visibility of breast lesions with dbPET was the same regardless of the lesion position, and it was higher than that in PET/CT. dbPET has a great potential for detecting breast lesions near the chest wall if they are at least 2 cm from the edge of the FOV, even in young women with small breasts.
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Affiliation(s)
- Yoko Satoh
- Yamanashi PET Imaging Clinic, Shimokato 3046-2, Chuo City, Yamanashi Prefecture, 409-3821, Japan. .,Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan.
| | - Utaroh Motosugi
- Department of Radiology, Kofu-kyoritsu Hospital, Kofu City, Yamanashi Prefecture, Japan
| | - Masamichi Imai
- Yamanashi PET Imaging Clinic, Shimokato 3046-2, Chuo City, Yamanashi Prefecture, 409-3821, Japan
| | - Yoshie Omiya
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
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15
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Wen X, Ou YC, Bogatcheva G, Thomas G, Mahadevan-Jansen A, Singh B, Lin EC, Bardhan R. Probing metabolic alterations in breast cancer in response to molecular inhibitors with Raman spectroscopy and validated with mass spectrometry. Chem Sci 2020; 11:9863-9874. [PMID: 34094246 PMCID: PMC8162119 DOI: 10.1039/d0sc02221g] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023] Open
Abstract
Rapid and accurate response to targeted therapies is critical to differentiate tumors that are resistant to treatment early in the regimen. In this work, we demonstrate a rapid, noninvasive, and label-free approach to evaluate treatment response to molecular inhibitors in breast cancer (BC) cells with Raman spectroscopy (RS). Metabolic reprogramming in BC was probed with RS and multivariate analysis was applied to classify the cells into responsive or nonresponsive groups as a function of drug dosage, drug type, and cell type. Metabolites identified with RS were then validated with mass spectrometry (MS). We treated triple-negative BC cells with Trametinib, an inhibitor of the extracellular-signal-regulated kinase (ERK) pathway. Changes measured with both RS and MS corresponding to membrane phospholipids, amino acids, lipids and fatty acids indicated that these BC cells were responsive to treatment. Comparatively, minimal metabolic changes were observed post-treatment with Alpelisib, an inhibitor of the mammalian target of rapamycin (mTOR) pathway, indicating treatment resistance. These findings were corroborated with cell viability assay and immunoblotting. We also showed estrogen receptor-positive MCF-7 cells were nonresponsive to Trametinib with minimal metabolic and viability changes. Our findings support that oncometabolites identified with RS will ultimately enable rapid drug screening in patients ensuring patients receive the most effective treatment at the earliest time point.
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Affiliation(s)
- Xiaona Wen
- Department of Chemical and Biomolecular Engineering, Vanderbilt University Nashville TN 37235 USA
| | - Yu-Chuan Ou
- Department of Chemical and Biomolecular Engineering, Vanderbilt University Nashville TN 37235 USA
| | - Galina Bogatcheva
- Department of Medicine, Vanderbilt University Medical Center Nashville TN 37232 USA
| | - Giju Thomas
- Vanderbilt Biophotonics Center, Vanderbilt University Nashville TN 37232 USA
| | | | - Bhuminder Singh
- Department of Medicine, Vanderbilt University Medical Center Nashville TN 37232 USA
| | - Eugene C Lin
- Department of Chemistry and Biochemistry, National Chung Cheng University Chiayi 62106 Taiwan
| | - Rizia Bardhan
- Department of Chemical and Biological Engineering, Iowa State University Ames IA 50012 USA
- Nanovaccine Institute, Iowa State University Ames IA 50012 USA
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16
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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: 25] [Impact Index Per Article: 4.2] [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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Iakovou I, Giannoula E, Gkantaifi A, Levva S, Frangos S. Positron emission tomography in breast cancer: 18F- FDG and other radiopharmaceuticals. Eur J Hybrid Imaging 2018. [DOI: 10.1186/s41824-018-0039-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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18
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Yanai A, Itoh M, Hirakawa H, Yanai K, Tashiro M, Harada R, Yoshikawa A, Yamamoto S, Ohuchi N, Ishida T. Newly-Developed Positron Emission Mammography (PEM) Device for the Detection of Small Breast Cancer. TOHOKU J EXP MED 2018; 245:13-19. [PMID: 29731479 DOI: 10.1620/tjem.245.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Positron emission mammography (PEM) has higher detection sensitivity for breast cancer compared with whole-body positron emission tomography (PET) due to higher spatial resolution. We have developed a new PEM device with high resolution over a wide field of view. This PEM device comprises novel scintillation crystals, praseodymium-doped lutetium aluminum garnet (Pr:LuAG). In the present study, the clinical use of the newly developed PEM for the detection of small breast cancer was compared with that of the conventional PET-computed tomography (PET/CT). Eighty-two patients with breast cancer less than 20 mm (UICC T1) participated in this study, including 23 patients with T1a or T1b breast cancer (less than 10 mm). Histologically-proved lesions were examined by PET/CT and PEM on the same day after injection of [18F]fluoro-2-deoxy-2-fluoro-D-glucose ([18F]FDG), a marker of glycolytic activity. The newly developed PEM showed better sensitivity of cancer detection compared with PET/CT especially in case of the small T1a or T1b lesions. Moreover, when the conventional PET/CT and new PEM were combined, the detection sensitivity with [18F]FDG molecular imaging for T1 (N = 82) and T1a plus T1b breast cancer (N = 23) were 90% and 70%, respectively. The uptake of [18F]FDG was proportional to the histological malignancy of breast cancer. Using the newly-developed PEM with [18F]FDG, we are able to identify and characterize exactly the small breast tumors less than 10 mm in combination with the conventional PET/CT. These data indicate that PEM and PET/CT are synergic and complementary for the detection of small breast cancer.
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Affiliation(s)
- Ai Yanai
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine.,Department of Pharmacology, Tohoku University Graduate School of Medicine
| | - Masatoshi Itoh
- Sendai Medical Imaging Center.,Cyclotron Radioisotope Center (CYRIC), Tohoku University
| | | | - Kazuhiko Yanai
- Cyclotron Radioisotope Center (CYRIC), Tohoku University.,Department of Pharmacology, Tohoku University Graduate School of Medicine
| | - Manabu Tashiro
- Cyclotron Radioisotope Center (CYRIC), Tohoku University
| | - Ryuichi Harada
- Department of Pharmacology, Tohoku University Graduate School of Medicine
| | | | | | - Noriaki Ohuchi
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine
| | - Takanori Ishida
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine
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19
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Yararbas U, Avci NC, Yeniay L, Argon AM. The value of 18F-FDG PET/CT imaging in breast cancer staging. Bosn J Basic Med Sci 2018; 18:72-79. [PMID: 28763628 DOI: 10.17305/bjbms.2017.2179] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/23/2017] [Accepted: 07/24/2017] [Indexed: 01/28/2023] Open
Abstract
The National Comprehensive Cancer Network (NCCN) guidelines recommend assessment with positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) in staging of breast cancer, starting from the stage IIIA. Previously, PET/CT contributed to the accurate staging from the stage IIB. Our aim is to evaluate the contribution of 18F-FDG PET/CT in staging of breast cancer patients. A total of 234 patients were retrospectively evaluated. PET/CT was performed preoperatively in 114/234 and postoperatively in 120/234 patients. Initial staging was performed based on histopathological results in 125/234 and clinical results in 109/234 patients, according to the American Joint Committee on Cancer (AJCC) classification. All patients had a normal abdominal ultrasound and chest x-ray. Following PET/CT imaging, modification in the staging was performed in patients with the metastatic findings. In 42/234 (17.9%) patients hypermetabolic extra-axillary regional lymph nodes and in 65/234 patients (27.7%) distant metastatic involvement were detected with PET/CT. Modification in the staging was applied in 82/234 (35%) patients. Patient management was changed in 69/234 (29.4%) cases. The percentage of patients with upstaging, according to each stage, was as follows: IIA: 18.6%, IIB: 30%, IIIA: 46.3%, IIIB: 68.8%, and IIIC: 20.8%. In 43/43 patients, 99mTc-methylene diphosphonate (MDP) bone scan did not show additional bone metastasis. In 5/32 patients, metastatic involvement was detected with sentinel lymph node biopsy (SLNB), but preoperative PET/CT scan did not reveal hypermetabolic lymph nodes. Although our study was limited by the referral bias and lack of homogeneity in the referral group, PET/CT still significantly contributed to the accurate staging and management of our breast cancer patients, starting from the stage IIA.
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Affiliation(s)
- Ulkem Yararbas
- Department of Nuclear Medicine, Ege University Medical Faculty, Izmir, Turkey.
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20
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Comparison of Diagnostic Performance of Three-Dimensional Positron Emission Mammography versus Whole Body Positron Emission Tomography in Breast Cancer. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:5438395. [PMID: 29097927 PMCID: PMC5612739 DOI: 10.1155/2017/5438395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/10/2017] [Indexed: 12/03/2022]
Abstract
Objective To compare the diagnostic performance of three-dimensional (3D) positron emission mammography (PEM) versus whole body positron emission tomography (WBPET) for breast cancer. Methods A total of 410 women with normal breast or benign or highly suspicious malignant tumors were randomized at 1 : 1 ratio to undergo 3D-PEM followed by WBPET or WBPET followed by 3D-PEM. Lumpectomy or mastectomy was performed on eligible participants after the scanning. Results The sensitivity and specificity of 3D-PEM were 92.8% and 54.5%, respectively. WBPET showed a sensitivity of 95.7% and specificity of 56.8%. After exclusion of the patients with lesions beyond the detecting range of the 3D-PEM instrument, 3D-PEM showed higher sensitivity than WBPET (97.0% versus 95.5%, P = 0.913), particularly for small lesions (<1 cm) (72.0% versus 60.0%, P = 0.685). Conclusions The 3D-PEM appears more sensitive to small lesions than WBPET but may fail to detect lesions that are beyond the detecting range. This study was approved by the Ethics Committee (E2012052) at the Tianjin Medical University Cancer Institute and Hospital (Tianjin, China). The instrument positron emission mammography (PEMi) was approved by China State Food and Drug Administration under the registration number 20153331166.
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21
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Zimmermann BB, Deng B, Singh B, Martino M, Selb J, Fang Q, Sajjadi AY, Cormier J, Moore RH, Kopans DB, Boas DA, Saksena MA, Carp SA. Multimodal breast cancer imaging using coregistered dynamic diffuse optical tomography and digital breast tomosynthesis. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:46008. [PMID: 28447102 PMCID: PMC5406652 DOI: 10.1117/1.jbo.22.4.046008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/07/2017] [Indexed: 05/02/2023]
Abstract
Diffuse optical tomography (DOT) is emerging as a noninvasive functional imaging method for breast cancer diagnosis and neoadjuvant chemotherapy monitoring. In particular, the multimodal approach of combining DOT with x-ray digital breast tomosynthesis (DBT) is especially synergistic as DBT prior information can be used to enhance the DOT reconstruction. DOT, in turn, provides a functional information overlay onto the mammographic images, increasing sensitivity and specificity to cancer pathology. We describe a dynamic DOT apparatus designed for tight integration with commercial DBT scanners and providing a fast (up to 1 Hz) image acquisition rate to enable tracking hemodynamic changes induced by the mammographic breast compression. The system integrates 96 continuous-wave and 24 frequency-domain source locations as well as 32 continuous wave and 20 frequency-domain detection locations into low-profile plastic plates that can easily mate to the DBT compression paddle and x-ray detector cover, respectively. We demonstrate system performance using static and dynamic tissue-like phantoms as well as in vivo images acquired from the pool of patients recalled for breast biopsies at the Massachusetts General Hospital Breast Imaging Division.
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Affiliation(s)
- Bernhard B. Zimmermann
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, Cambridge, Massachusetts, United States
| | - Bin Deng
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Harvard Medical School, Department of Radiology, Boston, Massachusetts, United States
| | - Bhawana Singh
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Harvard Medical School, Department of Radiology, Boston, Massachusetts, United States
| | - Mark Martino
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
| | - Juliette Selb
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Harvard Medical School, Department of Radiology, Boston, Massachusetts, United States
| | - Qianqian Fang
- Northeastern University, Department of Bioengineering, Boston, Massachusetts, United States
| | - Amir Y. Sajjadi
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Harvard Medical School, Department of Radiology, Boston, Massachusetts, United States
| | - Jayne Cormier
- Massachusetts General Hospital, Breast Imaging Division, Department of Radiology, Boston, Massachusetts, United States
| | - Richard H. Moore
- Massachusetts General Hospital, Breast Imaging Division, Department of Radiology, Boston, Massachusetts, United States
| | - Daniel B. Kopans
- Harvard Medical School, Department of Radiology, Boston, Massachusetts, United States
- Massachusetts General Hospital, Breast Imaging Division, Department of Radiology, Boston, Massachusetts, United States
| | - David A. Boas
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Harvard Medical School, Department of Radiology, Boston, Massachusetts, United States
| | - Mansi A. Saksena
- Harvard Medical School, Department of Radiology, Boston, Massachusetts, United States
- Massachusetts General Hospital, Breast Imaging Division, Department of Radiology, Boston, Massachusetts, United States
| | - Stefan A. Carp
- Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States
- Harvard Medical School, Department of Radiology, Boston, Massachusetts, United States
- Address all correspondence to: Stefan A. Carp, E-mail:
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22
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Nishimatsu K, Nakamoto Y, Miyake KK, Ishimori T, Kanao S, Toi M, Togashi K. Higher breast cancer conspicuity on dbPET compared to WB-PET/CT. Eur J Radiol 2017; 90:138-145. [PMID: 28583624 DOI: 10.1016/j.ejrad.2017.02.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 02/24/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate lesion detectability of a dedicated breast positron-emission tomography (dbPET) scanner for breast cancers with an updated reconstruction mode, comparing it to whole-body positron-emission tomography/computed tomography (WB-PET/CT). MATERIALS AND METHODS A total of 179 histologically-proven breast cancer lesions in 150 females who underwent both WB-PET/CT and dbPET with 18F-fluorodeoxyglucose were retrospectively analyzed. The patient/breast/lesion-based sensitivities based on visual analysis were compared between dbPET and WB-PET/CT. For lesions visible on both PET images, SUVmax values of the tumors were measured, and tumor-to-background ratios (T/B ratios) of SUVmax were compared between the two scans. Subgroup analyses according to clinical tumor stage, histopathology and histological grade were also performed. RESULTS Patient/breast/lesion-based sensitivities were 95%, 95%, and 92%, respectively, for dbPET, and 95%, 94%, and 88%, respectively, for WB-PET/CT. Mean±standard deviation SUVmax values of FDG-avid tumors were 13.0±9.7 on dbPET and 6.4±4.8 on WB-PET. T/B ratios were also significantly higher in dbPET than in WB-PET/CT (8.1±7.1 vs. 5.1±4.5). In the subgroup analysis, no significant differences in sensitivities between dbPET and WB-PET/CT were found. However, T/B ratios of dbPET were significantly higher than those of WB-PET/CT in cT1c, cT2, cT3, invasive cancer, invasive carcinoma of no special type, mucinous carcinoma and Grades 1-3. CONCLUSION No significant differences in sensitivities were identified between dbPET using an updated reconstruction mode and WB-PET/CT; however, T/B ratios of dbPET were significantly higher than those of WB-PET/CT, indicating higher tumor conspicuity on dbPET.
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Affiliation(s)
- Kayo Nishimatsu
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Kanae K Miyake
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takayoshi Ishimori
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shotaro Kanao
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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23
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MRI fused with prone FDG PET/CT improves the primary tumour staging of patients with breast cancer. Eur Radiol 2016; 27:3190-3198. [PMID: 28004161 DOI: 10.1007/s00330-016-4685-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/03/2016] [Accepted: 11/29/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Our aim was to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) fused with prone 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in primary tumour staging of patients with breast cancer. METHODS This retrospective study evaluated 45 women with 49 pathologically proven breast carcinomas. MRI and prone PET-CT scans with time-of-flight and point-spread-function reconstruction were performed with the same dedicated breast coil. The studies were assessed by a radiologist and a nuclear medicine physician, and evaluation of fused images was made by consensus. The final diagnosis was based on pathology (90 lesions) or follow-up ≥ 24 months (17 lesions). RESULTS The study assessed 72 malignant and 35 benign lesions with a median size of 1.8 cm (range 0.3-8.4 cm): 31 focal, nine multifocal and nine multicentric cases. In lesion-by-lesion analysis, sensitivity, specificity, positive and negative predictive values were 97%, 80%, 91% and 93% for MRI, 96%, 71%, 87%, and 89% for prone PET, and 97%. 94%, 97% and 94% for MRI fused with PET. Areas under the curve (AUC) were 0.953, 0.850, and 0.983, respectively (p < 0.01). CONCLUSIONS MRI fused with FDG-PET is more accurate than FDG-PET in primary tumour staging of breast cancer patients and increases the specificity of MRI. KEY POINTS • FDG PET-CT may improve the specificity of MRI in breast cancer staging. • MRI fused with prone 2-[fluorine-18]-fluoro-2-deoxy-D-glucose PET-CT has better overall diagnostic performance than MRI. • The clinical role of fused PET-MRI has not yet been established.
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Bitencourt AGV, Lima ENP, Macedo BRC, Conrado JLFA, Marques EF, Chojniak R. Can positron emission mammography help to identify clinically significant breast cancer in women with suspicious calcifications on mammography? Eur Radiol 2016; 27:1893-1900. [PMID: 27585658 DOI: 10.1007/s00330-016-4576-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/24/2016] [Accepted: 08/22/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of positron emission mammography (PEM) for identifying malignant lesions in patients with suspicious microcalcifications detected on mammography. METHODS A prospective, single-centre study that evaluated 40 patients with suspicious calcifications at mammography and indication for percutaneous or surgical biopsy, with mean age of 56.4 years (range: 28-81 years). Patients who agreed to participate in the study underwent PEM with 18F-fluorodeoxyglucose before the final histological evaluation. PEM findings were compared with mammography and histological findings. RESULTS Most calcifications (n = 34; 85.0 %) were classified as BIRADS 4. On histology, there were 25 (62.5 %) benign and 15 (37.5 %) malignant lesions, including 11 (27.5 %) ductal carcinoma in situ (DCIS) and 4 (10 %) invasive carcinomas. On subjective analysis, PEM was positive in 15 cases (37.5 %) and most of these cases (n = 14; 93.3 %) were confirmed as malignant on histology. There was one false-positive result, which corresponded to a fibroadenoma, and one false negative, which corresponded to an intermediate-grade DCIS. PEM had a sensitivity of 93.3 %, specificity of 96.0 % and accuracy of 95 %. CONCLUSION PEM was able to identify all invasive carcinomas and high-grade DCIS (nuclear grade 3) in the presented sample, suggesting that this method may be useful for further evaluation of patients with suspected microcalcifications. KEY POINTS • Many patients with suspicious microcalcifications at mammography have benign results at biopsy. • PEM may help to identify invasive carcinomas and high-grade DCIS. • Management of patients with suspicious calcifications can be improved.
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Affiliation(s)
- Almir G V Bitencourt
- A C Camargo Cancer Center-Department of Imaging, R. Prof. Antônio Prudente, 211, São Paulo, SP, Brazil, 01509-010.
| | - Eduardo N P Lima
- A C Camargo Cancer Center-Department of Imaging, R. Prof. Antônio Prudente, 211, São Paulo, SP, Brazil, 01509-010
| | - Bruna R C Macedo
- A C Camargo Cancer Center-Department of Imaging, R. Prof. Antônio Prudente, 211, São Paulo, SP, Brazil, 01509-010
| | - Jorge L F A Conrado
- A C Camargo Cancer Center-Department of Imaging, R. Prof. Antônio Prudente, 211, São Paulo, SP, Brazil, 01509-010
| | - Elvira F Marques
- A C Camargo Cancer Center-Department of Imaging, R. Prof. Antônio Prudente, 211, São Paulo, SP, Brazil, 01509-010
| | - Rubens Chojniak
- A C Camargo Cancer Center-Department of Imaging, R. Prof. Antônio Prudente, 211, São Paulo, SP, Brazil, 01509-010
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van Es SC, Venema CM, Glaudemans AWJM, Lub-de Hooge MN, Elias SG, Boellaard R, Hospers GAP, Schröder CP, de Vries EGE. Translation of New Molecular Imaging Approaches to the Clinical Setting: Bridging the Gap to Implementation. J Nucl Med 2016; 57 Suppl 1:96S-104S. [PMID: 26834109 DOI: 10.2967/jnumed.115.157974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Molecular imaging with PET is a rapidly emerging technique. In breast cancer patients, more than 45 different PET tracers have been or are presently being tested. With a good rationale, after development of the tracer and proven feasibility, it is of interest to evaluate whether there is a potential meaningful role for the tracer in the clinical setting-such as in staging, in the (early) prediction of a treatment response, or in supporting drug choices. So far, only (18)F-FDG PET has been incorporated into breast cancer guidelines. For proof of the clinical relevance of tracers, especially for analysis in a multicenter setting, standardization of the technology and access to the novel PET tracer are required. However, resources for PET implementation research are limited. Therefore, next to randomized studies, novel approaches are required for proving the clinical value of PET tracers with the smallest possible number of patients. The aim of this review is to describe the process of the development of PET tracers and the level of evidence needed for the use of these tracers in breast cancer. Several breast cancer trials have been performed with the PET tracers (18)F-FDG, 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT), and (18)F-fluoroestradiol ((18)F-FES). We studied them to learn lessons for the implementation of novel tracers. After defining the gap between a good rationale for a tracer and implementation in the clinical setting, we propose solutions to fill the gap to try to bring more PET tracers to daily clinical practice.
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Affiliation(s)
- Suzanne C van Es
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clasina M Venema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carolina P Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
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Mastografía por emisión de positrones: revisión de un promisorio instrumento diagnóstico. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tabouret-Viaud C, Botsikas D, Delattre BMA, Mainta I, Amzalag G, Rager O, Vinh-Hung V, Miralbell R, Ratib O. PET/MR in Breast Cancer. Semin Nucl Med 2016; 45:304-21. [PMID: 26050658 DOI: 10.1053/j.semnuclmed.2015.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Breast cancer is an international public health concern in which an optimal treatment plan requires a precise staging. Both MRI and PET imaging techniques have made significant progress in the last decades with constant improvements that made both modalities clinically relevant in several stages of breast cancer management and follow-up. On one hand, specific breast MRI permits high diagnostic accuracy for local tumor staging, and whole-body MRI can also be of great use in distant staging, eventually accompanied by organ-specific MRI sequences. Moreover, many different MRI sequences can be performed, including functional MRI, letting us foresee important improvements in breast cancer characterization in the future. On the contrary, (18)F-FDG-PET has a high diagnostic performance for the detection of distant metastases, and several other tracers currently under development may profoundly affect breast cancer management in the future with better determination of different types of breast cancers allowing personalized treatments. As a consequence PET/MR is a promising emerging technology, and it is foreseeable that in cases where both PET and MRI data are needed, a hybrid acquisition is justified when available. However, at this stage of deployment of such hybrid scanners in a clinical setting, more data are needed to demonstrate their added value beyond just patient comfort of having to undergo a single examination instead of two, and the higher confidence of diagnostic interpretation of these co-registered images. Optimized imaging protocols are still being developed and are prone to provide more efficient hybrid protocols with a potential improvement in diagnostic accuracy. More convincing studies with larger number of patients as well as cost-effectiveness studies are needed. This article provides insights into the current state-of-the-art of PET/MR in patients with breast cancer and gives an outlook on future developments of both imaging techniques and potential applications in the future.
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Affiliation(s)
- Claire Tabouret-Viaud
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Diomidis Botsikas
- Service de Radiologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Bénédicte M A Delattre
- Service de Radiologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Ismini Mainta
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Gaël Amzalag
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Olivier Rager
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Vincent Vinh-Hung
- Service de Radio-Oncologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland
| | - Raymond Miralbell
- Service de Radio-Oncologie, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland; Servei de Radio-Oncologia, Instituto Oncológico Teknon, Barcelona, Spain
| | - Osman Ratib
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Genève, rue Gabrielle-Perret-Gentil, Genève, Switzerland.
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Abstract
Breast cancer is the most common malignancy in females. Imaging plays a critical role in diagnosis, staging and surveillance, and management of disease. Fluorodeoxyglucose (FDG) PET the imaging is indicated in specific clinical setting. Sensitivity of detection depends on tumor histology and size. Whole body FDG PET can change staging and management. In recurrent disease, distant metastasis can be detected. FDG PET imaging has prognostic and predictive value. PET/MR is evolving rapidly and may play a role management, assessment of metastatic lesions, and treatment monitoring. This review discusses current PET modalities, focusing on of FDG PET imaging and novel tracers.
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Affiliation(s)
- Lizza Lebron
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Daniel Greenspan
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Neeta Pandit-Taskar
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Kitajima K, Miyoshi Y. Present and future role of FDG-PET/CT imaging in the management of breast cancer. Jpn J Radiol 2016; 34:167-80. [DOI: 10.1007/s11604-015-0516-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/20/2015] [Indexed: 02/08/2023]
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Müller FHH, Farahati J, Müller AG, Gillman E, Hentschel M. Positron emission mammography in the diagnosis of breast cancer. Is maximum PEM uptake value a valuable threshold for malignant breast cancer detection? Nuklearmedizin 2015; 55:15-20. [PMID: 26627876 DOI: 10.3413/nukmed-0753-15-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/30/2015] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the diagnostic value (sensitivity, specificity) of positron emission mammography (PEM) in a single site non-interventional study using the maximum PEM uptake value (PUVmax). PATIENTS, METHODS In a singlesite, non-interventional study, 108 patients (107 women, 1 man) with a total of 151 suspected lesions were scanned with a PEM Flex Solo II (Naviscan) at 90 min p.i. with 3.5 MBq 18F-FDG per kg of body weight. In this ROI(region of interest)-based analysis, maximum PEM uptake value (PUV) was determined in lesions, tumours (PUVmaxtumour), benign lesions (PUVmaxnormal breast) and also in healthy tissues on the contralateral side (PUVmaxcontralateral breast). These values were compared and contrasted. In addition, the ratios of PUVmaxtumour / PUVmaxcontralateral breast and PUVmaxnormal breast / PUVmaxcontralateral breast were compared. The image data were interpreted independently by two experienced nuclear medicine physicians and compared with histology in cases of suspected carcinoma. RESULTS Based on a criteria of PUV>1.9, 31 out of 151 lesions in the patient cohort were found to be malignant (21%). A mean PUVmaxtumour of 3.78 ± 2.47 was identified in malignant tumours, while a mean PUVmaxnormal breast of 1.17 ± 0.37 was reported in the glandular tissue of the healthy breast, with the difference being statistically significant (p < 0.001). Similarly, the mean ratio between tumour and healthy glandular tissue in breast cancer patients (3.15 ± 1.58) was found to be significantly higher than the ratio for benign lesions (1.17 ± 0.41, p < 0.001). CONCLUSION PEM is capable of differentiating breast tumours from benign lesions with 100% sensitivity along with a high specificity of 96%, when a threshold of PUVmax >1.9 is applied.
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Affiliation(s)
- F H H Müller
- Dr. Frank H. H. Müller, Radiologie und Nuklearmedizin Ludwigshafen, Otto-Stabel-Str. 2-4, 67059 Ludwigshafen, Tel. +49/(0)621/51 00 21, Fax +49/(0)621/51 00 25,
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Detection of Synchronous Parathyroid Adenoma and Breast Cancer with (18)F-Fluorocholine PET-CT. Nucl Med Mol Imaging 2015; 50:180-2. [PMID: 27275374 PMCID: PMC4870458 DOI: 10.1007/s13139-015-0357-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/08/2015] [Accepted: 07/21/2015] [Indexed: 12/30/2022] Open
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Minamimoto R, Senda M, Jinnouchi S, Terauchi T, Yoshida T, Inoue T. Detection of Breast Cancer in an FDG-PET Cancer Screening Program: Results of a Nationwide Japanese Survey. Clin Breast Cancer 2015; 15:e139-46. [DOI: 10.1016/j.clbc.2014.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/24/2014] [Indexed: 02/02/2023]
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Breast cancer: a new imaging approach as an addition to existing guidelines. Eur J Nucl Med Mol Imaging 2015; 42:813-7. [PMID: 25761830 DOI: 10.1007/s00259-015-3032-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/05/2015] [Indexed: 12/28/2022]
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Alcantara D, Leal MP, García-Bocanegra I, García-Martín ML. Molecular imaging of breast cancer: present and future directions. Front Chem 2014; 2:112. [PMID: 25566530 PMCID: PMC4270251 DOI: 10.3389/fchem.2014.00112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/01/2014] [Indexed: 12/21/2022] Open
Abstract
Medical imaging technologies have undergone explosive growth over the past few decades and now play a central role in clinical oncology. But the truly transformative power of imaging in the clinical management of cancer patients lies ahead. Today, imaging is at a crossroads, with molecularly targeted imaging agents expected to broadly expand the capabilities of conventional anatomical imaging methods. Molecular imaging will allow clinicians to not only see where a tumor is located in the body, but also to visualize the expression and activity of specific molecules (e.g., proteases and protein kinases) and biological processes (e.g., apoptosis, angiogenesis, and metastasis) that influence tumor behavior and/or response to therapy. Breast cancer, the most common cancer among women and a research area where our group is actively involved, is a very heterogeneous disease with diverse patterns of development and response to treatment. Hence, molecular imaging is expected to have a major impact on this type of cancer, leading to important improvements in diagnosis, individualized treatment, and drug development, as well as our understanding of how breast cancer arises.
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Affiliation(s)
- David Alcantara
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
| | - Manuel Pernia Leal
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
| | - Irene García-Bocanegra
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
| | - Maria L García-Martín
- Laboratory of Metabolomics and Molecular Imaging, BIONAND, Centro Andaluz de Nanomedicina y Biotecnología (Junta de Andalucía, Universidad de Málaga) Malaga, Spain
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