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Zarghami A, Mirmalek SA. Differentiating Primary and Recurrent Lesions in Patients with a History of Breast Cancer: A Comprehensive Review. Galen Med J 2024; 13:1-18. [PMID: 39224544 PMCID: PMC11368482 DOI: 10.31661/gmj.v13i.3340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Indexed: 09/04/2024] Open
Abstract
Breast cancer (BC) recurrence remains a concerning issue, requiring accurate identification and differentiation from primary lesions for optimal patient management. This comprehensive review aims to summarize and evaluate the current evidence on methods to distinguish primary breast tumors from recurrent lesions in patients with a history of BC. Also, we provide a comprehensive understanding of the different imaging techniques, including mammography, ultrasound, magnetic resonance imaging, and positron emission tomography, highlighting their diagnostic accuracy, limitations, and potential integration. In addition, the role of various biopsy modalities and molecular markers was explored. Furthermore, the potential role of liquid biopsy, circulating tumor cells, and circulating tumor DNA in differentiating between primary and recurrent BC was emphasized. Finally, it addresses emerging diagnostic modalities, such as radiomic analysis and artificial intelligence, which show promising potential in enhancing diagnostic accuracy. Through comprehensive analysis and review of the available literature, the current study provides an up-to-date understanding of the current state of knowledge, challenges, and future directions in accurately distinguishing between primary and recurrent breast lesions in patients with a history of BC.
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Affiliation(s)
- Anita Zarghami
- Department of Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Mirmalek
- Department of Surgery, Tehran Medical Sciences, Islamic Azad University, Tehran,
Iran
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2
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Diwanji D, Onishi N, Hathi DK, Lawhn-Heath C, Kornak J, Li W, Guo R, Molina-Vega J, Seo Y, Flavell RR, Heditsian D, Brain S, Esserman LJ, Joe BN, Hylton NM, Jones EF, Ray KM. 18F-FDG Dedicated Breast PET Complementary to Breast MRI for Evaluating Early Response to Neoadjuvant Chemotherapy. Radiol Imaging Cancer 2024; 6:e230082. [PMID: 38551406 PMCID: PMC10988337 DOI: 10.1148/rycan.230082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/30/2023] [Accepted: 02/16/2024] [Indexed: 04/02/2024]
Abstract
Purpose To compare quantitative measures of tumor metabolism and perfusion using fluorine 18 (18F) fluorodeoxyglucose (FDG) dedicated breast PET (dbPET) and breast dynamic contrast-enhanced (DCE) MRI during early treatment with neoadjuvant chemotherapy (NAC). Materials and Methods Prospectively collected DCE MRI and 18F-FDG dbPET examinations were analyzed at baseline (T0) and after 3 weeks (T1) of NAC in 20 participants with 22 invasive breast cancers. FDG dbPET-derived standardized uptake value (SUV), metabolic tumor volume, and total lesion glycolysis (TLG) and MRI-derived percent enhancement (PE), signal enhancement ratio (SER), and functional tumor volume (FTV) were calculated at both time points. Differences between FDG dbPET and MRI parameters were evaluated after stratifying by receptor status, Ki-67 index, and residual cancer burden. Parameters were compared using Wilcoxon signed rank and Mann-Whitney U tests. Results High Ki-67 tumors had higher baseline SUVmean (difference, 5.1; P = .01) and SUVpeak (difference, 5.5; P = .04). At T1, decreases were observed in FDG dbPET measures (pseudo-median difference T0 minus T1 value [95% CI]) of SUVmax (-6.2 [-10.2, -2.6]; P < .001), SUVmean (-2.6 [-4.9, -1.3]; P < .001), SUVpeak (-4.2 [-6.9, -2.3]; P < .001), and TLG (-29.1 mL3 [-71.4, -6.8]; P = .005) and MRI measures of SERpeak (-1.0 [-1.3, -0.2]; P = .02) and FTV (-11.6 mL3 [-22.2, -1.7]; P = .009). Relative to nonresponsive tumors, responsive tumors showed a difference (95% CI) in percent change in SUVmax of -34.3% (-55.9%, 1.5%; P = .06) and in PEpeak of -42.4% (95% CI: -110.5%, 8.5%; P = .08). Conclusion 18F-FDG dbPET was sensitive to early changes during NAC and provided complementary information to DCE MRI that may be useful for treatment response evaluation. Keywords: Breast, PET, Dynamic Contrast-enhanced MRI Clinical trial registration no. NCT01042379 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Devan Diwanji
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Natsuko Onishi
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Deep K. Hathi
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Courtney Lawhn-Heath
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - John Kornak
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Wen Li
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Ruby Guo
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Julissa Molina-Vega
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Youngho Seo
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Robert R. Flavell
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Diane Heditsian
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Susie Brain
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Laura J. Esserman
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Bonnie N. Joe
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Nola M. Hylton
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Ella F. Jones
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
| | - Kimberly M. Ray
- From the Departments of Radiology and Biomedical Imaging (D.D., N.O.,
D.K.H., C.L.H., W.L., R.G., Y.S., R.R.F., B.N.J., N.M.H., E.F.J., K.M.R.),
Epidemiology and Biostatistics (J.K.), and Surgery (J.M.V., L.J.E.), University
of California San Francisco, 550 16th St, San Francisco, CA 94158; and
I-SPY 2 Advocacy Group, San Francisco, Calif (D.H., S.B.)
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3
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Yuge S, Miyake KK, Ishimori T, Kataoka M, Matsumoto Y, Fujimoto K, Sugie T, Toi M, Nakamoto Y. Reproducibility assessment of uptake on dedicated breast PET for noise discrimination. Ann Nucl Med 2023; 37:121-130. [PMID: 36434200 DOI: 10.1007/s12149-022-01809-6] [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: 09/21/2022] [Accepted: 11/13/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Dedicated breast PET (dbPET) systems have improved the detection of small breast cancers but have increased false-positive diagnoses due to an increased chance of noise detection. This study examined whether reproducibility assessment using paired images helped to improve noise discrimination and diagnostic performance in dbPET. METHODS This study included 21 patients with newly diagnosed breast cancer who underwent [18F]FDG-dbPET and contrast-enhanced breast MRI. A 10-min dbPET data scan was acquired per breast, and two sets of reconstructed images were generated (named dbPET-1 and dbPET-2, respectively), each of which consisted of randomly allocated 5-min data from the 10-min data. Uptake spots higher than the background were indexed for the study with visual assessment. All indexed uptakes on dbPET-1 were evaluated using dbPET-2 for reproducibility. MRI findings based on the Breast Imaging-Reporting and Data System (BI-RADS) 2013 were used as the gold standard. Uptake spots that corresponded to BI-RADS 1 on MRI were considered noise, while those with BI-RADS 4b-6 were considered malignancies. The diagnostic performance of dbPET for malignancy was evaluated using four different criteria: any uptake on dbPET-1 regarded as positive (criterion A), a subjective visual assessment of dbPET-1 (criterion B), reproducibility assessment between dbPET-1 and dbPET-2 (criterion C), and a combination of B and C (criterion D). RESULTS A total of 213 indexed uptake spots were identified on dbPET-1, including 152, 15, 6, 6, and 34 lesions classified as BI-RADS MRI categories 1, 2, 4b, 4c, and 5, respectively. Overall, 31.9% of the index uptake values were reproducible. All malignant lesions were reproducible, whereas 93.4% of noise was not reproducible. The sensitivities for malignancy for criteria A, B, C, and D were 100%, 91.3%, 100%, and 91.3%, respectively, with positive predictive values (PPVs) of 21.4%, 68.9%, 67.6%, and 82.4%, respectively. CONCLUSIONS Our results demonstrated that reproducibility assessment helped reduce false-positive findings caused by noise on dbPET without lowering the sensitivity for malignancy. While subjective visual assessment was also efficient in increasing PPV, it occasionally missed malignant uptake.
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Affiliation(s)
- Shunsuke Yuge
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Kanae K Miyake
- Department of Advanced Medical Imaging Research, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto City, Kyoto, Japan, 606-8507.
| | - Takayoshi Ishimori
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Yoshiaki Matsumoto
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Koji Fujimoto
- Department of Real World Data Research and Development, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto, Japan
| | - Tomoharu Sugie
- Department of Breast Surgery, Kansai Medical University Hospital, Hirakata City, Osaka, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
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4
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van Loevezijn AA, Stokkel MPM, Donswijk ML, van Werkhoven ED, van der Noordaa MEM, van Duijnhoven FH, Vrancken Peeters MJTFD. [ 18F]FDG-PET/CT in prone compared to supine position for optimal axillary staging and treatment in clinically node-positive breast cancer patients with neoadjuvant systemic therapy. EJNMMI Res 2021; 11:78. [PMID: 34417932 PMCID: PMC8380204 DOI: 10.1186/s13550-021-00824-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/11/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Axillary staging before neoadjuvant systemic therapy in clinically node-positive breast cancer patients with tailored axillary treatment according to the Marking Axillary lymph nodes with radioactive iodine seeds (MARI)-protocol, a protocol developed at the Netherlands Cancer Institute, is performed with [18F] fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT). We aimed to assess the value of FDG-PET/CT in prone compared to standard supine position for axillary staging. METHODS We selected patients with FDG-PET/CT in supine and prone position who underwent the MARI-protocol. One hour after administration of 3.5 MBq/kg, [18F]FDG-PET was performed with a low-dose prone position CT-thorax followed by a supine whole-body scan. Scans were separately reviewed by two nuclear medicine physicians and categorized by number of FDG-positive axillary lymph nodes (ALNs; cALN<4 or cALN≥4). Main outcome was axillary up- or downstaging. RESULTS Of 153 patients included, 24 (16%) patients were up- or downstaged at evaluation of prone images: One observer upstaged 14 patients, downstaged 3 patients and reported a higher number of ALNs (3.6 vs. 3.2, p < 0.001), while staging (4 up- and 5 downstaged) and number of ALNs (2.8 vs. 2.8) did not differ for the other. Observers agreed on up- or downstaging in only 1 (1%) patient. Irrespective of supine or prone position scanning, observers agreed on axillary staging in 124 (81%) patients and disagreed in 5 (3%). Interobserver agreement was lower with prone assessments (86%, K = 0.67) than supine (92%, K = 0.80). CONCLUSIONS Axillary staging with FDG-PET/CT in prone compared to supine position did not result in concordant up- or downstaging. Therefore, FDG-PET/CT in supine position only can be considered sufficient for axillary staging.
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Affiliation(s)
- Ariane A van Loevezijn
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Erik D van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Marieke E M van der Noordaa
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Department of Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Xue C, Tang FH, Lai CWK, Grimm LJ, Lo JY. Multimodal Patient-Specific Registration for Breast Imaging Using Biomechanical Modeling with Reference to AI Evaluation of Breast Tumor Change. Life (Basel) 2021; 11:life11080747. [PMID: 34440490 PMCID: PMC8401473 DOI: 10.3390/life11080747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The strategy to combat the problem associated with large deformations in the breast due to the difference in the medical imaging of patient posture plays a vital role in multimodal medical image registration with artificial intelligence (AI) initiatives. How to build a breast biomechanical model simulating the large-scale deformation of soft tissue remains a challenge but is highly desirable. Methods: This study proposed a hybrid individual-specific registration model of the breast combining finite element analysis, property optimization, and affine transformation to register breast images. During the registration process, the mechanical properties of the breast tissues were individually assigned using an optimization process, which allowed the model to become patient specific. Evaluation and results: The proposed method has been extensively tested on two datasets collected from two independent institutions, one from America and another from Hong Kong. Conclusions: Our method can accurately predict the deformation of breasts from the supine to prone position for both the Hong Kong and American samples, with a small target registration error of lesions.
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Affiliation(s)
- Cheng Xue
- School of Medical and Health Sciences, Tung Wah College, Hong Kong, China;
| | - Fuk-Hay Tang
- School of Medical and Health Sciences, Tung Wah College, Hong Kong, China;
- Correspondence:
| | - Christopher W. K. Lai
- Health and Social Sciences, Singapore Institute of Technology, Singapore 138683, Singapore;
| | - Lars J. Grimm
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, NC 27705, USA; (L.J.G.); (J.Y.L.)
| | - Joseph Y. Lo
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, Durham, NC 27705, USA; (L.J.G.); (J.Y.L.)
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PET/MRI for Staging the Axilla in Breast Cancer: Current Evidence and the Rationale for SNB vs. PET/MRI Trials. Cancers (Basel) 2021; 13:cancers13143571. [PMID: 34298781 PMCID: PMC8303241 DOI: 10.3390/cancers13143571] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 01/03/2023] Open
Abstract
Simple Summary PET/MRI is a relatively new, hybrid imaging tool that allows practitioners to obtain both a local and systemic staging in breast cancer patients in a single exam. To date, the available evidence is not sufficient to determine the role of PET/MRI in breast cancer management. The aims of this paper are to provide an overview of the current literature on PET/MRI in breast cancer, and to illustrate two ongoing trials aimed at defining the eventual role of PET/MRI in axillary staging in two different settings: patients with early breast cancer and patients with positive axillary nodes that are candidates for primary systemic therapy. In both cases, findings from PET/MRI will be compared with the final pathology and could be helpful to better tailor axillary surgery in the future. Abstract Axillary surgery in breast cancer (BC) is no longer a therapeutic procedure but has become a purely staging procedure. The progressive improvement in imaging techniques has paved the way to the hypothesis that prognostic information on nodal status deriving from surgery could be obtained with an accurate diagnostic exam. Positron emission tomography/magnetic resonance imaging (PET/MRI) is a relatively new imaging tool and its role in breast cancer patients is still under investigation. We reviewed the available literature on PET/MRI in BC patients. This overview showed that PET/MRI yields a high diagnostic performance for the primary tumor and distant lesions of liver, brain and bone. In particular, the results of PET/MRI in staging the axilla are promising. This provided the rationale for two prospective comparative trials between axillary surgery and PET/MRI that could lead to a further de-escalation of surgical treatment of BC. • SNB vs. PET/MRI 1 trial compares PET/MRI and axillary surgery in staging the axilla of BC patients undergoing primary systemic therapy (PST). • SNB vs. PET/MRI 2 trial compares PET/MRI and sentinel node biopsy (SNB) in staging the axilla of early BC patients who are candidates for upfront surgery. Finally, these ongoing studies will help clarify the role of PET/MRI in BC and establish whether it represents a useful diagnostic tool that could guide, or ideally replace, axillary surgery in the future.
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7
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Zeng T, Zheng J, Xia X, Chen X, Wang B, Zhang S, Chandler A, Cao T, Hu L, Chen Q, Chu X. Design and system evaluation of a dual-panel portable PET (DP-PET). EJNMMI Phys 2021; 8:47. [PMID: 34117943 PMCID: PMC8197684 DOI: 10.1186/s40658-021-00392-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Integrated whole-body PET/MR technology continues to mature and is now extensively used in clinical settings. However, due to the special design architecture, integrated whole-body PET/MR comes with a few inherent limitations. Firstly, whole-body PET/MR lacks sensitivity and resolution for focused organs. Secondly, broader clinical access of integrated PET/MR has been significantly restricted due to its prohibitively high cost. The MR-compatible PET insert is an independent and removable PET scanner which can be placed within an MRI bore. However, the mobility and configurability of all existing MR-compatible PET insert prototypes remain limited. METHODS An MR-compatible portable PET insert prototype, dual-panel portable PET (DP-PET), has been developed for simultaneous PET/MR imaging. Using SiPM, digital readout electronics, novel carbon fiber shielding, phase-change cooling, and MRI compatible battery power, DP-PET was designed to achieve high-sensitivity and high-resolution with compatibility with a clinical 3-T MRI scanner. A GPU-based reconstruction method with resolution modeling (RM) has been developed for the DP-PET reconstruction. We evaluated the system performance on PET resolution, sensitivity, image quality, and the PET/MR interference. RESULTS The initial results reveal that the DP-PET prototype worked as expected in the MRI bore and caused minimal compromise to the MRI image quality. The PET performance was measured to show a spatial resolution ≤ 2.5 mm (parallel to the detector panels), maximum sensitivity = 3.6% at the center of FOV, and energy resolution = 12.43%. MR pulsing introduces less than 2% variation to the PET performance measurement results. CONCLUSIONS We developed a MR-compatible PET insert prototype and performed several studies to begin to characterize the performance of the proposed DP-PET. The results showed that the proposed DP-PET performed well in the MRI bore and would cause little influence on the MRI images. The Derenzo phantom test showed that the proposed reconstruction method could obtain high-quality images using DP-PET.
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Affiliation(s)
- Tianyi Zeng
- Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, 201210, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jiaxu Zheng
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
| | - Xinyuan Xia
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
| | - Xin Chen
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
| | - Beien Wang
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
| | - Shuangyue Zhang
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
| | - Adam Chandler
- United Imaging Healthcare, America, Houston, TX, 77054, USA
| | - Tuoyu Cao
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
| | - Lingzhi Hu
- United Imaging Healthcare, America, Houston, TX, 77054, USA.
| | - Qun Chen
- Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, 201210, China
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
| | - Xu Chu
- Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, 201210, China
- Shanghai United Imaging Healthcare Co., Ltd., Shanghai, 201807, China
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8
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Vi C, Mandarano G, Shigdar S. Diagnostics and Therapeutics in Targeting HER2 Breast Cancer: A Novel Approach. Int J Mol Sci 2021; 22:6163. [PMID: 34200484 PMCID: PMC8201268 DOI: 10.3390/ijms22116163] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 01/02/2023] Open
Abstract
Breast cancer is one of the most commonly occurring cancers in women globally and is the primary cause of cancer mortality in females. BC is highly heterogeneous with various phenotypic expressions. The overexpression of HER2 is responsible for 15-30% of all invasive BC and is strongly associated with malignant behaviours, poor prognosis and decline in overall survival. Molecular imaging offers advantages over conventional imaging modalities, as it provides more sensitive and specific detection of tumours, as these techniques measure the biological and physiological processes at the cellular level to visualise the disease. Early detection and diagnosis of BC is crucial to improving clinical outcomes and prognosis. While HER2-specific antibodies and nanobodies may improve the sensitivity and specificity of molecular imaging, the radioisotope conjugation process may interfere with and may compromise their binding functionalities. Aptamers are single-stranded oligonucleotides capable of targeting biomarkers with remarkable binding specificity and affinity. Aptamers can be functionalised with radioisotopes without compromising target specificity. The attachment of different radioisotopes can determine the aptamer's functionality in the treatment of HER2(+) BC. Several HER2 aptamers and investigations of them have been described and evaluated in this paper. We also provide recommendations for future studies with HER2 aptamers to target HER2(+) BC.
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Affiliation(s)
- Chris Vi
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; (C.V.); (G.M.)
| | - Giovanni Mandarano
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; (C.V.); (G.M.)
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Sarah Shigdar
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia; (C.V.); (G.M.)
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC 3220, Australia
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9
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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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10
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Evaluation of primary breast cancers using dedicated breast PET and whole-body PET. Sci Rep 2020; 10:21930. [PMID: 33318514 PMCID: PMC7736887 DOI: 10.1038/s41598-020-78865-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/17/2020] [Indexed: 01/06/2023] Open
Abstract
Metabolic imaging of the primary breast tumor with 18F-fluorodeoxyglucose ([18F]FDG) PET may assist in predicting treatment response in the neoadjuvant chemotherapy (NAC) setting. Dedicated breast PET (dbPET) is a high-resolution imaging modality with demonstrated ability in highlighting intratumoral heterogeneity and identifying small lesions in the breast volume. In this study, we characterized similarities and differences in the uptake of [18F]FDG in dbPET compared to whole-body PET (wbPET) in a cohort of ten patients with biopsy-confirmed, locally advanced breast cancer at the pre-treatment timepoint. Patients received bilateral dbPET and wbPET following administration of 186 MBq and 307 MBq [18F]FDG on separate days, respectively. [18F]FDG uptake measurements and 20 radiomic features based on morphology, tumor intensity, and texture were calculated and compared. There was a fivefold increase in SULpeak for dbPET (median difference (95% CI): 4.0 mL−1 (1.8–6.4 mL−1), p = 0.006). Additionally, spatial heterogeneity features showed statistically significant differences between dbPET and wbPET. The higher [18F]FDG uptake in dbPET highlighted the dynamic range of this breast-specific imaging modality. Combining with the higher spatial resolution, dbPET may be able to detect treatment response in the primary tumor during NAC, and future studies with larger cohorts are warranted.
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11
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Shawky M, Ali ZAE, Hashem DH, Houseni M. Role of positron-emission tomography/computed tomography (PET/CT) in breast cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breast cancer is the most common cancer type in women and the most common cause of deaths in women worldwide.
FDG-PET/CT was used in the early stage, estimation of the therapeutic response, revelation of recurrent disease, and distal metastasis. However, with the increasing use of FDG PET/CT, sites of accelerated activity have been occasionally found out in unexpected locations which may not correlate with the patient’s clinical history or the expected propagation of the primary malignancy.
The aim of this study is to detect the diagnostic value of PET/CT in breast cancer patients; comparing PET/CT performance with that of contrast-enhanced CT in diagnosis of breast cancer and distant metastasis.
Results
The study included 30 female patients with breast cancer, mean age 53.56 years ± 10.64 (SD), age range 33–73 years. PET/CT detect contralateral breast affection in 2 patients (6.7%), and distant metastasis was seen on PET/CT. Sites of distant metastasis included the bone (n = 12), axillary lymph nodes (n = 11), cervical lymph nodes (n = 6), mediastinal lymph nodes (n = 12), abdominal lymph nodes (n = 8), liver (n = 5), lung (n = 11), and other visceral sites metastasis (n = 9). PET/CT detected breast lesions with a sensitivity of 100% and specificity of 95.4%. In contrast, the sensitivity and specificity of CT alone were 81.2% and 90.4%, respectively.
Conclusion
PET/CT has superiority over CT alone in revelation of breast lesions and distant metastases.
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Magometschnigg H, Pinker K, Helbich T, Brandstetter A, Rudas M, Nakuz T, Baltzer P, Wadsak W, Hacker M, Weber M, Dubsky P, Filipits M. PIK3CA Mutational Status Is Associated with High Glycolytic Activity in ER+/HER2- Early Invasive Breast Cancer: a Molecular Imaging Study Using [ 18F]FDG PET/CT. Mol Imaging Biol 2020; 21:991-1002. [PMID: 30652258 DOI: 10.1007/s11307-018-01308-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE In PIK3CA mutant breast cancer, downstream hyperactivation of the PI3K/AKT/mTOR pathway may be associated with increased glycolysis of cancer cells. The purpose of this study was to investigate the functional association of PIK3CA mutational status and tumor glycolysis in invasive ER+/HER2- early breast cancer. PROCEDURES This institutional review board-approved retrospective study included a dataset of 67 ER+/HER2- early breast cancer patients. All patients underwent 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/X-ray computed tomography ([18F]FDG PET/CT) and clinico-pathologic assessments as part of a prospective study. For this retrospective analysis, pyrosequencing was used to detect PIK3CA mutations of exons 4, 7, 9, and 20. Tumor glucose metabolism was assessed semi-quantitatively with [18F]FDG PET/CT using maximum standardized uptake values (SUVmax). SUVmax values were corrected for the partial volume effect, and metabolic tumor volume was calculated using the volume of interest automated lesion growing function 2D tumor size, i.e., maximum tumor diameter was assessed on concurrent pre-treatment contrast-enhanced magnetic resonance imaging. RESULTS PIK3CA mutations were present in 45 % of all tumors. Mutations were associated with a small tumor diameter (p < 0.01) and with low nuclear grade (p = 0.04). Glycolytic activity was positively associated with nuclear grade (p = 0.01), proliferation (p = 0.002), regional lymph node metastasis (p = 0.015), and metabolic tumor volume (p = 0.001) but not with tumor size/T-stage. In invasive ductal carcinomas, median SUVmax was increased in PIK3CA-mutated compared to wild-type tumors; however, this increase did not reach statistical significance (p = 0.05). Multivariate analysis of invasive ductal carcinomas revealed [18F]FDG uptake to be independently associated with PIK3CA status (p = 0.002) and nuclear tumor grade (p = 0.046). Size, volume, and regional nodal status had no influence on glycolytic activity. PIK3CA mutational status did not influence glycolytic metabolism in lobular carcinomas. Glycolytic activity and PIK3CA mutational status had no significant influence on recurrence-free survival or disease-specific survival. CONCLUSIONS In ER+/HER2- invasive ductal carcinomas of the breast, glucose uptake is independently associated with PIK3CA mutations. Initial data suggest that [18F]FDG uptake reflects complex genomic alterations and may have the potential to be used as candidate biomarker for monitoring therapeutic response and resistance mechanisms in emerging therapies that target the PI3K/AKT/mTOR pathway.
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Affiliation(s)
- Heinrich Magometschnigg
- Department of Biomedical Imaging and Image-guided Therapy, Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Thomas Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Anita Brandstetter
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Margaretha Rudas
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Thomas Nakuz
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Pascal Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Wadsak
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Peter Dubsky
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Department of Surgery, Breast Centre Clinic St. Anna, Lucerne, Switzerland.
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Subiros-Funosas R, Ho VCL, Barth ND, Mendive-Tapia L, Pappalardo M, Barril X, Ma R, Zhang CB, Qian BZ, Sintes M, Ghashghaei O, Lavilla R, Vendrell M. Fluorogenic Trp(redBODIPY) cyclopeptide targeting keratin 1 for imaging of aggressive carcinomas. Chem Sci 2019; 11:1368-1374. [PMID: 34123261 PMCID: PMC8148049 DOI: 10.1039/c9sc05558d] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
Keratin 1 (KRT1) is overexpressed in squamous carcinomas and associated with aggressive pathologies in breast cancer. Herein we report the design and preparation of the first Trp-based red fluorogenic amino acid, which is synthetically accessible in a few steps and displays excellent photophysical properties, and its application in a minimally-disruptive labelling strategy to prepare a new fluorogenic cyclopeptide for imaging of KRT1+ cells in whole intact tumour tissues.
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Affiliation(s)
- Ramon Subiros-Funosas
- Centre for Inflammation Research, University of Edinburgh 47 Little France Crescent EH16 4TJ Edinburgh UK
| | - Vivian Cheuk Lam Ho
- Centre for Inflammation Research, University of Edinburgh 47 Little France Crescent EH16 4TJ Edinburgh UK
| | - Nicole D Barth
- Centre for Inflammation Research, University of Edinburgh 47 Little France Crescent EH16 4TJ Edinburgh UK
| | - Lorena Mendive-Tapia
- Centre for Inflammation Research, University of Edinburgh 47 Little France Crescent EH16 4TJ Edinburgh UK
| | - Morena Pappalardo
- Laboratory of Physical Chemistry, Facultat de Farmàcia, Universitat de Barcelona and Institut de Biomedicina de la Universitat de Barcelona (IBUB) Av. Joan XXIII s/n 08028 Barcelona Spain
| | - Xavier Barril
- Laboratory of Physical Chemistry, Facultat de Farmàcia, Universitat de Barcelona and Institut de Biomedicina de la Universitat de Barcelona (IBUB) Av. Joan XXIII s/n 08028 Barcelona Spain
| | - Ruoyu Ma
- MRC Centre for Reproductive Health, University of Edinburgh 47 Little France Crescent EH16 4TJ Edinburgh UK
| | - Cheng-Bin Zhang
- MRC Centre for Reproductive Health, University of Edinburgh 47 Little France Crescent EH16 4TJ Edinburgh UK
| | - Bin-Zhi Qian
- MRC Centre for Reproductive Health, University of Edinburgh 47 Little France Crescent EH16 4TJ Edinburgh UK
| | - Miquel Sintes
- Laboratory of Medicinal Chemistry, Faculty of Pharmacy, University of Barcelona and Institut de Biomedicina de la Universitat de Barcelona (IBUB) Avda Joan XXIII 27-30 Barcelona 08028 Spain
| | - Ouldouz Ghashghaei
- Laboratory of Medicinal Chemistry, Faculty of Pharmacy, University of Barcelona and Institut de Biomedicina de la Universitat de Barcelona (IBUB) Avda Joan XXIII 27-30 Barcelona 08028 Spain
| | - Rodolfo Lavilla
- Laboratory of Medicinal Chemistry, Faculty of Pharmacy, University of Barcelona and Institut de Biomedicina de la Universitat de Barcelona (IBUB) Avda Joan XXIII 27-30 Barcelona 08028 Spain
| | - Marc Vendrell
- Centre for Inflammation Research, University of Edinburgh 47 Little France Crescent EH16 4TJ Edinburgh UK
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14
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Sakaguchi R, Kataoka M, Kanao S, Miyake KK, Nakamoto Y, Sugie T, Toi M, Mikami Y, Togashi K. Distribution pattern of FDG uptake using ring-type dedicated breast PET in comparison to whole-body PET/CT scanning in invasive breast cancer. Ann Nucl Med 2019; 33:570-578. [PMID: 31115856 DOI: 10.1007/s12149-019-01364-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/03/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to investigate the incidence of rim uptake (RU) or multifocal uptake (MU) by invasive breast cancers on a ring-type dedicated breast positron emission tomography (dbPET) scanner compared with whole-body PET (wbPET) scanner imaging and to correlate uptake patterns with pathological features and prognosis. METHODS Between 2009 and 2011, 76 lesions in 74 patients with primary invasive breast cancers were included. Each patient underwent dbPET and wbPET scanning on the same day after administration of 18F-fluorodeoxyglucose (FDG). The images were evaluated to identify specific uptake patterns (RU and MU). Their association with pathological characteristics and prognosis was analyzed. RESULTS On dbPET, RU and MU patterns were observed in 18 lesions (24%) and 28 lesions (37%), respectively. On wbPET, RU and MU patterns were observed in six lesions (8%) and 17 lesions (22%), respectively. Lesions with RU on dbPET were of higher grade than lesions without RU (P = 0.024) and a higher Ki-67 index (mean; 31% vs. 18%, P = 0.015). They tended to be triple-negative (33% vs. 12%, P = 0.046) and less likely to be luminal A subtype (17% vs. 47%, P = 0.020). On wbPET, however, no significant differences in these markers were seen between RU and non-RU. The MU pattern did not correlate with pathological characteristics in either scanner. Lesions with RU or MU were not significantly associated with disease-free survival. CONCLUSIONS DbPET can identify detailed FDG distribution patterns of breast cancer better than wbPET. Breast cancer with RU on dbPET was associated with higher grade and triple-negative subtype.
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Affiliation(s)
- Rena Sakaguchi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shotaro Kanao
- Department of Radiology, Kobe City Medical Center General Hospital, 2-1-1 Minatojikaminamicho, Chou-ku, Kobe, Hyogo, 650-0047, Japan
| | - Kanae K Miyake
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomohatru Sugie
- Department of Breast Surgery, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University Hospital, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan
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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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16
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Jones EF, Ray KM, Li W, Seo Y, Franc BL, Chien AJ, Esserman LJ, Pampaloni MH, Joe BN, Hylton NM. Dedicated Breast Positron Emission Tomography for the Evaluation of Early Response to Neoadjuvant Chemotherapy in Breast Cancer. Clin Breast Cancer 2016; 17:e155-e159. [PMID: 28110902 DOI: 10.1016/j.clbc.2016.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ella F Jones
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA.
| | - Kimberly M Ray
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Wen Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Benjamin L Franc
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Amy J Chien
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Laura J Esserman
- Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Miguel H Pampaloni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Bonnie N Joe
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Nola M Hylton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
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Dalm SU, Melis M, Emmering J, Kwekkeboom DJ, de Jong M. Breast cancer imaging using radiolabelled somatostatin analogues. Nucl Med Biol 2016; 43:559-565. [DOI: 10.1016/j.nucmedbio.2016.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/12/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
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Evaluation of a Hanging-Breast PET System for Primary Tumor Visualization in Patients With Stage I-III Breast Cancer: Comparison With Standard PET/CT. AJR Am J Roentgenol 2016; 206:1307-14. [PMID: 27058014 DOI: 10.2214/ajr.15.15371] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purposes of this study were to evaluate the performance of a mammography with molecular imaging PET (MAMMI-PET) system for breast imaging in the hanging-breast position for the visualization of primary breast cancer lesions and to compare this method with whole-body PET/CT. SUBJECTS AND METHODS Between March 2011 and March 2014, a prospective evaluation included women with one or more histologically confirmed primary breast cancer lesions (index lesions). After injection of 180-240 MBq of (18)F-FDG, whole-body PET/CT and MAMMI-PET acquisitions were performed, index lesions were scored 0, 1, or 2 for FDG uptake relative to background. Detection and FDG uptake were compared by breast length, maximal tumor diameter, affected breast quadrants, tumor grade, and histologic and immunologic sub-types. Finally, the two PET modalities were compared for detection of index lesions. RESULTS For 234 index lesions (diameter, 5-170 mm), the overall sensitivity was 88.9% for MAMMI-PET and 91% for PET/CT (p = 0.61). Twenty-three (9.8%) index lesions located too close to the pectoral muscle were missed with MAMMI-PET, and 20 index lesions were missed with PET/CT. Lesion visibility on MAMMI-PET images was influenced by tumor grade (p = 0.034) but not by cancer subtype (p = 0.65). CONCLUSION Although in an overall evaluation MAMMI-PET was not superior to PET/CT, MAMMI-PET does have higher sensitivity for primary breast cancer lesions within the scanning range of the device. Optimization of the positioning device may increase visualization of the most dorsal lesions.
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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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Teixeira SC, Veen LDWVD, Sonneborn M, Koolen BB, Stokkel MPM, Olmos RAV. Dedicated breast PET (MAMMI-PET) in daily clinical practice: implications for radiation safety of nuclear medicine personnel. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/1/015003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Diagnostic accuracy of (18)F-FDG PET/CT compared with that of contrast-enhanced MRI of the breast at 3 T. Eur J Nucl Med Mol Imaging 2015; 42:1656-1665. [PMID: 26121928 DOI: 10.1007/s00259-015-3099-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the diagnostic accuracy of prone (18)F-FDG PET/CT with that of contrast-enhanced MRI (CE-MRI) at 3 T in suspicious breast lesions. To evaluate the influence of tumour size on diagnostic accuracy and the use of maximum standardized uptake value (SUVMAX) thresholds to differentiate malignant from benign breast lesions. METHODS A total of 172 consecutive patients with an imaging abnormality were included in this IRB-approved prospective study. All patients underwent (18)F-FDG PET/CT and CE-MRI of the breast at 3 T in the prone position. Two reader teams independently evaluated the likelihood of malignancy as determined by (18)F-FDG PET/CT and CE-MRI independently. (18)F-FDG PET/CT data were qualitatively evaluated by visual interpretation. Quantitative assessment was performed by calculation of SUVMAX. Sensitivity, specificity, diagnostic accuracy, area under the curve and interreader agreement were calculated for all lesions and for lesions <10 mm. Histopathology was used as the standard of reference. RESULTS There were 132 malignant and 40 benign lesions; 23 lesions (13.4%) were <10 mm. Both (18)F-FDG PET/CT and CE-MRI achieved an overall diagnostic accuracy of 93%. There were no significant differences in sensitivity (p = 0.125), specificity (p = 0.344) or diagnostic accuracy (p = 1). For lesions <10 mm, diagnostic accuracy deteriorated to 91% with both (18)F-FDG PET/CT and CE-MRI. Although no significant difference was found for lesions <10 mm, CE-MRI at 3 T seemed to be more sensitive but less specific than (18)F-FDG PET/CT. Interreader agreement was excellent (κ = 0.85 and κ = 0.92). SUVMAX threshold was not helpful in differentiating benign from malignant lesions. CONCLUSION (18)F-FDG PET/CT and CE-MRI at 3 T showed equal diagnostic accuracies in breast cancer diagnosis. For lesions <10 mm, diagnostic accuracy deteriorated, but was equal for (18)F-FDG PET/CT and CE-MRI at 3 T. For lesions <10 mm, CE-MRI at 3 T seemed to be more sensitive but less specific than (18)F-FDG PET/CT. Quantitative assessment using an SUVMAX threshold for differentiating benign from malignant lesions was not helpful in breast cancer diagnosis.
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Vercher-Conejero JL, Pelegrí-Martinez L, Lopez-Aznar D, Cózar-Santiago MDP. Positron Emission Tomography in Breast Cancer. Diagnostics (Basel) 2015; 5:61-83. [PMID: 26854143 PMCID: PMC4665546 DOI: 10.3390/diagnostics5010061] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 12/26/2022] Open
Abstract
Gradually, FDG-PET/CT has been strengthening within the diagnostic algorithms of oncological diseases. In many of these, PET/CT has shown to be useful at different stages of the disease: diagnosis, staging or re-staging, treatment response assessment, and recurrence. Some of the advantages of this imaging modality versus CT, MRI, bone scan, mammography, or ultrasound, are based on its great diagnostic capacity since, according to the radiopharmaceutical used, it reflects metabolic changes that often occur before morphological changes and therefore allows us to stage at diagnosis. Moreover, another advantage of this technique is that it allows us to evaluate the whole body so it can be very useful for the detection of distant disease. With regard to breast cancer, FDG-PET/CT has proven to be important when recurrence is suspected or in the evaluation of treatment response. The technological advancement of PET equipment through the development of new detectors and equipment designed specifically for breast imaging, and the development of more specific radiopharmaceuticals for the study of the different biological processes of breast cancer, will allow progress not only in making the diagnosis of the disease at an early stage but also in enabling personalized therapy for patients with breast cancer.
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Affiliation(s)
- Jose Luis Vercher-Conejero
- Clinical Area of Medical Imaging, Department of Nuclear Medicine, GIBI230, Polytechnic and University Hospital La Fe, Valencia 46026, Spain.
| | - Laura Pelegrí-Martinez
- Diagnostic Imaging, Sant Joan Despí Moisès Broggi Hospital, Sant Joan Despí, Barcelona 08970, Spain.
| | - Diego Lopez-Aznar
- Department of Nuclear Medicine, Provincial Hospital Consortium, Castellón de la Plana 12002, Spain.
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Ming M, Wang ZG, Li D, Wu F, Liu S, Shi B, Xue W. The applications of corrected standardized uptake values in the diagnosis of peripheral lung lesions. Medicine (Baltimore) 2015; 94:e531. [PMID: 25674754 PMCID: PMC4602734 DOI: 10.1097/md.0000000000000531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Fluorine 18-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) imaging has been widely used to diagnose many types of tumors. However, many factors can affect the accuracy of standardized uptake values (SUVs). In this study, we aimed to explore the applications of corrected SUVs in the diagnosis of peripheral solitary pulmonary lesions.A retrospective study was undertaken in 69 patients with peripheral solitary pulmonary lesions. Whole-body PET/CT was acquired approximately 60 min after F-FDG injection. The lesions were found to be malignant in 57 cases and benign in 12 cases. Of the 69 cases, 68 were correctly diagnosed, and only 1 was misdiagnosed by the corrected SUVs. The diagnostic accuracy rate was 98.5%. The sensitivity, specificity, positive predictive value, and negative predictive value of the corrected SUV were 100%, 91.7%, 98.3%, and 100%, respectively.F-FDG PET/CT with corrected SUVs is of great value for improving diagnostic accuracy in peripheral lung lesions.
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Affiliation(s)
- Ming Ming
- From the Hospital of Qingdao University, Qingdao, China (MM, ZGW, DL, FY, SL, BS, WX)
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Noninvasive nodal restaging in clinically node positive breast cancer patients after neoadjuvant systemic therapy: A systematic review. Eur J Radiol 2015; 84:41-47. [DOI: 10.1016/j.ejrad.2014.09.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/21/2014] [Accepted: 09/26/2014] [Indexed: 11/19/2022]
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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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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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Evaluating heterogeneity of primary tumor (18)F-FDG uptake in breast cancer with a dedicated breast PET (MAMMI): a feasibility study based on correlation with PET/CT. Nucl Med Commun 2014; 35:446-52. [PMID: 24686195 DOI: 10.1097/mnm.0000000000000072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of the study was to evaluate the heterogeneity of primary tumor F-fluorodeoxyglucose ((18)F-FDG) uptake in breast cancer patients using a dedicated breast PET. PATIENTS AND METHODS A positron emission tomography/computed tomography (PET/CT) of the thorax was performed 60 min after administration of 180-240 MBq of (18)F-FDG in patients with breast cancer. Subsequently, 110 min after injection, a scan was taken with a dedicated high-resolution breast PET [MAMmography with Molecular Imaging (MAMMI)]. Both procedures were performed with the patients in the prone position. Four-point scores were used to compare the intensity (0: none; 1: mild; 2: moderate; 3: high) and heterogeneity (0: none; 1: mild; 2: moderate; 3: high) of (18)F-FDG uptake between PET/CT and MAMMI images. RESULTS Thirty-five patients in whom the primary tumor was visualized on both scans were included in this analysis. The mean primary tumor size was 35.1 mm (range 10-108 mm). The mean intensity score was similar on both devices (2.4 for PET/CT and 2.3 for MAMMI; P=0.439), but the mean heterogeneity score on MAMMI images was significantly higher (PET/CT 1.9 vs. MAMMI 2.3; P=0.005). MAMMI showed a higher heterogeneity score in 11 (31%) of 35 patients, especially in tumors with moderate or high intensity. Significantly higher heterogeneity scores on both PET/CT and MAMMI were seen in large tumors (P=0.005 and 0.014, respectively) and in tumors with high intensity scores (P=0.012 and P<0.001, respectively). CONCLUSION Heterogeneous tumor (18)F-FDG uptake in breast cancer is frequently observed, particularly in large tumors with intense (18)F-FDG uptake. It is more often seen on MAMMI PET than on conventional PET/CT. Although the observed heterogeneity should be proven histopathologically, this finding offers a rationale for (18)F-FDG-guided biopsies.
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Gallamini A, Zwarthoed C, Borra A. Positron Emission Tomography (PET) in Oncology. Cancers (Basel) 2014; 6:1821-89. [PMID: 25268160 PMCID: PMC4276948 DOI: 10.3390/cancers6041821] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/25/2014] [Accepted: 08/07/2014] [Indexed: 02/07/2023] Open
Abstract
Since its introduction in the early nineties as a promising functional imaging technique in the management of neoplastic disorders, FDG-PET, and subsequently FDG-PET/CT, has become a cornerstone in several oncologic procedures such as tumor staging and restaging, treatment efficacy assessment during or after treatment end and radiotherapy planning. Moreover, the continuous technological progress of image generation and the introduction of sophisticated software to use PET scan as a biomarker paved the way to calculate new prognostic markers such as the metabolic tumor volume (MTV) and the total amount of tumor glycolysis (TLG). FDG-PET/CT proved more sensitive than contrast-enhanced CT scan in staging of several type of lymphoma or in detecting widespread tumor dissemination in several solid cancers, such as breast, lung, colon, ovary and head and neck carcinoma. As a consequence the stage of patients was upgraded, with a change of treatment in 10%-15% of them. One of the most evident advantages of FDG-PET was its ability to detect, very early during treatment, significant changes in glucose metabolism or even complete shutoff of the neoplastic cell metabolism as a surrogate of tumor chemosensitivity assessment. This could enable clinicians to detect much earlier the effectiveness of a given antineoplastic treatment, as compared to the traditional radiological detection of tumor shrinkage, which usually takes time and occurs much later.
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Affiliation(s)
- Andrea Gallamini
- Department of Research and Medical Innovation, Antoine Lacassagne Cancer Center, Nice University, Nice Cedex 2-06189 Nice, France.
| | - Colette Zwarthoed
- Department of Nuclear Medicine, Antoine Lacassagne Cancer Center, Nice University, Nice Cedex 2-06189 Nice, France.
| | - Anna Borra
- Hematology Department S. Croce Hospital, Via M. Coppino 26, Cuneo 12100, Italy.
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Magometschnigg HF, Helbich T, Brader P, Abeyakoon O, Baltzer P, Füger B, Wengert G, Polanec S, Bickel H, Pinker K. Molecular imaging for the characterization of breast tumors. Expert Rev Anticancer Ther 2014; 14:711-22. [DOI: 10.1586/14737140.2014.885383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Koolen BB, van der Leij F, Vogel WV, Rutgers EJT, Vrancken Peeters MJTFD, Elkhuizen PHM, Valdés Olmos RA. Accuracy of 18F-FDG PET/CT for primary tumor visualization and staging in T1 breast cancer. Acta Oncol 2014; 53:50-7. [PMID: 23672678 DOI: 10.3109/0284186x.2013.783714] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to assess the accuracy of 18F-FDG PET/CT in T1 breast cancer regarding visualization of the primary tumor and the detection of locoregional and distant metastases. METHODS Sixty-two women with invasive T1 breast cancer underwent a PET/CT. Image acquisition of the thorax was done in prone position with hanging breasts, followed by whole-body scanning in supine position. Primary tumor FDG uptake was evaluated and compared with clinical and histopathological characteristics. Presence of locoregional and distant metastases was assessed and compared with conventional imaging procedures. RESULTS The primary tumor was visible with PET/CT in 54 (87%) of 62 patients, increasing from 59% (10/17) in tumors ≤ 10 mm to 98% (44/45) in tumors over 10 mm. All triple negative and HER2-positive tumors and 40/48 (83%) ER-positive/HER2-negative tumors were visualized. Sensitivity and specificity of PET/CT in the detection of axillary metastases were 73% and 100%, respectively. PET/CT depicted periclavicular nodes in two patients. Of 12 distant lesions, one was confirmed to be a lung metastasis, three were false positive, and eight were new primary proliferative lesions. CONCLUSION Using optimal imaging acquisition, the majority of T1 breast carcinomas can be visualized with PET/CT. Specificity in the detection of axillary metastases is excellent, but sensitivity appears to be limited. Additional whole body imaging has a low yield in this specific patient group.
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Affiliation(s)
- Bas B Koolen
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital , Amsterdam , The Netherlands
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Hruska CB, O'Connor MK. Nuclear imaging of the breast: translating achievements in instrumentation into clinical use. Med Phys 2013; 40:050901. [PMID: 23635248 DOI: 10.1118/1.4802733] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Approaches to imaging the breast with nuclear medicine and∕or molecular imaging methods have been under investigation since the late 1980s when a technique called scintimammography was first introduced. This review charts the progress of nuclear imaging of the breast over the last 20 years, covering the development of newer techniques such as breast specific gamma imaging, molecular breast imaging, and positron emission mammography. Key issues critical to the adoption of these technologies in the clinical environment are discussed, including the current status of clinical studies, the efforts at reducing the radiation dose from procedures associated with these technologies, and the relevant radiopharmaceuticals that are available or under development. The necessary steps required to move these technologies from bench to bedside are also discussed.
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Affiliation(s)
- Carrie B Hruska
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Does the pretreatment tumor sampling location correspond with metabolic activity on 18F-FDG PET/CT in breast cancer patients scheduled for neoadjuvant chemotherapy? Eur J Radiol 2013; 82:2353-8. [DOI: 10.1016/j.ejrad.2013.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
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Kim HS, An YS, Paik MJ, Lee YS, Choi HD, Kim BC, Pack JK, Kim N, Ahn YH. The effects of exposure to 915 MHz radiofrequency identification on cerebral glucose metabolism in rat: a [F-18] FDG micro-PET study. Int J Radiat Biol 2013; 89:750-5. [PMID: 23581879 DOI: 10.3109/09553002.2013.791756] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We investigated the effect of whole-body exposure to 915-MHz radiofrequency identification (RFID) on rat cortical glucose metabolism by using (18)F-deoxyglucose positron emission tomography (FDG-PET). MATERIALS AND METHODS Male Sprague-Dawley rats were divided into three groups: Cage-control, sham-exposed and RFID-exposed groups. Rats were exposed to the 915-MHz RFID for 8 h daily, 5 days per week, for 2 or 16 weeks. The whole-body average specific absorption rate (SAR) was 4 W/kg for the field of the 915 MHz RFID signal. FDG-PET images were obtained the day after RFID exposure, using micro-PET with a FDG tracer. With a Xeleris functional imaging workstation, absolute values in regions of interest (ROI) in the frontal, temporal and parietal cortexes and cerebellum were measured. Cortical ROI values were normalized to the cerebellar value and compared. RESULTS The data showed that the relative cerebral glucose metabolic rate was unchanged in the frontal, temporal and parietal cortexes of the 915 MHz RFID-exposed rats, compared with rats in cage-control and sham-exposed groups. CONCLUSION Our results suggest that 915 MHz RFID radiation exposure did not cause a significant long lasting effect on glucose metabolism in the rat brain.
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Affiliation(s)
- Hye Sun Kim
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, South Korea
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