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Narayanan D, Berg WA. Dedicated Breast Gamma Camera Imaging and Breast PET: Current Status and Future Directions. PET Clin 2018; 13:363-381. [PMID: 30100076 DOI: 10.1016/j.cpet.2018.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recent advances in nuclear medicine instrumentation have led to the emergence of improved molecular imaging techniques to image breast cancer: dedicated gamma cameras using γ-emitting 99mTc-sestamibi and breast-specific PET cameras using 18F-fluorodeoxyglucose. This article focuses on the current role of such approaches in the clinical setting including diagnosis, assessing local extent of disease, monitoring response to therapy, and, for gamma camera imaging, possible supplemental screening in women with dense breasts. Barriers to clinical adoption and technologies and radiotracers under development are also discussed.
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Affiliation(s)
- Deepa Narayanan
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.
| | - Wendie A Berg
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213
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Ong E. Preoperative imaging for breast conservation surgery-do we need more than conventional imaging for local disease assessment? Gland Surg 2018; 7:554-559. [PMID: 30687628 DOI: 10.21037/gs.2018.08.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Breast conservation surgery (BCS) is offered for early breast cancer. Conventional imaging with mammography and ultrasound would have been performed prior to surgery. This article considers other imaging modalities available [such as 3D tomosynthesis, magnetic resonance imaging (MRI), contrast-enhanced spectral mammography, positron emission mammography (PEM), breast-specific gamma imaging (BSGI) and cone beam computed tomography (CBCT)] and discusses the evidence for these in terms of diagnostic accuracy and clinical outcomes.
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Affiliation(s)
- Eugene Ong
- Diagnostic Radiology, Mount Elizabeth Novena Hospital, Singapore
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Nuvoli S, Galassi S, Gelo I, Rocchitta G, Fancellu A, Serra PA, Madeddu G, Spanu A. The role of molecular breast imaging in predicting complete tumor response to treatment and residual tumor extent following neoadjuvant therapy. Oncol Rep 2018; 39:2055-2062. [PMID: 29512735 PMCID: PMC5928762 DOI: 10.3892/or.2018.6299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/01/2018] [Indexed: 02/05/2023] Open
Abstract
The aim of the present study was to investigate the usefulness of molecular breast imaging (MBI) in predicting complete tumor response to treatment and residual tumor extent following neoadjuvant therapy. A consecutive series of 43 female patients with large or locally advanced primary breast cancer, scheduled for surgery following neoadjuvant therapy, was retrospectively reviewed. Prior to surgery, all patients underwent MBI using a high-resolution semiconductor-based device for image acquisition. MBI data were correlated with surgical histopathological findings. Spearman's correlation coefficient was calculated to assess differences in residual tumor size with MBI and histopathological examination. From the images obtained using MBI, 7 patients were negative for residual tumors with pathological complete response (specificity, 100%) and positive in 34/36 patients with residual disease (sensitivity, 94.4%), including 26/27 patients with unifocal and 8/9 patients with multicentric/multifocal tumors, 5 of which exhibited multiple microscopic foci scattered in a fibrotic area. Overall accuracy was 95.3% and the positive predictive value (PPV) and negative predictive value (NPV) were 100 and 77.8%, respectively. MBI was false-negative in one patient with a 2.5-cm invasive ductal carcinoma located close to the chest wall and in one patient with microscopic foci of epithelial carcinoma. In the patients with unifocal residual tumors, correlation of tumor size between MBI and histopathology was r=0.981 (P<0.0001); however, MBI overestimated the number of lesions in one of these cases. In the patients with multifocal/multicentric tumors, MBI adequately assessed residual tumor extent in 5/8 positive cases, overestimating the number of lesions in one case and underestimating tumor extent in 2 further cases with microscopic foci scattered in a fibrotic area. MBI proved to be a highly accurate diagnostic tool in predicting complete tumor response to neoadjuvant therapy and residual tumor extent, correlating with surgical histopathological findings in 86% of overall cases. A positive result was always associated with the presence of residual disease and MBI tumor size was strongly correlated with histopathological analysis mainly in unifocal residual tumors.
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Affiliation(s)
- Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, I‑07100 Sassari, Italy
| | - Sarah Galassi
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, I‑07100 Sassari, Italy
| | - Ilaria Gelo
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, I‑07100 Sassari, Italy
| | - Gaia Rocchitta
- Unit of Pharmacology, Department of Clinical and Experimental Medicine, University of Sassari, I‑07100 Sassari, Italy
| | - Alessandro Fancellu
- Unit of Surgery, Department of Clinical and Experimental Medicine, University of Sassari, I‑07100 Sassari, Italy
| | - Pier Andrea Serra
- Unit of Pharmacology, Department of Clinical and Experimental Medicine, University of Sassari, I‑07100 Sassari, Italy
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, I‑07100 Sassari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of Sassari, I‑07100 Sassari, Italy
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