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Freitas V, Li X, Scaranelo A, Au F, Kulkarni S, Ghai S, Taeb S, Bubon O, Baldassi B, Komarov B, Parker S, Macsemchuk CA, Waterston M, Olsen KO, Reznik A. Breast Cancer Detection Using a Low-Dose Positron Emission Digital Mammography System. Radiol Imaging Cancer 2024; 6:e230020. [PMID: 38334470 PMCID: PMC10988332 DOI: 10.1148/rycan.230020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 02/10/2024]
Abstract
Purpose To investigate the feasibility of low-dose positron emission mammography (PEM) concurrently to MRI to identify breast cancer and determine its local extent. Materials and Methods In this research ethics board-approved prospective study, participants newly diagnosed with breast cancer with concurrent breast MRI acquisitions were assigned independently of breast density, tumor size, and histopathologic cancer subtype to undergo low-dose PEM with up to 185 MBq of fluorine 18-labeled fluorodeoxyglucose (18F-FDG). Two breast radiologists, unaware of the cancer location, reviewed PEM images taken 1 and 4 hours following 18F-FDG injection. Findings were correlated with histopathologic results. Detection accuracy and participant details were examined using logistic regression and summary statistics, and a comparative analysis assessed the efficacy of PEM and MRI additional lesions detection (ClinicalTrials.gov: NCT03520218). Results Twenty-five female participants (median age, 52 years; range, 32-85 years) comprised the cohort. Twenty-four of 25 (96%) cancers (19 invasive cancers and five in situ diseases) were identified with PEM from 100 sets of bilateral images, showcasing comparable performance even after 3 hours of radiotracer uptake. The median invasive cancer size was 31 mm (range, 10-120). Three additional in situ grade 2 lesions were missed at PEM. While not significant, PEM detected fewer false-positive additional lesions compared with MRI (one of six [16%] vs eight of 13 [62%]; P = .14). Conclusion This study suggests the feasibility of a low-dose PEM system in helping to detect invasive breast cancer. Though large-scale clinical trials are essential to confirm these preliminary results, this study underscores the potential of this low-dose PEM system as a promising imaging tool in breast cancer diagnosis. ClinicalTrials.gov registration no. NCT03520218 Keywords: Positron Emission Digital Mammography, Invasive Breast Cancer, Oncology, MRI Supplemental material is available for this article. © RSNA, 2024 See also commentary by Barreto and Rapelyea in this issue.
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Affiliation(s)
- Vivianne Freitas
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Xuan Li
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Anabel Scaranelo
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Frederick Au
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Supriya Kulkarni
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Sandeep Ghai
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Samira Taeb
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Oleksandr Bubon
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Brandon Baldassi
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Borys Komarov
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Shayna Parker
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Craig A. Macsemchuk
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Michael Waterston
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Kenneth O. Olsen
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
| | - Alla Reznik
- From the Temerty Faculty of Medicine, Joint Department of Medical
Imaging, University Health Network, Sinai Health System, Women's College
Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9
(V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret
Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay
Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.);
Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc,
Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of
Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and
Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada (C.A.M.)
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