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Song L, Qiu Y, Huang W, Sun X, Yang Q, Peng Y, Kang L. Untypical bilateral breast cancer with peritoneal fibrosis on 18F-FDG PET/CT: case report and literature review. Front Med (Lausanne) 2024; 11:1353822. [PMID: 38741768 PMCID: PMC11089181 DOI: 10.3389/fmed.2024.1353822] [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: 12/11/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
Background Retroperitoneal fibrosis, a condition of uncertain origin, is rarely linked to 8% of malignant cases, including breast, lung, gastrointestinal, genitourinary, thyroid, and carcinoid. The mechanism leading to peritoneal fibrosis induced by tumors is not well understood, possibly encompassing direct infiltration of neoplastic cells or the initiation of inflammatory responses prompted by cytokines released by tumor cells. We report a case of breast cancer with renal metastasis and retroperitoneal fibrosis detected using 18F-FDG PET/CT, providing help for clinical diagnosis and treatment. Case report A 49-year-old woman was referred to the hospital with elevated creatinine and oliguria for over a month. Abdominal computer tomography (CT) and magnetic resonance imaging (MRI) showed a retroperitoneal fibrosis-induced acute kidney injury (AKI) was suspected. However, a percutaneous biopsy of the kidney lesion confirmed metastasis from breast cancer. The physical examination revealed inverted nipples and an orange peel appearance on the skin of both breasts. Ultrasonography revealed bilateral hyperplasia (BIRADS 4a) of the mammary glands and bilateral neck and axillary lymphadenopathy. Subsequently, 18F-deoxyglucose positron emission tomography/computer tomography (18F-FDG PET/CT) detected abnormally high uptake (SUVmax) in the bilateral mammary glands and axillary lymph nodes, suggesting bilateral breast cancer. Furthermore, abnormal 18F-FDG uptake was detected in the kidney, suggesting renal metastasis. In addition, abnormal 18F-FDG uptake was observed in the vertebrae, accompanied by an elevation in inhomogeneous bone mineral density, raising suspicion of bone metastases. However, the possibility of myelodysplasia cannot be dismissed, and further investigations will be conducted during close follow-ups. There was significant 18F-FDG uptake in the retroperitoneal position indicating a potential association between retroperitoneal fibrosis and breast cancer. The final pathological diagnosis of the breast tissue confirmed bilateral invasive ductal carcinoma. The patient had been treated with 11 cycles of albumin-bound (nab)-paclitaxel (0.3 mg) and had no significant adverse reaction. Conclusion In this case, neither the bilateral breast cancer nor the kidney metastatic lesion showed typical nodules or masses, so breast ultrasound, abdominal CT, and MRI did not suggest malignant lesions. PET/CT played an important role in detecting occult metastases and primary lesions, thereby contributing to more accurate staging, monitoring treatment responses, and prediction of prognosis in breast cancer.
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Affiliation(s)
| | | | | | | | | | | | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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Ruan D, Sun L. Diagnostic Performance of PET/MRI in Breast Cancer: A Systematic Review and Bayesian Bivariate Meta-analysis. Clin Breast Cancer 2023; 23:108-124. [PMID: 36549970 DOI: 10.1016/j.clbc.2022.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/07/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION By performing a systematic review and meta-analysis, the diagnostic value of 18F-FDG PET/MRI in breast lesions, lymph nodes, and distant metastases was assessed, and the merits and demerits of PET/MRI in the application of breast cancer were comprehensively reviewed. METHODS Breast cancer-related studies using 18F-FDG PET/MRI as a diagnostic tool published before September 12, 2022 were included. The pooled sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under the curve (AUC) were calculated using Bayesian bivariate meta-analysis in a lesion-based and patient-based manner. RESULTS We ultimately included 24 studies (including 1723 patients). Whether on a lesion-based or patient-based analysis, PET/MRI showed superior overall pooled sensitivity (0.95 [95% CI: 0.92-0.98] & 0.93 [95% CI: 0.88-0.98]), specificity (0.94 [95% CI: 0.90-0.97] & 0.94 [95% CI: 0.92-0.97]), LDOR (5.79 [95% CI: 4.95-6.86] & 5.64 [95% CI: 4.58-7.03]) and AUC (0.98 [95% CI: 0.94-0.99] & 0.98[95% CI: 0.92-0.99]) for diagnostic applications in breast cancer. In the specific subgroup analysis, PET/MRI had high pooled sensitivity and specificity for the diagnosis of breast lesions and distant metastatic lesions and was especially excellent for bone lesions. PET/MRI performed poorly for diagnosing axillary lymph nodes but was better than for lymph nodes at other sites (pooled sensitivity, specificity, LDOR, AUC: 0.86 vs. 0.58, 0.90 vs. 0.82, 4.09 vs. 1.98, 0.89 vs. 0.84). CONCLUSION 18F-FDG PET/MRI performed excellently in diagnosing breast lesions and distant metastases. It can be applied to the initial diagnosis of suspicious breast lesions, accurate staging of breast cancer patients, and accurate restaging of patients with suspected recurrence.
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Affiliation(s)
- Dan Ruan
- Department of Nuclear Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Long Sun
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China.
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Zheng D, He X, Jing J. Overview of Artificial Intelligence in Breast Cancer Medical Imaging. J Clin Med 2023; 12:jcm12020419. [PMID: 36675348 PMCID: PMC9864608 DOI: 10.3390/jcm12020419] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023] Open
Abstract
The heavy global burden and mortality of breast cancer emphasize the importance of early diagnosis and treatment. Imaging detection is one of the main tools used in clinical practice for screening, diagnosis, and treatment efficacy evaluation, and can visualize changes in tumor size and texture before and after treatment. The overwhelming number of images, which lead to a heavy workload for radiologists and a sluggish reporting period, suggests the need for computer-aid detection techniques and platform. In addition, complex and changeable image features, heterogeneous quality of images, and inconsistent interpretation by different radiologists and medical institutions constitute the primary difficulties in breast cancer screening and imaging diagnosis. The advancement of imaging-based artificial intelligence (AI)-assisted tumor diagnosis is an ideal strategy for improving imaging diagnosis efficient and accuracy. By learning from image data input and constructing algorithm models, AI is able to recognize, segment, and diagnose tumor lesion automatically, showing promising application prospects. Furthermore, the rapid advancement of "omics" promotes a deeper and more comprehensive recognition of the nature of cancer. The fascinating relationship between tumor image and molecular characteristics has attracted attention to the radiomic and radiogenomics, which allow us to perform analysis and detection on the molecular level with no need for invasive operations. In this review, we integrate the current developments in AI-assisted imaging diagnosis and discuss the advances of AI-based breast cancer precise diagnosis from a clinical point of view. Although AI-assisted imaging breast cancer screening and detection is an emerging field and draws much attention, the clinical application of AI in tumor lesion recognition, segmentation, and diagnosis is still limited to research or in limited patients' cohort. Randomized clinical trials based on large and high-quality cohort are lacking. This review aims to describe the progress of the imaging-based AI application in breast cancer screening and diagnosis for clinicians.
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Baysal H, Serdaroglu AY, Ozemir IA, Baysal B, Gungor S, Erol CI, Ozsoy MS, Ekinci O, Alimoglu O. Comparison of Magnetic Resonance Imaging With Positron Emission Tomography/Computed Tomography in the Evaluation of Response to Neoadjuvant Therapy of Breast Cancer. J Surg Res 2022; 278:223-232. [DOI: 10.1016/j.jss.2022.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 04/12/2022] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
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Principe DR, Raicu A, Bergsten TM, Rubin J, Hagen C. Ileal carcinoid tumor represents after prolonged remission as a solitary breast mass. J Surg Case Rep 2019; 2019:rjz171. [PMID: 31214312 PMCID: PMC6565812 DOI: 10.1093/jscr/rjz171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/13/2019] [Indexed: 12/24/2022] Open
Abstract
While the metastatic spread of breast cancer is well documented, the breast is seldom a site for metastasis. Non-mammillary cancers can involve the breast or axilla, though this is exceedingly rare with few reported instances. Here, we present the case of a 62-year-old woman who attended an outpatient breast clinic with a history of an ileal carcinoid tumor complicated by multi-organ metastasis. Her disease was in clinical remission for several years, though she recently re-presented with a single solitary lesion to the breast that was later confirmed as a recurrence of her carcinoid tumor. This serves as an important reminder that the breast can indeed be a site for metastasis. As metastatic breast lesions can often be difficult to diagnose, it is essential to obtain a thorough medical history in order to determine the appropriate clinical course.
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Affiliation(s)
- Daniel R Principe
- Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, IL, USA
| | - Andreea Raicu
- University of Illinois, Metropolitan Group Hospitals General Surgery Residency, Advocate Illinois Masonic Hospital, Chicago, IL, USA
| | - Tova M Bergsten
- Medical Scientist Training Program, University of Illinois College of Medicine, Chicago, IL, USA
| | - Jonathan Rubin
- University of Illinois, Metropolitan Group Hospitals General Surgery Residency, Advocate Illinois Masonic Hospital, Chicago, IL, USA
| | - Colleen Hagen
- Department of Surgery, Mercy Hospital and Medical Center, Chicago, IL, USA
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Bitencourt AGV, Andrade WP, da Cunha RR, Conrado JLFDA, Lima ENP, Barbosa PNVP, Chojniak R. Detection of distant metastases in patients with locally advanced breast cancer: role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging with computed tomography scans. Radiol Bras 2017; 50:211-215. [PMID: 28894327 PMCID: PMC5586510 DOI: 10.1590/0100-3984.2015-0232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To evaluate positron emission tomography/computed tomography (PET/CT) and conventional imaging tests for the detection of distant metastases in patients with locally advanced breast cancer. MATERIALS AND METHODS We included 81 patients with breast cancer who had undergone 18F-fluorodeoxyglucose (FDG) PET/CT before treatment. Conventional imaging included the following: bone scintigraphy; chest X-ray (in 14.5%) or CT (in 85.5%); and abdominal ultrasound (in 10.8%), CT (in 87.8%), or magnetic resonance imaging (in 1.4%). Histopathology and clinical/imaging follow-up served as reference. RESULTS Distant metastases were observed in nine patients (11.1%). On patient-based analysis, conventional imaging identified distant metastases in all 9 patients. In one patient, the initial 18F-FDG PET/CT failed to demonstrate bone metastases that was evident on bone scintigraphy. In two patients, the CT scan failed to show extra-axillary lymph node metastases that were identified on 18F-FDG PET/CT. There was no significant difference between 18F-FDG PET/CT and conventional imaging in terms of their sensitivity for the detection of distant metastases in patients with locally advanced breast cancer. CONCLUSION This study showed that 18F-FDG PET/CT and conventional imaging with CT scans had similar sensitivity for the diagnosis of distant metastases in patients with locally advanced breast cancer. 18F-FDG PET/CT can add information about extra-axillary lymph node involvements.
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Affiliation(s)
| | - Wesley Pereira Andrade
- PhD, MD, Breast Surgery, Instituto de OncoMastologia, Hospital Alemão Oswaldo Cruz e Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Rubens Chojniak
- PhD, MD, Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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Abramson RG, Lambert KF, Jones-Jackson LB, Arlinghaus LR, Williams J, Abramson VG, Chakravarthy AB, Yankeelov TE. Prone Versus Supine Breast FDG-PET/CT for Assessing Locoregional Disease Distribution in Locally Advanced Breast Cancer. Acad Radiol 2015; 22:853-9. [PMID: 25865435 DOI: 10.1016/j.acra.2015.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/13/2014] [Accepted: 02/16/2015] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES Prone (18)F fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) may have advantages for breast imaging because of improved separation of deep anatomic structures. There are limited data on whether prone and supine FDG-PET/CT provide similar information regarding breast and axillary disease in the setting of locally advanced breast cancer (LABC). The purpose of this study was to compare the information on locoregional disease distribution provided by prone versus supine FDG-PET in newly diagnosed LABC. MATERIALS AND METHODS In an Institutional Review Board-approved prospective trial, 24 patients with newly diagnosed LABC underwent both supine and prone FDG-PET/CT at the same scanning session. Three readers performed an independent review of all scans and categorized the locoregional disease distribution as breast only (BO)-unifocal, BO-multifocal, BO-multicentric, or breast + axillary involvement. For breast + axillary disease, the readers also assessed the number of involved axillary lymph nodes. Interobserver discrepancies were resolved at a consensus reading session. RESULTS Two scanning sessions were excluded because the prone scan had omitted part of the axilla from the field of view. In the remaining 22 patients, the consensus categorization of anatomic disease distribution was concordant between prone and supine scanning in 21 patients (linear kappa 0.91, 95% confidence interval [0.79-1]). In the 16 patients with breast + axillary disease, equal numbers of involved lymph nodes were identified on prone and supine scanning in 12 patients, whereas in the remaining four patients, prone scanning resulted in a higher number of visualized lymph nodes. CONCLUSIONS Prone and supine FDG-PET/CT provided statistically identical information on locoregional disease distribution in LABC. However, prone scanning may perform better than supine for assessing the number of involved lymph nodes. Prone FDG-PET/CT may be useful in future clinical and research efforts, including hybrid PET-magnetic resonance imaging (MRI) applications.
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Taneja S, Jena A, Goel R, Sarin R, Kaul S. Simultaneous whole-body 18 F-FDG PET-MRI in primary staging of breast cancer: A pilot study. Eur J Radiol 2014; 83:2231-2239. [DOI: 10.1016/j.ejrad.2014.09.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/16/2014] [Accepted: 09/11/2014] [Indexed: 11/25/2022]
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Additional value of F-18 FDG PET/CT for initial staging in breast cancer with clinically negative axillary nodes. Breast Cancer Res Treat 2014; 145:137-42. [PMID: 24682676 DOI: 10.1007/s10549-014-2924-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/17/2014] [Indexed: 12/19/2022]
Abstract
The aim of this study was to evaluate the clinical impact of the preoperative ¹⁸F-FDG PET/CT in the initial workup of breast cancer with clinically negative axillary nodes. Whether the status of the clinical axillary nodal involvement can be considered a parameter for making a decision to omit the preoperative ¹⁸F-FDG PET/CT in the situation reported herein was also determined. A total of 178 patients who had newly diagnosed breast cancer and for whom the conventional diagnostic modalities showed no sign of axillary node metastasis were retrospectively enrolled in this study. All the patients underwent preoperative ¹⁸F-FDG PET/CT. The images and histologic results that were obtained were analyzed. ¹⁸F-FDG PET/CT detected primary lesions in 156 of the 178 patients, with an overall sensitivity of 87.6 %, and false negative results were obtained for 22 patients (12.4 %). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ¹⁸F-FDG PET/CT in the detection of axillary nodes were 20.8, 86.9, 37.0, 74.8, and 69.1 %, respectively. Extra-axillary node metastasis was identified in two patients (1.1 %) who had internal mammary nodes. There was no distant metastasis, but coexisting primary tumor was detected in five patients (2.8 %). In total, the therapeutic plan was changed based on ¹⁸F-FDG PET/CT in seven (3.9 %) of the 178 patients, but considering only the cases confined to breast cancer, the change occurred in only two patients (1.1 %). ¹⁸F-FDG PET/CT almost did not affect the initial staging and treatment plan in breast cancer with clinically negative axillary node. If the axillary node is clinically negative in the preoperative workup of breast cancer, then ¹⁸F-FDG PET/CT can be omitted.
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Kruse V, Cocquyt V, Borms M, Maes A, Van de Wiele C. Serum tumor markers and PET/CT imaging for tumor recurrence detection. Ann Nucl Med 2012; 27:97-104. [DOI: 10.1007/s12149-012-0664-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/22/2012] [Indexed: 12/12/2022]
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