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Kuzmova M, Cullinane C, Rutherford C, McCartan D, Rothwell J, Evoy D, Geraghty J, Prichard RS. The accuracy of MRI in detecting pathological complete response following neoadjuvant chemotherapy in different breast cancer subtypes. Surg Oncol 2023; 51:102011. [PMID: 37931546 DOI: 10.1016/j.suronc.2023.102011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/03/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Pathological complete response (pCR) following neo-adjuvant chemotherapy (NACT) for breast cancer is associated with improved disease-free and overall survival in certain breast cancer subtypes. Magnetic Resonance Imaging (MRI) is increasingly used as standard to assess treatment response in patients receiving NACT. The aim of this study was to determine the clinical utility of MRI in accurately predicting pCR post-NACT. METHODS A single-centre, retrospective study was conducted in breast cancer patients, who received NACT between 2013 and 2020. Patients who had an MRI before and after NACT were included. Pathological and MRI radiological response rates to NACT were analyzed and MRI accuracy assessed in detecting pCR according to breast cancer subtype. RESULTS One hundred and sixty-seven patients were included in the study. Forty-one of the 167 patients achieved pCR (24.6 %), with the highest proportion in HR- HER2+ subgroup (58.3 %), followed by triple negative breast cancer (TNBC) (35 %). Only 22.2 % and 10.5 % of patients with HR + HER2+ and HR + HER2-respectively achieved pCR. The overall accuracy of MRI in predicting pCR after NACT was 77.3 %. The greatest accuracy was in TNBC (87.5 %) with a specificity and positive predictive value (PPV) of 100 % and the highest number of correctly diagnosed complete responses (14 of 40). MRI was less accurate in predicting response rates in HR + HER2- (PPV 91.2 %) and HR + HER2+ groups (PPV 90.5 %). MRI performed significantly better in predicting complete response in TNBC compared to HR + HER2-subtype (p = 0.0057). CONCLUSION MRI is a clinically useful adjunct in assessing pCR following NACT and appears to predict pathological response more accurately in TNBC compared to HR + HER2-breast cancer subtypes. This has significant clinical implications in terms of surgical planning, adjuvant treatment options and prognosis.
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Affiliation(s)
- Miroslava Kuzmova
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland.
| | - Carolyn Cullinane
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Claire Rutherford
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Damian McCartan
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Jane Rothwell
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Denis Evoy
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - James Geraghty
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Ruth S Prichard
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Dublin 4, Ireland
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Morimoto-Ishikawa D, Hanaoka K, Watanabe S, Yamada T, Yamakawa Y, Minagawa S, Takenouchi S, Ohtani A, Mizuta T, Kaida H, Ishii K. Evaluation of the performance of a high-resolution time-of-flight PET system dedicated to the head and breast according to NEMA NU 2-2012 standard. EJNMMI Phys 2022; 9:88. [PMID: 36525103 PMCID: PMC9758266 DOI: 10.1186/s40658-022-00518-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study evaluated the physical performance of a positron emission tomography (PET) system dedicated to the head and breast according to the National Electrical Manufacturers Association (NEMA) NU2-2012 standard. METHODS The spatial resolution, sensitivity, scatter fraction, count rate characteristics, corrections for count losses and randoms, and image quality of the system were determined. All measurements were performed according to the NEMA NU2-2012 acquisition protocols, but image quality was assessed using a brain-sized phantom. Furthermore, scans of the three-dimensional (3D) Hoffmann brain phantom and mini-Derenzo phantom were acquired to allow visual evaluation of the imaging performance for small structures. RESULTS The tangential, radial, and axial full width at half maximum (FWHM) at a 10-mm offset in half the axial field of view were measured as 2.3, 2.5, and 2.9 mm, respectively. The average system sensitivity at the center of the field of view and at a 10-cm radial offset was 7.18 and 8.65 cps/kBq, respectively. The peak noise-equivalent counting rate was 35.2 kcps at 4.8 kBq/ml. The corresponding scatter fraction at the peak noise-equivalent counting rate was 46.8%. The peak true rate and scatter fraction at 8.6 kBq/ml were 127.8 kcps and 54.3%, respectively. The percent contrast value for a 10-mm sphere was approximately 50%. On the 3D Hoffman brain phantom image, the structures of the thin layers composing the phantom were visualized on the sagittal and coronal images. On the mini-Derenzo phantom, each of the 1.6-mm rods was clearly visualized. CONCLUSION Taken together, these results indicate that the head- and breast-dedicated PET system has high resolution and is well suited for clinical PET imaging.
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Affiliation(s)
- Daisuke Morimoto-Ishikawa
- grid.413111.70000 0004 0466 7515Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Kindai University Hospital, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511 Japan
| | - Kohei Hanaoka
- grid.413111.70000 0004 0466 7515Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Kindai University Hospital, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511 Japan
| | - Shota Watanabe
- grid.413111.70000 0004 0466 7515Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Kindai University Hospital, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511 Japan
| | - Takahiro Yamada
- grid.413111.70000 0004 0466 7515Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Kindai University Hospital, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511 Japan
| | - Yoshiyuki Yamakawa
- grid.274249.e0000 0004 0571 0853Medical Systems Division, Shimadzu Corporation, Kyoto, Japan
| | - Suzuka Minagawa
- grid.274249.e0000 0004 0571 0853Medical Systems Division, Shimadzu Corporation, Kyoto, Japan
| | - Shiho Takenouchi
- grid.274249.e0000 0004 0571 0853Medical Systems Division, Shimadzu Corporation, Kyoto, Japan
| | - Atsushi Ohtani
- grid.274249.e0000 0004 0571 0853Medical Systems Division, Shimadzu Corporation, Kyoto, Japan
| | - Tetsuro Mizuta
- grid.274249.e0000 0004 0571 0853Medical Systems Division, Shimadzu Corporation, Kyoto, Japan
| | - Hayato Kaida
- grid.413111.70000 0004 0466 7515Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Kindai University Hospital, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511 Japan ,grid.258622.90000 0004 1936 9967Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kazunari Ishii
- grid.413111.70000 0004 0466 7515Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Kindai University Hospital, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511 Japan ,grid.258622.90000 0004 1936 9967Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Japan
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Evaluation of a High-Sensitivity Organ-Targeted PET Camera. SENSORS 2022; 22:s22134678. [PMID: 35808181 PMCID: PMC9269056 DOI: 10.3390/s22134678] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/05/2023]
Abstract
The aim of this study is to evaluate the performance of the Radialis organ-targeted positron emission tomography (PET) Camera with standardized tests and through assessment of clinical-imaging results. Sensitivity, count-rate performance, and spatial resolution were evaluated according to the National Electrical Manufacturers Association (NEMA) NU-4 standards, with necessary modifications to accommodate the planar detector design. The detectability of small objects was shown with micro hotspot phantom images. The clinical performance of the camera was also demonstrated through breast cancer images acquired with varying injected doses of 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (18F-FDG) and qualitatively compared with sample digital full-field mammography, magnetic resonance imaging (MRI), and whole-body (WB) PET images. Micro hotspot phantom sources were visualized down to 1.35 mm-diameter rods. Spatial resolution was calculated to be 2.3 ± 0.1 mm for the in-plane resolution and 6.8 ± 0.1 mm for the cross-plane resolution using maximum likelihood expectation maximization (MLEM) reconstruction. The system peak noise equivalent count rate was 17.8 kcps at a 18F-FDG concentration of 10.5 kBq/mL. System scatter fraction was 24%. The overall efficiency at the peak noise equivalent count rate was 5400 cps/MBq. The maximum axial sensitivity achieved was 3.5%, with an average system sensitivity of 2.4%. Selected results from clinical trials demonstrate capability of imaging lesions at the chest wall and identifying false-negative X-ray findings and false-positive MRI findings, even at up to a 10-fold dose reduction in comparison with standard 18F-FDG doses (i.e., at 37 MBq or 1 mCi). The evaluation of the organ-targeted Radialis PET Camera indicates that it is a promising technology for high-image-quality, low-dose PET imaging. High-efficiency radiotracer detection also opens an opportunity to reduce administered doses of radiopharmaceuticals and, therefore, patient exposure to radiation.
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Hruska CB, Corion C, de Geus-Oei LF, Adrada BE, Fowler AM, Hunt KN, Kappadath SC, Pilkington P, Arias-Bouda LMP, Rauch GM. SNMMI Procedure Standard/EANM Practice Guideline for Molecular Breast Imaging with Dedicated γ-Cameras. J Nucl Med Technol 2022. [DOI: 10.2967/jnmt.121.264204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Physiological background parenchymal uptake of 18F-FDG in normal breast tissues using dedicated breast PET: correlation with mammographic breast composition, menopausal status, and menstrual cycle. Ann Nucl Med 2022; 36:728-735. [PMID: 35610443 DOI: 10.1007/s12149-022-01754-4] [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: 02/22/2022] [Accepted: 05/08/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to quantitatively evaluate the effects of age, mammographic density, menopausal status, and menstrual cycle on background parenchymal uptake (BPU) using ring-shaped dedicated breast positron emission tomography (dbPET). METHODS This study included 186 adult women who underwent mammography and dbPET on the same day and had no abnormalities classified as Breast Imaging Reporting and Data System (BI-RADS) category 1 on both examinations. The volume of interest (VOI) was placed in the glandular tissue of both breasts, and the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and metabolic breast volume (MBV) were measured as indicators of BPU. We analyzed the correlation between BPU and age, mammographic density, menopausal status, and menstrual cycle. RESULTS The SUVmax and SUVmean for normal breast tissue were inversely correlated with age (both p < 0.001). The SUVmax, SUVmean, and MBV of mammographically dense breast tissues were significantly higher than those of non-dense breast tissues (all p < 0.001). The SUVmax, SUVmean, and MBV of normal breast tissue in premenopausal women were significantly higher than those in postmenopausal women (p < 0.001, p < 0.001, p = 0.002, respectively). In the study, 59 premenopausal women, the SUVmax of normal breast tissue in the menstrual-follicular phase was significantly lower than that in the periovulatory-luteal phase (p = 0.02). When we sorted the premenopausal women by mammographic breast composition, the SUVmax and SUVmean of normal breast tissues in the menstrual-follicular phase were significantly lower than those in the periovulatory-luteal phase in the 44 premenopausal women with dense breasts (p = 0.007, and p = 0.038, respectively), whereas no statistically significant difference was found between the menstrual-follicular phase and the periovulatory-luteal phase in the 15 premenopausal women with non-dense breasts. CONCLUSIONS BPU in normal breast tissues assessed using ring-shaped dbPET was associated with mammographic density, menopausal status, and women's menstrual cycle. The menstrual cycle was significantly associated with BPU in premenopausal women with dense breasts but not in women with non-dense breasts.
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Sasada S, Masumoto N, Emi A, Kadoya T, Okada M. Malignant prediction of incidental findings using ring-type dedicated breast positron emission tomography. Sci Rep 2022; 12:1144. [PMID: 35064184 PMCID: PMC8782852 DOI: 10.1038/s41598-022-05166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/06/2022] [Indexed: 11/09/2022] Open
Abstract
The classification according to uptake patterns and metabolic parameters on ring-type dedicated breast positron emission tomography (dbPET) is useful for detecting breast cancer. This study investigated the performance of dbPET for incidental findings that were not detected by mammography and ultrasonography. In 1,076 patients with breast cancer who underwent dbPET, 276 findings were incidentally diagnosed before treatment. Each finding was categorized as focus (uptake size ≤ 5 mm), mass (> 5 mm), or non-mass (multiple uptake) according to uptake patterns. Non-mass uptakes were additionally classified based on their distributions as-linear, focal, segmental, regional, or diffuse. Thirty-two findings (11.6%) were malignant and 244 (88.4%) were benign. Visually, 227 (82.3%) findings were foci, 7 (2.5%) were masses, and 42 (15.2%) were non-masses. Malignant rates of focus, mass, and non-mass were 9.7%, 28.6%, and 19.0%, respectively. In the non-mass findings, 23 were regional and diffuse distributions, and presented as benign lesions. Focus uptake with low lesion-to-background ratio (LBR) and no hereditary risk were relatively low (2.7%) in breast cancer. In multivariate analysis, LBR and hereditary risk were significantly associated with breast cancer (p = 0.006 and p = 0.013, respectively). Uptake patterns, LBR, and hereditary risk are useful for predicting breast cancer risk in incidental dbPET findings.
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Affiliation(s)
- Shinsuke Sasada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551, Japan.
| | - Norio Masumoto
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Akiko Emi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Takayuki Kadoya
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-8551, Japan
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7
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Tokuda Y, Yanagawa M, Fujita Y, Honma K, Tanei T, Shimoda M, Miyake T, Naoi Y, Kim SJ, Shimazu K, Hamada S, Tomiyama N. Prediction of pathological complete response after neoadjuvant chemotherapy in breast cancer: comparison of diagnostic performances of dedicated breast PET, whole-body PET, and dynamic contrast-enhanced MRI. Breast Cancer Res Treat 2021; 188:107-115. [PMID: 33730265 DOI: 10.1007/s10549-021-06179-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/03/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE To compare the diagnostic performance of ring-type dedicated breast PET (dbPET), whole-body PET (WBPET), and DCE-MRI for predicting pathological complete response (pCR) after neoadjuvant chemotherapy (NAC). METHODS This prospective study included 29 women with histologically proven breast cancer on needle biopsy between July 2016 and July 2019 (age: mean 55 years; range 35-78). Patients underwent WBPET followed by ring-type dbPET and DCE-MRI pre- and post-NAC for preoperative evaluation. pCR was defined as an invasive tumor that disappeared in the breast. Standardized uptake values corrected for lean body mass (SULpeak) were calculated for dbPET and WBPET scans. Maximum tumor length was measured in DCE-MRI images. Reduction rates were calculated for quantitative evaluation. Two radiologists independently evaluated the qualitative findings. Reduction rates and qualitative findings were compared between the pCR (n = 7) and non-pCR (n = 22) groups for each modality. Differences in quantitative and qualitative data between the two groups were analyzed statistically. RESULTS Significant differences were observed in the reduction rates of dbPET and DCE-MRI (P = 0.01 and 0.03, respectively) between the two groups. Univariate and multiple logistic regression analyses revealed that SULpeak reduction rates in WBPET and dbPET (P = 0.02 and P = 0.01, respectively) and in dbPET (odds ratio, 16.00; 95% CI 1.57-162.10; P = 0.01) were significant indicators associated with pCR, respectively. No between-group differences were observed in qualitative findings in the three modalities. CONCLUSION SULpeak reduction rate of dbPET > 82% was an independent indicator associated with pCR after NAC in breast cancer.
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Affiliation(s)
- Yukiko Tokuda
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
| | - Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Yuka Fujita
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Keiichiro Honma
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
- Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka city, Osaka, 541-8567, Japan
| | - Tomonori Tanei
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Masafumi Shimoda
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Tomohiro Miyake
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Yasuto Naoi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Seung Jin Kim
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Seiki Hamada
- MI Clinic, 1-12-13 Shoji, Toyonaka-shi, Osaka, 560-0004, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
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Sasada S, Kimura Y, Masumoto N, Emi A, Kadoya T, Arihiro K, Okada M. Breast cancer detection by dedicated breast positron emission tomography according to the World Health Organization classification of breast tumors. Eur J Surg Oncol 2021; 47:1588-1592. [PMID: 33685728 DOI: 10.1016/j.ejso.2021.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Considering the difficulty in detecting primary breast cancers using whole-body positron emission tomography (WBPET) owing to its limited spatial resolution, we aimed to evaluate the detectability of breast cancer by ring-type dedicated breast PET (DbPET) on the World Health Organization (WHO) histological classification in comparison with WBPET. METHODS A total of 938 patients with breast cancer underwent WBPET and ring-type DbPET, and 1021 lesions were histologically assessed based on the WHO classification of tumors of the breast. The findings of WBPET and DbPET were retrospectively evaluated and compared. RESULTS The size-related sensitivity of DbPET was superior to that of WBPET for subcentimetric tumors (81.9% vs. 52.4%, P < 0.001). The histological distribution was as follows: 11 lobular carcinoma in situ, 158 ductal carcinoma in situ, 738 infiltrating duct carcinoma not otherwise specified (NOS), 12 lobular carcinoma NOS, 40 mucinous adenocarcinoma, 13 tubular carcinoma, 36 invasive breast carcinoma others, and 13 papillary neoplasms. WBPET had low sensitivity for lobular carcinoma in situ, ductal carcinoma in situ, lobular carcinoma NOS, mucinous adenocarcinoma, and tubular carcinoma. DbPET showed improved sensitivity for all the above except lobular and tubular carcinoma. The maximum standardized uptake values (SUVmax) of DbPET were significantly higher than those of WBPET for histological types, excluding lobular carcinoma in situ. The SUVmax of papillary neoplasms was high regardless of low-grade histology and Ki-67 labeling index. CONCLUSIONS DBPET was found to have high sensitivity and SUVmax values for all histologic types that showed low sensitivity of detection on WBPET, except lobular carcinoma in situ.
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Affiliation(s)
- Shinsuke Sasada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
| | - Yuri Kimura
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Norio Masumoto
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Akiko Emi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Takayuki Kadoya
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Satoh Y, Kawamoto M, Kubota K, Murakami K, Hosono M, Senda M, Sasaki M, Momose T, Ito K, Okamura T, Oda K, Kuge Y, Sakurai M, Tateishi U, Fujibayashi Y, Magata Y, Yoshida T, Waki A, Kato K, Hashimoto T, Uchiyama M, Kinuya S, Higashi T, Magata Y, Machitori A, Maruno H, Minamimoto R, Yoshinaga K. Clinical practice guidelines for high-resolution breast PET, 2019 edition. Ann Nucl Med 2021; 35:406-414. [PMID: 33492646 PMCID: PMC7902575 DOI: 10.1007/s12149-021-01582-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 02/08/2023]
Abstract
Breast positron emission tomography (PET) has had insurance coverage when performed with conventional whole-body PET in Japan since 2013. Together with whole-body PET, accurate examination of breast cancer and diagnosis of metastatic disease are possible, and are expected to contribute significantly to its treatment planning. To facilitate a safer, smoother, and more appropriate examination, the Japanese Society of Nuclear Medicine published the first edition of practice guidelines for high-resolution breast PET in 2013. Subsequently, new types of breast PET have been developed and their clinical usefulness clarified. Therefore, the guidelines for breast PET were revised in 2019. This article updates readers as to what is new in the second edition. This edition supports two different types of breast PET depending on the placement of the detector: the opposite-type (positron emission mammography; PEM) and the ring-shaped type (dedicated breast PET; dbPET), providing an overview of these scanners and appropriate imaging methods, their clinical applications, and future prospects. The name "dedicated breast PET" from the first edition is widely used to refer to ring-shaped type breast PET. In this edition, "breast PET" has been defined as a term that refers to both opposite- and ring-shaped devices. Up-to-date breast PET practice guidelines would help provide useful information for evidence-based breast imaging.
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Affiliation(s)
- Yoko Satoh
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan.
- Yamanashi PET Imaging Clinic, Shimokato 3046-2, Chuo City, Yamanashi Prefecture, 409-3821, Japan.
| | - Masami Kawamoto
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | | | - Koji Murakami
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Makoto Hosono
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Michio Senda
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Masayuki Sasaki
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Toshimitsu Momose
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Kengo Ito
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Terue Okamura
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Keiichi Oda
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Yuji Kuge
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Minoru Sakurai
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Ukihide Tateishi
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Yasuhisa Fujibayashi
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Yasuhiro Magata
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Takeshi Yoshida
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Atsuo Waki
- PET Nuclear Medicine Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Katsuhiko Kato
- Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Teisuke Hashimoto
- Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Mayuki Uchiyama
- Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Seigo Kinuya
- Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Tatsuya Higashi
- Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Yasuhiro Magata
- Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Akihiro Machitori
- Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Hirotaka Maruno
- Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Ryogo Minamimoto
- Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
| | - Keiichiro Yoshinaga
- Health Insurance Committee, Japanese Society of Nuclear Medicine, Tokyo, Japan
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Rietbergen DD, VAN Oosterom MN, Kleinjan GH, Brouwer OR, Valdes-Olmos RA, VAN Leeuwen FW, Buckle T. Interventional nuclear medicine: a focus on radioguided intervention and surgery. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:4-19. [PMID: 33494584 DOI: 10.23736/s1824-4785.21.03286-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Within interventional nuclear medicine (iNM) a prominent role is allocated for the sub-discipline of radioguided surgery. Unique for this discipline is the fact that an increasing number of clinical indications (e.g. lymphatic mapping, local tumor demarcation and/or tumor receptor targeted applications) have been adopted into routine care. The clinical integration is further strengthened by technical innovations in chemistry and engineering that enhance the translational potential of radioguided procedures in iNM. Together, these features not only ensure ongoing expansion of iNM but also warrant a lasting clinical impact for the sub-discipline of radioguided surgery.
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Affiliation(s)
- Daphne D Rietbergen
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N VAN Oosterom
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Gijs H Kleinjan
- Department of Urology, Leiden University Medical Center, Leiden, the Netherlands
| | - Oscar R Brouwer
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Renato A Valdes-Olmos
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W VAN Leeuwen
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Tessa Buckle
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands - .,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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Satoh Y, Motosugi U, Imai M, Omiya Y, Onishi H. Evaluation of image quality at the detector's edge of dedicated breast positron emission tomography. EJNMMI Phys 2021; 8:5. [PMID: 33462645 PMCID: PMC7813900 DOI: 10.1186/s40658-020-00351-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Using phantoms and clinical studies in prone hanging breast imaging, we assessed the image quality of a commercially available dedicated breast PET (dbPET) at the detector's edge, where mammary glands near the chest wall are located. These are compared to supine PET/CT breast images of the same clinical subjects. METHODS A breast phantom with four spheres (16-, 10-, 7.5-, and 5-mm diameter) was filled with 18F-fluorodeoxyglucose solution (sphere-to-background activity concentration ratio, 8:1). The spheres occupied five different positions from the top edge to the centre of the detector and were scanned for 5 min in each position. Reconstructed images were visually evaluated, and the contrast-to-noise ratio (CNR), contrast recovery coefficient (CRC) for all spheres, and coefficient of variation of the background (CVB) were calculated. Subsequently, clinical images obtained with standard supine PET/CT and prone dbPET were retrospectively analysed. Tumour-to-background ratios (TBRs) between breast cancer near the chest wall (close to the detector's edge; peripheral group) and at other locations (non-peripheral group) were compared. The TBR of each lesion was compared between dbPET and PET/CT. RESULTS Closer to the detector's edge, the CNR and CRC of all spheres decreased while the CVB increased in the phantom study. The disadvantages of this placement were visually confirmed. Regarding clinical images, TBR of dbPET was significantly higher than that of PET/CT in both the peripheral (12.38 ± 6.41 vs 6.73 ± 3.5, p = 0.0006) and non-peripheral (12.44 ± 5.94 vs 7.71 ± 7.1, p = 0.0183) groups. There was no significant difference in TBR of dbPET between the peripheral and non-peripheral groups. CONCLUSION The phantom study revealed poorer image quality at < 2-cm distance from the detector's edge than at other more central parts. In clinical studies, however, the visibility of breast lesions with dbPET was the same regardless of the lesion position, and it was higher than that in PET/CT. dbPET has a great potential for detecting breast lesions near the chest wall if they are at least 2 cm from the edge of the FOV, even in young women with small breasts.
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Affiliation(s)
- Yoko Satoh
- Yamanashi PET Imaging Clinic, Shimokato 3046-2, Chuo City, Yamanashi Prefecture, 409-3821, Japan. .,Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan.
| | - Utaroh Motosugi
- Department of Radiology, Kofu-kyoritsu Hospital, Kofu City, Yamanashi Prefecture, Japan
| | - Masamichi Imai
- Yamanashi PET Imaging Clinic, Shimokato 3046-2, Chuo City, Yamanashi Prefecture, 409-3821, Japan
| | - Yoshie Omiya
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
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12
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Molecular Breast Cancer Imaging in the Era of Precision Medicine. AJR Am J Roentgenol 2020; 215:1512-1519. [DOI: 10.2214/ajr.20.22883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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13
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Emami A, Ghadiri H, Ghafarian P, Geramifar P, Ay MR. Performance evaluation of developed dedicated breast PET scanner and improvement of the spatial resolution by wobbling: a Monte Carlo study. Jpn J Radiol 2020; 38:790-799. [PMID: 32253654 DOI: 10.1007/s11604-020-00966-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/26/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Molecular imaging, particularly PET scanning, has become an important cancer diagnostic tool. Whole-body PET is not effective for local staging of cancer because of their declining efficiency in detecting small lesions. The preliminary results of the performance evaluation of designed dedicated breast PET scanner presented. METHODS AND MATERIALS A new scanner is based on LYSO crystals coupled with SiPM, and it consists of 14 compact modules with a transaxial FOV of 180 mm in diameter. In this study, initial GATE simulation studies were performed to predict the spatial resolution, absolute sensitivity, noise equivalent count rate (NECR) and scatter fraction (SF) of the new design. Spatial wobbling acquisitions were also implemented. Finally, the obtained projections were reconstructed using analytical and iterative algorithms. RESULTS The simulation results indicate that absolute sensitivity is 1.42% which is appropriate than other commercial breast PET systems. The calculated SF and NECR in our design are 20.6% and 21.8 kcps. The initial simulation results demonstrate the potential of this design for breast cancer detection. A small wobble motion to improve spatial resolution and contrast. CONCLUSION The performance of the dedicated breast PET scanner is considered to be reasonable enough to support its use in breast cancer imaging.
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Affiliation(s)
- Azadeh Emami
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Sina Campus, Tehran, 1417613151, Iran.,International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghadiri
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Sina Campus, Tehran, 1417613151, Iran.
| | - Pardis Ghafarian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,PET/CT and Cyclotron Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Parham Geramifar
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Ay
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Sina Campus, Tehran, 1417613151, Iran.
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Grabher BJ. Breast Cancer: Evaluating Tumor Estrogen Receptor Status with Molecular Imaging to Increase Response to Therapy and Improve Patient Outcomes. J Nucl Med Technol 2020; 48:191-201. [DOI: 10.2967/jnmt.119.239020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/15/2020] [Indexed: 11/16/2022] Open
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15
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Multiple Bilateral Circumscribed Breast Masses Detected at Imaging: Review of Evidence for Management Recommendations. AJR Am J Roentgenol 2019; 214:276-281. [PMID: 31825259 DOI: 10.2214/ajr.19.22061] [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] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Historically, management recommendations for multiple bilateral circumscribed breast masses encountered with breast imaging have varied. This article reviews the evidence and provides best-practice recommendations for managing these masses. CONCLUSION. Meticulous imaging technique and interpretation are required to correctly diagnose multiple bilateral circumscribed breast masses. Radiologists should classify such masses identified at mammography, digital breast tomosynthesis, or bilateral whole-breast sonography as benign and recommend annual follow-up. Elucidating the significance of these masses on MRI, contrast-enhanced mammography, or nuclear breast imaging requires further study.
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16
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Satoh Y, Sekine T, Omiya Y, Onishi H, Motosugi U. Reduction of the fluorine-18-labeled fluorodeoxyglucose dose for clinically dedicated breast positron emission tomography. EJNMMI Phys 2019; 6:21. [PMID: 31784863 PMCID: PMC6884607 DOI: 10.1186/s40658-019-0256-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To determine the clinically acceptable level of reduction in the injected fluorine-18 (18F)-labeled fluorodeoxyglucose (18F-FDG) dose in dedicated breast positron emission tomography (dbPET). METHODS A breast phantom with four spheres exhibiting various diameters (5, 7.5, 10, and 16 mm), a background 18F-FDG radioactivity of 2.28 kBq/mL, and a sphere-to-background radioactivity ratio of 8:1 was used. True dose-reduced dbPET images were obtained by data acquisition for 20 min in list mode at multiple time points over 7 h of radioactive decay. Simulated dose-reduced images were generated by reconstruction with a portion of the list mode acquisition data. True and simulated dose-reduced images were visually and quantitatively compared. On the basis of the phantom study, dbPET images for 32 breasts of 28 women with abnormal uptake were generated after simulated reduction of the injected 18F-FDG doses; these images were compared with those acquired using current clinical doses. RESULTS There were no qualitative differences between true and simulated dose-reduced phantom images. The phantom study revealed that the minimal required dose was 12.5% for the detection of 5-mm spheres and 25% for precise semi-quantification of FDG in the spheres. The 7-min reconstruction with a 100% dose was defined as the reference for the clinical study. The image quality and lesion conspicuity were clinically acceptable for the 25% dose images. Lesion detectability on the 12.5% dose images was maintained despite image quality degradation. CONCLUSIONS In summary, 25% of the standard 18F-FDG dose for dbPET can provide a clinically acceptable image quality, while 12.5% of the standard dose results in acceptable quality in terms of lesion detection when lesions are located at a sufficient distance from the edge of the dbPET detector.
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Affiliation(s)
- Yoko Satoh
- Yamanashi PET Imaging Clinic, Shimokato 3046-2, Chuo City, Yamanashi Prefecture, 409-3821, Japan. .,Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan.
| | - Tetsuro Sekine
- Department of Radiology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Yoshie Omiya
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
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Satoh Y, Motosugi U, Imai M, Onishi H. Comparison of dedicated breast positron emission tomography and whole-body positron emission tomography/computed tomography images: a common phantom study. Ann Nucl Med 2019; 34:119-127. [PMID: 31768819 DOI: 10.1007/s12149-019-01422-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE High-resolution dedicated breast positron emission tomography (dbPET) can visualize breast cancer more clearly than whole-body PET/computed tomography (CT). In Japan, the combined use of dbPET and whole-body PET/CT is necessary in indications for health insurance. Although several clinical studies have compared both devices, a physical evaluation by the phantom test has not been reported. The aim of this study was to compare the ability of ring-shaped dbPET and whole-body PET/CT using a common phantom with reference to the Japanese guideline for the oncology 18F-fluorodeoxyglucose (FDG)-PET/CT data acquisition protocol. METHODS A cylindrical breast phantom with four spheres of different diameters (16, 10, 7.5, and 5 mm) filled an FDG solution at sphere-to-background radioactivity ratios (SBRs) of 2:1, 4:1, and 8:1 was prepared. Images were then acquired by whole-body PET/CT and subsequently by dbPET. The reconstructed images were visually evaluated and the coefficient of variation and uniformity of the background (CVbackground and SDΔSUVmean), percentages of contrast and background variability (%QH,5mm and %N5mm), and their ratio (%QH,5mm/N5mm), and relative recovery coefficient were compared with the standards defined in the protocol for whole-body PET/CT. RESULTS The parameters were calculated at an SBR of 8:1, which was the only SBR in which a 5-mm sphere was visible on both devices. The standards were defined as < 10% for CVbackground, ≤ 0.025 for SDΔSUVmean, < 5.6% for %N5mm, > 2.8 for %QH,5mm/N5mm, and > 0.38 for the relative recovery coefficient of the smallest sphere (10 mm in diameter) in the protocol for whole-body PET/CT (the %QH,5mm was not determined for that protocol); the respective values were 6.14%, 0.024, 4.55%, 3.66, and 0.33 for dbPET and 2.21%, 0.021, 3.11%, 1.72, and 0.18 for PET/CT. The QH,5mm was 16.67% for dbPET and 5.34% for PET/CT. The human images also showed higher lesion-to-background contrast on dbPET than on PET/CT despite the noisier background observed with dbPET. CONCLUSION The common phantom study showed that the background was noisier and that the contrast was much higher in the dbPET image than in the PET/CT image. The acquisition protocol and standards for dbPET will need to be different from those used for whole-body PET/CT.
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Affiliation(s)
- Yoko Satoh
- Yamanashi PET Imaging Clinic, Shimokato 3046-2, Chuo, Yamanashi, 409-3821, Japan. .,Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan.
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Masamichi Imai
- Yamanashi PET Imaging Clinic, Shimokato 3046-2, Chuo, Yamanashi, 409-3821, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo, Yamanashi, Japan
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Advanced approaches to imaging primary breast cancer: an update. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sasada S, Shiroma N, Goda N, Kajitani K, Emi A, Masumoto N, Kadoya T, Arihiro K, Okada M. The relationship between ring-type dedicated breast PET and immune microenvironment in early breast cancer. Breast Cancer Res Treat 2019; 177:651-657. [PMID: 31267329 DOI: 10.1007/s10549-019-05339-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 06/27/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) is related to the biological parameters and prognosis of breast cancer. However, whether whole-body PET (WBPET) and dedicated breast PET (DbPET) can reflect the tumor microenvironment is unclear. This study investigated the relationship between stromal tumor-infiltrating lymphocytes (TILs) and maximum standardized uptake value (SUVmax) in WBPET and DbPET. METHODS A total of 125 invasive breast cancers underwent WBPET and ring-type DbPET and resected specimens were pathologically assessed. The impact of SUVmax on the tumor biological parameters and TILs was retrospectively evaluated. SUVmax was classified as high and low relative to the median values (WBPET-SUVmax: 2.2 and DbPET-SUVmax: 6.0). RESULTS SUVmax correlated with tumor size, nuclear grade, Ki-67 labeling index, and TILs in both WBPET and DbPET (all p < 0.001). In multiple linear regression analysis, tumor size, Ki-67 labeling index, and TILs predicted SUVmax in WBPET and DbPET. The cutoff values of tumor size, Ki-67 labeling index, and TILs predicting high SUVmax were 20 mm, 20%, and 20%, respectively. In multivariate analysis, the predictive factors for high SUVmax were tumor size and Ki-67 labeling index for WBPET and tumor size and TILs for DbPET. High SUVmax in DbPET was related to high numbers of TILs after propensity score matching analysis; however, WBPET was not (p = 0.007 and p = 0.624, respectively). CONCLUSIONS Both SUVmax values in WBPET and DbPET predicted TIL concentration of the primary breast cancer. In DbPET, SUVmax represented the immune microenvironment after adjusting for tumor biological factors.
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Affiliation(s)
- Shinsuke Sasada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan.
| | - Noriyuki Shiroma
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Noriko Goda
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Keiko Kajitani
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Akiko Emi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Norio Masumoto
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Takayuki Kadoya
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, Hiroshima, 734-8551, Japan
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Satoh Y, Motosugi U, Omiya Y, Onishi H. Unexpected Abnormal Uptake in the Breasts at Dedicated Breast PET: Incidentally Detected Small Cancers or Nonmalignant Features? AJR Am J Roentgenol 2019; 212:443-449. [DOI: 10.2214/ajr.18.20066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Yoko Satoh
- Yamanashi PET Imaging Clinic, Shimokato 3046-2, Chuo City, Yamanashi, 409-3821, Japan
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi, Japan
| | - Utaroh Motosugi
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi, Japan
| | - Yoshie Omiya
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi, Japan
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Jiang J, Li K, Komarov S, O'Sullivan JA, Tai YC. Feasibility study of a point-of-care positron emission tomography system with interactive imaging capability. Med Phys 2019; 46:1798-1813. [PMID: 30667069 DOI: 10.1002/mp.13397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/26/2018] [Accepted: 01/14/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE We investigated the feasibility of a novel positron emission tomography (PET) system that provides near real-time feedback to an operator who can interactively scan a patient to optimize image quality. The system should be compact and mobile to support point-of-care (POC) molecular imaging applications. In this study, we present the key technologies required and discuss the potential benefits of such new capability. METHODS The core of this novel PET technology includes trackable PET detectors and a fully three-dimensional, fast image reconstruction engine implemented on multiple graphics processing units (GPUs) to support dynamically changing geometry by calculating the system matrix on-the-fly using a tube-of-response approach. With near real-time image reconstruction capability, a POC-PET system may comprise a maneuverable front PET detector and a second detector panel which can be stationary or moved synchronously with the front detector such that both panels face the region-of-interest (ROI) with the detector trajectory contoured around a patient's body. We built a proof-of-concept prototype using two planar detectors each consisting of a photomultiplier tube (PMT) optically coupled to an array of 48 × 48 lutetium-yttrium oxyorthosilicate (LYSO) crystals (1.0 × 1.0 × 10.0 mm3 each). Only 38 × 38 crystals in each arrays can be clearly re-solved and used for coincidence detection. One detector was mounted to a robotic arm which can position it at arbitrary locations, and the other detector was mounted on a rotational stage. A cylindrical phantom (102 mm in diameter, 150 mm long) with nine spherical lesions (8:1 tumor-to-background activity concentration ratio) was imaged from 27 sampling angles. List-mode events were reconstructed to form images without or with time-of-flight (TOF) information. We conducted two Monte Carlo simulations using two POC-PET systems. The first one uses the same phantom and detector setup as our experiment, with the detector coincidence re-solving time (CRT) ranging from 100 to 700 ps full-width-at-half-maximum (FWHM). The second study simulates a body-size phantom (316 × 228 × 160 mm3 ) imaged by a larger POC-PET system that has 4 × 6 modules (32 × 32 LYSO crystals/module, four in axial and six in transaxial directions) in the front panel and 3 × 8 modules (16 × 16 LYSO crystals/module, three in axial and eight in transaxial directions) in the back panel. We also evaluated an interactive scanning strategy by progressively increasing the number of data sets used for image reconstruction. The updated images were analyzed based on the number of data sets and the detector CRT. RESULTS The proof-of-concept prototype re-solves most of the spherical lesions despite a limited number of coincidence events and incomplete sampling. TOF information reduces artifacts in the reconstructed images. Systems with better timing resolution exhibit improved image quality and reduced artifacts. We observed a reconstruction speed of 0.96 × 106 events/s/iteration for 600 × 600 × 224 voxel rectilinear space using four GPUs. A POC-PET system with significantly higher sensitivity can interactively image a body-size object from four angles in less than 7 min. CONCLUSIONS We have developed GPU-based fast image reconstruction capability to support a PET system with arbitrary and dynamically changing geometry. Using TOF PET detectors, we demonstrated the feasibility of a PET system that can provide timely visual feedback to an operator who can scan a patient interactively to support POC imaging applications.
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Affiliation(s)
- Jianyong Jiang
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MI, 63110, USA
| | - Ke Li
- Department of Electrical and Systems Engineering, Washington University in St. Louis, St. Louis, MI, 63130, USA
| | - Sergey Komarov
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MI, 63110, USA
| | - Joseph A O'Sullivan
- Department of Electrical and Systems Engineering, Washington University in St. Louis, St. Louis, MI, 63130, USA
| | - Yuan-Chuan Tai
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MI, 63110, USA
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Dedicated breast PET value to evaluate BI-RADS 4 breast lesions. Eur J Radiol 2018; 108:201-207. [DOI: 10.1016/j.ejrad.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/06/2018] [Accepted: 10/01/2018] [Indexed: 11/18/2022]
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Which type of breast cancers is undetectable on ring-type dedicated breast PET? Clin Imaging 2018; 51:186-191. [DOI: 10.1016/j.clinimag.2018.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/04/2018] [Accepted: 05/21/2018] [Indexed: 01/24/2023]
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Sampaio Vieira T, Borges Faria D, Souto Moura C, Francisco E, Barroso S, Pereira de Oliveira J. Incidental finding of a breast carcinoma on Ga-68-DOTA-1-Nal3-octreotide positron emission tomography/computed tomography performed for the evaluation of a pancreatic neuroendocrine tumor: A case report. Medicine (Baltimore) 2018; 97:e11878. [PMID: 30200073 PMCID: PMC6133576 DOI: 10.1097/md.0000000000011878] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Functional imaging using radiolabeled somatostatin analogues plays an important role in the management of patients with neuroendocrine tumors, and it is a promising tool in the new era of theragnosis and personalized medicine. PATIENTS CONCERNS The authors present the case of a 63-year-old woman referred for evaluation of a suspected pancreatic neuroendocrine tumor by Ga-68-DOTA-1-Nal3-octreotide positron emission tomography/computed tomography (Ga-68-DOTA-NOC PET/CT). DIAGNOSES PET/CT confirmed increased uptake of Ga-68-DOTA-NOC in a pancreatic lesion compatible with hyperexpression of somatostatin receptors in a neuroendocrine tumor. Furthermore, PET/CT revealed increased uptake in a breast lesion and in lymphadenomegalies (less intense than in the pancreatic tumor), which conducted to the incidental diagnosis of a breast carcinoma with lymph node metastases. INTERVENTIONS For the breast cancer, the patient underwentneoadjuvant chemotherapy and anti-HER2 monoclonal antibody, after which she was submitted to surgery. Regarding thepancreatic neuroendocrine tumor, it was decided to maintain itunder surveillance. OUTCOMES Breast carcinomas are known to express somatostatin receptors and this is the first report of Ga-68-DOTA-NOC uptake in a breast tumor. LESSONS Ga-68-DOTA-NOC PET/CT could be useful for the management of breast cancer patients in the new era of theragnosis and personalized medicine.
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Affiliation(s)
| | - Diogo Borges Faria
- HPP - Medicina Molecular SA; Lenitudes Medical Center & Research; School of Health Sciences - University of Aveiro
| | | | - Elsa Francisco
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Sérgio Barroso
- HPP - Medicina Molecular SA; Lenitudes Medical Center & Research
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Intratumoral heterogeneity on dedicated breast positron emission tomography predicts malignancy grade of breast cancer. Breast Cancer Res Treat 2018; 171:315-323. [DOI: 10.1007/s10549-018-4791-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 01/02/2023]
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van Roosmalen J, Beekman FJ, Goorden MC. Comparison of fan beam, slit-slat and multi-pinhole collimators for molecular breast tomosynthesis. Phys Med Biol 2018; 63:105009. [PMID: 29676285 DOI: 10.1088/1361-6560/aabfa3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Recently, we proposed and optimized dedicated multi-pinhole molecular breast tomosynthesis (MBT) that images a lightly compressed breast. As MBT may also be performed with other types of collimators, the aim of this paper is to optimize MBT with fan beam and slit-slat collimators and to compare its performance to that of multi-pinhole MBT to arrive at a truly optimized design. Using analytical expressions, we first optimized fan beam and slit-slat collimator parameters to reach maximum sensitivity at a series of given system resolutions. Additionally, we performed full system simulations of a breast phantom containing several tumours for the optimized designs. We found that at equal system resolution the maximum achievable sensitivity increases from pinhole to slit-slat to fan beam collimation with fan beam and slit-slat MBT having on average a 48% and 20% higher sensitivity than multi-pinhole MBT. Furthermore, by inspecting simulated images and applying a tumour-to-background contrast-to-noise (TB-CNR) analysis, we found that slit-slat collimators underperform with respect to the other collimator types. The fan beam collimators obtained a similar TB-CNR as the pinhole collimators, but the optimum was reached at different system resolutions. For fan beam collimators, a 6-8 mm system resolution was optimal in terms of TB-CNR, while with pinhole collimation highest TB-CNR was reached in the 7-10 mm range.
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Affiliation(s)
- Jarno van Roosmalen
- Section Radiation, Detection and Medical Imaging, Delft University of Technology, Delft, Netherlands
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Novel light-guide-PMT geometries to reduce dead edges of a scintillation camera. Phys Med 2018; 48:84-90. [DOI: 10.1016/j.ejmp.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/04/2018] [Indexed: 11/18/2022] Open
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Sasada S, Masumoto N, Goda N, Kajitani K, Emi A, Kadoya T, Okada M. Dedicated breast PET for detecting residual disease after neoadjuvant chemotherapy in operable breast cancer: A prospective cohort study. Eur J Surg Oncol 2018; 44:444-448. [DOI: 10.1016/j.ejso.2018.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/10/2017] [Accepted: 01/07/2018] [Indexed: 11/15/2022] Open
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van Roosmalen J, Beekman FJ, Goorden MC. System geometry optimization for molecular breast tomosynthesis with focusing multi-pinhole collimators. Phys Med Biol 2017; 63:015018. [PMID: 28994663 DOI: 10.1088/1361-6560/aa9265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Imaging of 99mTc-labelled tracers is gaining popularity for detecting breast tumours. Recently, we proposed a novel design for molecular breast tomosynthesis (MBT) based on two sliding focusing multi-pinhole collimators that scan a modestly compressed breast. Simulation studies indicate that MBT has the potential to improve the tumour-to-background contrast-to-noise ratio significantly over state-of-the-art planar molecular breast imaging. The aim of the present paper is to optimize the collimator-detector geometry of MBT. Using analytical models, we first optimized sensitivity at different fixed system resolutions (ranging from 5 to 12 mm) by tuning the pinhole diameters and the distance between breast and detector for a whole series of automatically generated multi-pinhole designs. We evaluated both MBT with a conventional continuous crystal detector with 3.2 mm intrinsic resolution and with a pixelated detector with 1.6 mm pixels. Subsequently, full system simulations of a breast phantom containing several lesions were performed for the optimized geometry at each system resolution for both types of detector. From these simulations, we found that tumour-to-background contrast-to-noise ratio was highest for systems in the 7 mm-10 mm system resolution range over which it hardly varied. No significant differences between the two detector types were found.
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Affiliation(s)
- Jarno van Roosmalen
- Section Biomedical Imaging, Delft University of Technology, Delft, Netherlands
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Wang B, van Roosmalen J, Piët L, van Schie MA, Beekman FJ, Goorden MC. Voxelized ray-tracing simulation dedicated to multi-pinhole molecular breast tomosynthesis. Biomed Phys Eng Express 2017. [DOI: 10.1088/2057-1976/aa8012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Role of Runx2 in breast cancer-mediated bone metastasis. Int J Biol Macromol 2017; 99:608-614. [PMID: 28268169 DOI: 10.1016/j.ijbiomac.2017.03.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/21/2022]
Abstract
Breast cancer is one of the most prevalent forms of cancer in women. The currently available treatment for breast cancer is mostly curative except when it becomes metastatic. One of the major sites for metastasis of breast cancer is the bone. Homing of the circulating tumor cells is tightly regulated including a number of factors present in the cells and their microenvironment. Runx2, a transcription factor plays an important role in osteogenesis and breast cancer mediated bone metastases. One of the recent advances in molecular therapy includes the discovery of the small, non-coding microRNAs (miRNAs) and they target specific genes to reduce their expression at the post-transcriptional level. This review provides an outline of breast cancer mediated bone metastasis and summarizes the recent development on the regulation of Runx2 expression by miRNAs which can lead to novel molecular therapeutics for the same.
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García Hernández T, Vicedo González A, Ferrer Rebolleda J, Sánchez Jurado R, Roselló Ferrando J, Brualla González L, Granero Cabañero D, Del Puig Cozar Santiago M. Performance evaluation of a high resolution dedicated breast PET scanner. Med Phys 2017; 43:2261. [PMID: 27147338 DOI: 10.1118/1.4945271] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Early stage breast cancers may not be visible on a whole-body PET scan. To overcome whole-body PET limitations, several dedicated breast positron emission tomography (DbPET) systems have emerged nowadays aiming to improve spatial resolution. In this work the authors evaluate the performance of a high resolution dedicated breast PET scanner (Mammi-PET, Oncovision). METHODS Global status, uniformity, sensitivity, energy, and spatial resolution were measured. Spheres of different sizes (2.5, 4, 5, and 6 mm diameter) and various 18 fluorodeoxyglucose ((18)F-FDG) activity concentrations were randomly inserted in a gelatine breast phantom developed at our institution. Several lesion-to-background ratios (LBR) were simulated, 5:1, 10:1, 20:1, 30:1, and 50:1. Images were reconstructed using different voxel sizes. The ability of experienced reporters to detect spheres was tested as a function of acquisition time, LBR, sphere size, and matrix reconstruction voxel size. For comparison, phantoms were scanned in the DbPET camera and in a whole body PET (WB-PET). Two patients who just underwent WB-PET/CT exams were imaged with the DbPET system and the images were compared. RESULTS The measured absolute peak sensitivity was 2.0%. The energy resolution was 24.0% ± 1%. The integral and differential uniformity were 10% and 6% in the total field of view (FOV) and 9% and 5% in the central FOV, respectively. The measured spatial resolution was 2.0, 1.9, and 1.7 mm in the radial, tangential, and axial directions. The system exhibited very good detectability for spheres ≥4 mm and LBR ≥10 with a sphere detection of 100% when acquisition time was set >3 min/bed. For LBR = 5 and acquisition time of 7 min the detectability was 100% for spheres of 6 mm and 75% for spheres of 5, 4, and 2.5 mm. Lesion WB-PET detectability was only comparable to the DbPET camera for lesion sizes ≥5 mm when acquisition time was >3 min and LBR > 10. CONCLUSIONS The DbPET has a good performance for its clinical use and shows an improved resolution and lesion detectability of small lesions compared to WB-PET.
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Affiliation(s)
| | - Aurora Vicedo González
- Department of Medical Physics, ERESA, Hospital General Universitario, Valencia 46014, Spain
| | - Jose Ferrer Rebolleda
- Department of Nuclear Medicine, ERESA, Hospital General Universitario, Valencia 46014, Spain
| | - Raúl Sánchez Jurado
- Department of Nuclear Medicine, ERESA, Hospital General Universitario, Valencia 46014, Spain
| | - Joan Roselló Ferrando
- Department of Medical Physics, ERESA, Hospital General Universitario, Valencia 46014, Spain and Department of Physiology, University of Valencia, Valencia 46010, Spain
| | - Luis Brualla González
- Department of Medical Physics, ERESA, Hospital General Universitario, Valencia 46014, Spain
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van Roosmalen J, Goorden MC, Beekman FJ. Molecular breast tomosynthesis with scanning focus multi-pinhole cameras. Phys Med Biol 2016; 61:5508-28. [PMID: 27384301 DOI: 10.1088/0031-9155/61/15/5508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Planar molecular breast imaging (MBI) is rapidly gaining in popularity in diagnostic oncology. To add 3D capabilities, we introduce a novel molecular breast tomosynthesis (MBT) scanner concept based on multi-pinhole collimation. In our design, the patient lies prone with the pendant breast lightly compressed between transparent plates. Integrated webcams view the breast through these plates and allow the operator to designate the scan volume (e.g. a whole breast or a suspected region). The breast is then scanned by translating focusing multi-pinhole plates and NaI(Tl) gamma detectors together in a sequence that optimizes count yield from the volume-of-interest. With simulations, we compared MBT with existing planar MBI. In a breast phantom containing different lesions, MBT improved tumour-to-background contrast-to-noise ratio (CNR) over planar MBI by 12% and 111% for 4.0 and 6.0 mm lesions respectively in case of whole breast scanning. For the same lesions, much larger CNR improvements of 92% and 241% over planar MBI were found in a scan that focused on a breast region containing several lesions. MBT resolved 3.0 mm rods in a Derenzo resolution phantom in the transverse plane compared to 2.5 mm rods distinguished by planar MBI. While planar MBI cannot provide depth information, MBT offered 4.0 mm depth resolution. Our simulations indicate that besides offering 3D localization of increased tracer uptake, multi-pinhole MBT can significantly increase tumour-to-background CNR compared to planar MBI. These properties could be promising for better estimating the position, extend and shape of lesions and distinguishing between single and multiple lesions.
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Affiliation(s)
- Jarno van Roosmalen
- Section Radiation, Detection & Medical Imaging, Delft University of Technology, Delft, The Netherlands
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Even-Sapir E, Golan O, Menes T, Weinstein Y, Lerman H. Breast Imaging Utilizing Dedicated Gamma Camera and (99m)Tc-MIBI: Experience at the Tel Aviv Medical Center and Review of the Literature Breast Imaging. Semin Nucl Med 2016; 46:286-93. [PMID: 27237439 DOI: 10.1053/j.semnuclmed.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The scope of the current article is the clinical role of gamma cameras dedicated for breast imaging and (99m)Tc-MIBI tumor-seeking tracer, as both a screening modality among a healthy population and as a diagnostic modality in patients with breast cancer. Such cameras are now commercially available. The technology utilizing a camera composed of a NaI (Tl) detector is termed breast-specific gamma imaging. The technology of dual-headed camera composed of semiconductor cadmium zinc telluride detectors that directly converts gamma-ray energy into electronic signals is termed molecular breast imaging. Molecular breast imaging system has been installed at the Department of Nuclear medicine at the Tel Aviv Sourasky Medical Center, Tel Aviv in 2009. The article reviews the literature well as our own experience.
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Affiliation(s)
- Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orit Golan
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Breast Imaging Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tehillah Menes
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Breast surgery unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuliana Weinstein
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Breast Imaging Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Hedva Lerman
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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35
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Molecular, Functional, and Structural Imaging of Major Depressive Disorder. Neurosci Bull 2016; 32:273-85. [PMID: 27142698 DOI: 10.1007/s12264-016-0030-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/16/2016] [Indexed: 12/31/2022] Open
Abstract
Major depressive disorder (MDD) is a significant cause of morbidity and mortality worldwide, correlating with genetic susceptibility and environmental risk factors. Molecular, functional, and structural imaging approaches have been increasingly used to detect neurobiological changes, analyze neurochemical correlates, and parse pathophysiological mechanisms underlying MDD. We reviewed recent neuroimaging publications on MDD in terms of molecular, functional, and structural alterations as detected mainly by magnetic resonance imaging (MRI) and positron emission tomography. Altered structure and function of brain regions involved in the cognitive control of affective state have been demonstrated. An abnormal default mode network, as revealed by resting-state functional MRI, is likely associated with aberrant metabolic and serotonergic function revealed by radionuclide imaging. Further multi-modal investigations are essential to clarify the characteristics of the cortical network and serotonergic system associated with behavioral and genetic variations in MDD.
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Tade FI, Cohen MA, Styblo TM, Odewole OA, Holbrook AI, Newell MS, Savir-Baruch B, Li X, Goodman MM, Nye JA, Schuster DM. Anti-3-18F-FACBC (18F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study. J Nucl Med 2016; 57:1357-63. [DOI: 10.2967/jnumed.115.171389] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/09/2016] [Indexed: 02/07/2023] Open
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Liu Y, An S, Ward R, Yang Y, Guo XX, Li W, Xu TR. G protein-coupled receptors as promising cancer targets. Cancer Lett 2016; 376:226-39. [PMID: 27000991 DOI: 10.1016/j.canlet.2016.03.031] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023]
Abstract
G protein-coupled receptors (GPCRs) regulate an array of fundamental biological processes, such as growth, metabolism and homeostasis. Specifically, GPCRs are involved in cancer initiation and progression. However, compared with the involvement of the epidermal growth factor receptor in cancer, that of GPCRs have been largely ignored. Recent findings have implicated many GPCRs in tumorigenesis, tumor progression, invasion and metastasis. Moreover, GPCRs contribute to the establishment and maintenance of a microenvironment which is permissive for tumor formation and growth, including effects upon surrounding blood vessels, signaling molecules and the extracellular matrix. Thus, GPCRs are considered to be among the most useful drug targets against many solid cancers. Development of selective ligands targeting GPCRs may provide novel and effective treatment strategies against cancer and some anticancer compounds are now in clinical trials. Here, we focus on tumor related GPCRs, such as G protein-coupled receptor 30, the lysophosphatidic acid receptor, angiotensin receptors 1 and 2, the sphingosine 1-phosphate receptors and gastrin releasing peptide receptor. We also summarize their tissue distributions, activation and roles in tumorigenesis and discuss the potential use of GPCR agonists and antagonists in cancer therapy.
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Affiliation(s)
- Ying Liu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan 650500, China
| | - Su An
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan 650500, China
| | - Richard Ward
- Molecular Pharmacology Group, Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, United Kingdom
| | - Yang Yang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan 650500, China
| | - Xiao-Xi Guo
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan 650500, China
| | - Wei Li
- Kidney Cancer Research, Diagnosis and Translational Technology Center of Yunnan Province, Department of Urology, The People's Hospital of Yunnan Province, Kunming, Yunnan 650032, China.
| | - Tian-Rui Xu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan 650500, China.
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Kijanka MM, van Brussel ASA, van der Wall E, Mali WPTM, van Diest PJ, van Bergen En Henegouwen PMP, Oliveira S. Optical imaging of pre-invasive breast cancer with a combination of VHHs targeting CAIX and HER2 increases contrast and facilitates tumour characterization. EJNMMI Res 2016; 6:14. [PMID: 26860296 PMCID: PMC4747965 DOI: 10.1186/s13550-016-0166-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/20/2016] [Indexed: 11/30/2022] Open
Abstract
Background Optical molecular imaging is an emerging novel technology with applications in the diagnosis of cancer and assistance in image-guided surgery. A high tumour-to-background (T/B) ratio is crucial for successful imaging, which strongly depends on tumour-specific probes that rapidly accumulate in the tumour, while non-bound probes are rapidly cleared. Here, using pre-invasive breast cancer as a model, we investigate whether the use of combinations of probes with different target specificities results in higher T/B ratios and whether dual-spectral imaging leads to improvements in tumour characterization. Methods We performed optical molecular imaging of an orthotopic breast cancer model mimicking ductal carcinoma in situ (DCIS). A combination of carbonic anhydrase IX (CAIX)- and human epidermal growth factor receptor 2 (HER2)-specific variable domains of the heavy chain from heavy-chain antibodies (VHHs) was conjugated either to the same fluorophore (IRDye800CW) to evaluate T/B ratios or to different fluorophores (IRDye800CW, IRDye680RD or IRDye700DX) to analyse the expression of CAIX and HER2 simultaneously through dual-fluorescence detection. These experiments were performed non-invasively in vivo, in a mimicked intra-operative setting, and ex vivo on tumour sections. Results Application of the CAIX- and HER2-specific VHH combination resulted in an increase of the T/B ratio, as compared to T/B ratios obtained from each of these single VHHs together with an irrelevant VHH. This dual tumour marker-specific VHH combination also enabled the detection of small metastases in the lung. Furthermore, dual-spectral imaging enabled the assessment of the expression status of both CAIX and HER2 in a mimicked intra-operative setting, as well as on tumour sections, which was confirmed by immunohistochemistry. Conclusions These results establish the feasibility of the use of VHH ‘cocktails’ to increase T/B ratios and improve early detection of heterogeneous tumours and the use of multispectral molecular imaging to facilitate the assessment of the target expression status of tumours and metastases, both invasive or non-invasively. Electronic supplementary material The online version of this article (doi:10.1186/s13550-016-0166-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marta M Kijanka
- Division of Cell Biology, Department of Biology, Science Faculty, Utrecht University, Utrecht, The Netherlands.
| | - Aram S A van Brussel
- Division of Cell Biology, Department of Biology, Science Faculty, Utrecht University, Utrecht, The Netherlands. .,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Elsken van der Wall
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Willem P T M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - Sabrina Oliveira
- Division of Cell Biology, Department of Biology, Science Faculty, Utrecht University, Utrecht, The Netherlands. .,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Fowler AM. Molecular Imaging Approaches for Supplemental Screening in Women at Increased Breast Cancer Risk. J Nucl Med 2016; 57:661-2. [DOI: 10.2967/jnumed.115.171330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 01/26/2016] [Indexed: 12/25/2022] Open
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Müller FHH, Farahati J, Müller AG, Gillman E, Hentschel M. Positron emission mammography in the diagnosis of breast cancer. Is maximum PEM uptake value a valuable threshold for malignant breast cancer detection? Nuklearmedizin 2015; 55:15-20. [PMID: 26627876 DOI: 10.3413/nukmed-0753-15-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/30/2015] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the diagnostic value (sensitivity, specificity) of positron emission mammography (PEM) in a single site non-interventional study using the maximum PEM uptake value (PUVmax). PATIENTS, METHODS In a singlesite, non-interventional study, 108 patients (107 women, 1 man) with a total of 151 suspected lesions were scanned with a PEM Flex Solo II (Naviscan) at 90 min p.i. with 3.5 MBq 18F-FDG per kg of body weight. In this ROI(region of interest)-based analysis, maximum PEM uptake value (PUV) was determined in lesions, tumours (PUVmaxtumour), benign lesions (PUVmaxnormal breast) and also in healthy tissues on the contralateral side (PUVmaxcontralateral breast). These values were compared and contrasted. In addition, the ratios of PUVmaxtumour / PUVmaxcontralateral breast and PUVmaxnormal breast / PUVmaxcontralateral breast were compared. The image data were interpreted independently by two experienced nuclear medicine physicians and compared with histology in cases of suspected carcinoma. RESULTS Based on a criteria of PUV>1.9, 31 out of 151 lesions in the patient cohort were found to be malignant (21%). A mean PUVmaxtumour of 3.78 ± 2.47 was identified in malignant tumours, while a mean PUVmaxnormal breast of 1.17 ± 0.37 was reported in the glandular tissue of the healthy breast, with the difference being statistically significant (p < 0.001). Similarly, the mean ratio between tumour and healthy glandular tissue in breast cancer patients (3.15 ± 1.58) was found to be significantly higher than the ratio for benign lesions (1.17 ± 0.41, p < 0.001). CONCLUSION PEM is capable of differentiating breast tumours from benign lesions with 100% sensitivity along with a high specificity of 96%, when a threshold of PUVmax >1.9 is applied.
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Affiliation(s)
- F H H Müller
- Dr. Frank H. H. Müller, Radiologie und Nuklearmedizin Ludwigshafen, Otto-Stabel-Str. 2-4, 67059 Ludwigshafen, Tel. +49/(0)621/51 00 21, Fax +49/(0)621/51 00 25,
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Koulikov V, Lerman H, Kesler M, Even-Sapir E. (99m)Tc-MDP bone scintigraphy of the hand: comparing the use of novel cadmium zinc telluride (CZT) and routine NaI(Tl) detectors. EJNMMI Res 2015; 5:63. [PMID: 26566952 PMCID: PMC4644133 DOI: 10.1186/s13550-015-0139-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/16/2015] [Indexed: 11/10/2022] Open
Abstract
Background Cadmium zinc telluride (CZT) solid-state detectors have been recently introduced in the field of nuclear medicine in cardiology and breast imaging. The aim of the current study was to evaluate the performance of the novel detectors (CZT) compared to that of the routine NaI(Tl) in bone scintigraphy. A dual-headed CZT-based camera dedicated originally to breast imaging has been used, and in view of the limited size of the detectors, the hands were chosen as the organ for assessment. This is a clinical study. Methods Fifty-eight consecutive patients (total 116 hands) referred for bone scan for suspected hand pathology gave their informed consent to have two acquisitions, using the routine camera and the CZT-based camera. The latter was divided into full-dose full-acquisition time (FD CZT) and reduced-dose short-acquisition time (RD CZT) on CZT technology, so three image sets were available for analysis. Data analysis included comparing the detection of hot lesions and identification of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints. Results A total of 69 hot lesions were detected on the CZT image sets; of these, 61 were identified as focal sites of uptake on NaI(Tl) data. On FD CZT data, 385 joints were identified compared to 168 on NaI(Tl) data (p < 0.001). There was no statistically significant difference in delineation of joints between FD and RD CZT data as the latter identified 383 joints. Conclusions Bone scintigraphy using a CZT-based gamma camera is associated with improved lesion detection and anatomic definition. The superior physical characteristics of this technique raised a potential reduction in administered dose and/or acquisition time without compromising image quality.
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Affiliation(s)
- Victoria Koulikov
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, Tel-Aviv, 64239, Israel
| | - Hedva Lerman
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, Tel-Aviv, 64239, Israel
| | - Mikhail Kesler
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, Tel-Aviv, 64239, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, Tel-Aviv, 64239, Israel.
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Alternative screening for women with dense breasts: breast-specific gamma imaging (molecular breast imaging). AJR Am J Roentgenol 2015; 204:252-6. [PMID: 25615745 DOI: 10.2214/ajr.14.13525] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Given mammography's limitations in evaluating dense breasts, examination with breast-specific gamma imaging (BSGI)-also called molecular breast imaging (MBI)-has been proposed. We review the literature pertinent to the performance of BSGI in patients with dense breasts. CONCLUSION. Many studies have reported the sensitivity of BSGI in finding cancers even in dense breasts. However, BSGI has not yet been validated as an effective screening tool in large prospective studies. In addition, whole-body dose remains a significant concern.
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Greene LR, Wilkinson D. The role of general nuclear medicine in breast cancer. J Med Radiat Sci 2015; 62:54-65. [PMID: 26229668 PMCID: PMC4364807 DOI: 10.1002/jmrs.97] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/08/2015] [Accepted: 01/14/2015] [Indexed: 12/12/2022] Open
Abstract
The rising incidence of breast cancer worldwide has prompted many improvements to current care. Routine nuclear medicine is a major contributor to a full gamut of clinical studies such as early lesion detection and stratification; guiding, monitoring, and predicting response to therapy; and monitoring progression, recurrence or metastases. Developments in instrumentation such as the high-resolution dedicated breast device coupled with the diagnostic versatility of conventional cameras have reinserted nuclear medicine as a valuable tool in the broader clinical setting. This review outlines the role of general nuclear medicine, concluding that targeted radiopharmaceuticals and versatile instrumentation position nuclear medicine as a powerful modality for patients with breast cancer.
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Affiliation(s)
- Lacey R Greene
- Faculty of Science, Charles Sturt University Wagga Wagga, New South Wales, Australia
| | - Deborah Wilkinson
- Faculty of Health, Wheeling Jesuit University Wheeling, West Virginia
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Bitencourt AGV, Lima ENP, Chojniak R, Marques EF, Souza JA, Andrade WP, Guimarães MD. Multiparametric evaluation of breast lesions using PET-MRI: initial results and future perspectives. Medicine (Baltimore) 2014; 93:e115. [PMID: 25396329 PMCID: PMC4616313 DOI: 10.1097/md.0000000000000115] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate the diagnostic accuracy of multiparametric evaluation of breast lesions combining information of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), and F-fluoro-deoxi-glucose (F-FDG) positron emission tomography/computed tomography (PET-CT). After approval of the institutional research ethics committee, 31 patients with suspicious breast lesions on MRI performed F-FDG PET-CT with a specific protocol for breast evaluation. Patients' mean age was 47.8 years (range, 29-77 years). Positron emission tomography and magnetic resonance imaging (PET-MRI) images were fused. A lesion was considered positive on multiparametric evaluation if at least 1 of the following was present: washout/type 3 kinetic curve on DCE-MRI, restricted diffusion on DWI with minimum apparent diffusion coefficient value <1.00 × 10 mm/s, and abnormal metabolism on F-FDG PET-CT (higher than the physiologic uptake of the normal breast parenchyma). Thirty-eight lesions with histologic correlation were evaluated on the 31 included patients, being 32 mass lesions (84.2%), and 6 nonmass lesions (15.8%). Lesions' mean diameter was 31.1 mm (range, 8-94 mm). Multiparametric evaluation provided 100% sensitivity, 55.5% specificity, 87.9% positive predictive value, 100% negative predictive value, and 89.5% accuracy, with 29 true-positives results, 5 true-negatives, 4 false-positives, and no false-negative results. Multiparametric evaluation with PET-MRI functional data showed good diagnostic accuracy to differentiate benign from malignant breast lesions, reducing the number of unnecessary biopsies, without missing any diagnosis of cancer in our case series.
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Affiliation(s)
- Almir G V Bitencourt
- Department of Imaging (AGVB, ENPL, RC, EFM, JAS, MDG); and Department of Mastology (WPA), A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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Prossnitz ER, Barton M. Estrogen biology: new insights into GPER function and clinical opportunities. Mol Cell Endocrinol 2014; 389:71-83. [PMID: 24530924 PMCID: PMC4040308 DOI: 10.1016/j.mce.2014.02.002] [Citation(s) in RCA: 285] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 12/16/2022]
Abstract
Estrogens play an important role in the regulation of normal physiology, aging and many disease states. Although the nuclear estrogen receptors have classically been described to function as ligand-activated transcription factors mediating genomic effects in hormonally regulated tissues, more recent studies reveal that estrogens also mediate rapid signaling events traditionally associated with G protein-coupled receptors. The G protein-coupled estrogen receptor GPER (formerly GPR30) has now become recognized as a major mediator of estrogen's rapid cellular effects throughout the body. With the discovery of selective synthetic ligands for GPER, both agonists and antagonists, as well as the use of GPER knockout mice, significant advances have been made in our understanding of GPER function at the cellular, tissue and organismal levels. In many instances, the protective/beneficial effects of estrogen are mimicked by selective GPER agonism and are absent or reduced in GPER knockout mice, suggesting an essential or at least parallel role for GPER in the actions of estrogen. In this review, we will discuss recent advances and our current understanding of the role of GPER and the activity of clinically used drugs, such as SERMs and SERDs, in physiology and disease. We will also highlight novel opportunities for clinical development towards GPER-targeted therapeutics, for molecular imaging, as well as for theranostic approaches and personalized medicine.
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Affiliation(s)
- Eric R Prossnitz
- Department of Cell Biology and Physiology, UNM Cancer Center, University of New Mexico Health Sciences Center, Albuquerque, NM 87120, USA.
| | - Matthias Barton
- Molecular Internal Medicine, University of Zurich, Switzerland.
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