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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-01-2011 | Original Article

Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging

Authors: Kathy Schilling, Deepa Narayanan, Judith E. Kalinyak, Juliette The, Maria Victoria Velasquez, Simone Kahn, Matthew Saady, Ravinder Mahal, Larraine Chrystal

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 1/2011

Abstract

Purpose

The objective of this study was to compare the performance characteristics of ¹⁸F-fluorodeoxyglucose (FDG) positron emission mammography (PEM) with breast magnetic resonance imaging (MRI) as a presurgical imaging and planning option for index and ipsilateral lesions in patients with newly diagnosed, biopsy-proven breast cancer.

Methods

Two hundred and eight women >25 years of age (median age = 59.7 ± 14.1 years) with biopsy-proven primary breast cancer enrolled in this prospective, single-site study. MRI, PEM, and whole-body positron emission tomography (WBPET) were conducted on each patient within 7 business days. PEM and WBPET images were acquired on the same day after intravenous administration of 370 MBq of FDG (median = 432.9 MBq). PEM and MRI images were blindly evaluated, compared with final surgical histopathology, and the sensitivity determined. Substudy analysis compared the sensitivity of PEM versus MRI in patients with different menopausal status, breast density, and use of hormone replacement therapy (HRT) as well as determination of performance characteristics for additional ipsilateral lesion detection.

Results

Two hundred and eight patients enrolled in the study of which 87% (182/208) were analyzable. Of these analyzable patients, 26.4% (48/182), 7.1% (13/182), and 64.2% (120/182) were pre-, peri-, and postmenopausal, respectively, and 48.4% (88/182) had extremely or heterogeneously dense breast tissue, while 33.5% (61/182) had a history of HRT use. Ninety-two percent (167/182) underwent core biopsy for index lesion diagnosis. Invasive cancer was found in 77.5% (141/182), while ductal carcinoma in situ (DCIS) and/or Paget’s disease were found in 22.5% (41/182) of patients. Both PEM and MRI had index lesion depiction sensitivity of 92.8% and both were significantly better than WBPET (67.9%, p < 0.001, McNemar’s test). For index lesions, PEM and MRI had equivalent sensitivity of various tumors, categorized by tumor stage as well as similar invasive tumor size predictions with Spearman's correlation coefficient of 0.61 for both PEM and MRI compared to surgical pathology. Menopausal status, breast density, and HRT did not influence the sensitivity of PEM or MRI. For 67 additional unsuspected ipsilateral lesions or multifocal lesions, PEM had sensitivity of 85% (34/40) and specificity of 74%, (20/27) compared to MRI's sensitivity of 98% (39/40) and specificity of 48% (13/27) [p = 0.074, for sensitivity; p = 0.096 for specificity]

Conclusion

PEM is a good alternative to MRI as a presurgical breast imaging option and its performance characteristics are not affected by patient menopausal/hormonal status or breast density.

Elmore JG, Armstrong K, Lehman CD, Fletcher SW. Screening for breast cancer. JAMA 2005;293:1245–56.CrossRefPubMed

Kalager M, Haldorsen T, Bretthauer M, Hoff G, Thoresen SO, Adami HO. Improved breast cancer survival following introduction of an organized mammography screening program among both screened and unscreened women: a population-based cohort study. Breast Cancer Res 2009;11:R44.CrossRefPubMed

Tafra L. Positron emission mammography: a new breast imaging device. J Surg Oncol 2008;97:372–3.CrossRefPubMed

Mushlin Al, Kouides RW, Shapiro DE. Estimating the accuracy of screening mammography: a meta-analysis. Am J. Pre Med 1998;14(2):143–53.

Tafra L, Fine R, Whitworth P, Berry M, Woods J, Ekbom G, et al. Prospective randomized study comparing cryo-assisted and needle-wire localization of ultrasound-visible breast tumors. Am J Surg 2006;192:462–70.CrossRefPubMed

Enriquez L, Listinsky J. Role of MRI in breast cancer management. Cleve Clin J Med 2009;76(9):525–32.CrossRefPubMed

Biglia N, Mariani L, Sgro L, Mininanni P, Moggio G, Sismondi P. Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: implications for diagnosis, surgical and medical treatment. Endocr Relat Cancer 2007;14:549–67.CrossRefPubMed

Degani H, Chetrit-Dadiani M, Bogin L, Furman-Haran E. Magnetic resonance imaging of tumor vasculature. Thromb Haemost 2003;89:25–33.PubMed

Furman-Haran E, Kelcz F, Degani H. Magnetic resonance imaging of breast cancer angiogenesis: a review. J Exp Clin Cancer Res 2002;21:47–54.PubMed

10.

Kriege M, Brekelmans CT, Boetes C, Besnard PE, Zonderland HM, Obdeijn IM, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 2004;351:427–37.CrossRefPubMed

11.

Bassett LW, Dhaliwal SG, Eradat J, et al. National trends and practices in breast MRI. AJR Am J Roentgenol 2008;191(2):332–339.

12.

Kuhl C. The current status of breast MR imaging. Part I. Choice of technique, image interpretation, diagnostic accuracy, and transfer to clinical practice. Radiology 2007;244:356–78.CrossRefPubMed

13.

Heywang-Köbrunner SH, Viehweg P, Heinig A, Küchler C. Contrast-enhanced MRI of the breast: accuracy, value, controversies, solutions. Eur J Radiol 1997;24:94–108.CrossRefPubMed

14.

Liberman L, Morris EA, Dershaw DD, Abramson AF, Tan LK. MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. AJR Am J Roentgenol 2003;180:901–10.PubMed

15.

Grobner T. Gadolinium—a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 2006;21:1104–8.CrossRefPubMed

16.

Kribben A, Witzke O, Hillen U, Barkhausen J, Daul AE, Erbel R. Nephrogenic systemic fibrosis: pathogenesis, diagnosis, and therapy. J Am Coll Cardiol 2009;53:1621–8.CrossRefPubMed

17.

Weinberg I, Beylin D, Zavarzin V, Yarnall S, Stepanov PY, Anashkin E, et al. Positron emission mammography: high-resolution biochemical breast imaging. Technol Cancer Res Treat 2005;4:55–60.PubMed

18.

Weinberg IN. Applications for positron emission mammography. Phys Med 2006;21:132–7.CrossRefPubMed

19.

Weinberg I, Beylin D, Yarnall S, Anashkin E, Stepanov P, Dolinsky S, et al. Applications of a PET device with 1.5 mm FWHM intrinsic spatial resolution to breast cancer imaging. Proceedings of the 2004 IEEE International Symposium on Biomedical Imaging: From Nano to Macro, Arlington, VA, 2004, New York: IEEE, 2004; 1396–99.

20.

Avril N, Adler LP. F-18 fluorodeoxyglucose-positron emission tomography imaging for primary breast cancer and loco-regional staging. Radiol Clin North Am 2007;45:645–57.CrossRefPubMed

21.

Berg WA, Weinberg IN, Narayanan D, Lobrano ME, Ross E, Amodei L, et al. High-resolution fluorodeoxyglucose positron emission tomography with compression (“positron emission mammography”) is highly accurate in depicting primary breast cancer. Breast J 2006;12:309–23.CrossRefPubMed

22.

Berg WA, Madsen KS, Schilling K, Tartar M, Pisano ED, Hovanessian Larsen L, et al. Comparative Effectiveness of Positron Emission Mammography and MRI for Presurgical Planning of the Ipsilateral Breast in Women with Breast Cancer. Radiology 2010; in press.

23.

Ikeda DM, Hylton NM, Kuhl CK, et al. Breast Imaging Reporting and Data System, BI-RADS: Magnetic Resonance Imaging. Reston: American College of Radiology; 2003.

24.

Narayanan D, Kalinyak JE, Berg WA. Interpretation of Positron Emission Mammography (PEM) by Experienced Breast Imaging Radiologists: Comparison to MRI. AJR Am J Roentgenol 2010; in press.

25.

Narayanan D, Madsen KS, Kalinyak JE, Berg WA. Interpretation of Positron Emission Mammography: Feature Analysis and Rates of Malignancy. AJR Am J Roentgenol 2010; in press.

26.

Santra A, Kumar R, Reddy R, Halanaik D, Kumar R, Bal CS, et al. FDG PET-CT in the management of primary breast lymphoma. Clin Nucl Med 2009;34:848–53.CrossRefPubMed

27.

Ueda S, Tsuda H, Asakawa H, Shigekawa T, Fukatsu K, Kondo N, et al. Clinicopathological and prognostic relevance of uptake level using 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in primary breast cancer. Jpn J Clin Oncol 2008;38:250–8.CrossRefPubMed

28.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225–49.CrossRefPubMed

29.

Levine EA, Freimanis RI, Perrier ND, Morton K, Lesko NM, Bergman S, et al. Positron emission mammography: initial clinical results. Ann Surg Oncol 2003;10:86–91.CrossRefPubMed

30.

Rosen EL, Turkington TG, Soo MS, Baker JA, Coleman RE. Detection of primary breast carcinoma with a dedicated, large-field-of-view FDG PET mammography device: initial experience. Radiology 2005;234:527–34.CrossRefPubMed

31.

Tafra L, Cheng Z, Uddo J, Lobrano MB, Stein W, Berg WA, et al. Pilot clinical trial of 18F-fluorodeoxyglucose positron-emission mammography in the surgical management of breast cancer. Am J Surg 2005;190:628–32.CrossRefPubMed

32.

Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 2004;233:830–49.CrossRefPubMed

33.

Vranjesevic D, Schiepers C, Silverman DH, Quon A, Villalpando J, Dahlborn M, et al. Relationship between 18F-FDG uptake and breast density in women with normal breast tissue. J Nucl Med 2003;44:1238–42.PubMed

34.

Kumar R, Mitchell S, Alavi A. 18F-FDG uptake and breast density in women with normal breast tissue. J Nucl Med 2004;45:1423.PubMed

35.

Delille JP, Slanetz PJ, Yeh ED, Kopans DB, Garrido L. Physiologic changes in breast magnetic resonance imaging during the menstrual cycle: perfusion imaging, signal enhancement, and influence of the T1 relaxation time of the breast tissue. Breast J 2005;11:236–41.CrossRefPubMed

36.

Mavi A, Cermik TF, Urhan M, Puskulcu H, Basu S, Cucchiara AJ, et al. The effect of age, menopausal state, and breast density on (18)F-FDG uptake in normal glandular breast tissue. J Nucl Med 2010;51:347–52.CrossRefPubMed

37.

Wahl RL. Current status of PET in breast cancer imaging, staging, and therapy. Semin Roentgenol 2001;36:250–60.CrossRefPubMed

38.

Avril N, Rosé CA, Schelling M, Dose J, Kühn W, Bense S, et al. Breast imaging with positron emission tomography and fluorine-18 fluorodeoxyglucose: use and limitations. J Clin Oncol 2000;18:3495–502.PubMed

39.

Mavi A, Urhan M, Yu JQ, Zhuang H, Houseni M, Cermik TF, et al. Dual time point 18F-FDG PET imaging detects breast cancer with high sensitivity and correlates well with histologic subtypes. J Nucl Med 2006;47:1440–6.PubMed

40.

Zytoon AA, Murakami K, El-Kholy MR, El-Shorbagy E. Dual time point FDG-PET/CT imaging. Potential tool for diagnosis of breast cancer. Clin Radiol 2008;63:1213–27.CrossRefPubMed

41.

Mankoff DA, Dunnwald LK, Kinahan P. Are we ready for dedicated breast imaging approaches? J Nucl Med 2003;44:594–5.PubMed

42.

Berg WA, Blume JD, Adams AM, Jong RA, Barr RG, Lehrer DE, et al. Reasons women at elevated risk of breast cancer refuse breast MR imaging screening: ACRIN 6666. Radiology 2010;254:79–87.CrossRefPubMed

43.

Lee SG, Orel SG, Woo IJ, Cruz-Jove E, Putt ME, Solin LJ, et al. MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results. Radiology 2003;226:773–8.CrossRefPubMed

44.

Lehman CD, Blume JD, Thickman D, Bluemke DA, Pisano E, Kuhl C, et al. Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol 2005;92:9–15.CrossRefPubMed

45.

Lehman CD, Gatsonis C, Kuhl CK, Hendrick RE, Pisano ED, Hanna L, et al. MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med 2007;356:1295–303.CrossRefPubMed

46.

Liberman L, Morris EA, Kim CM, Kaplan JB, Abramson AF, Menell JH, et al. MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. AJR Am J Roentgenol 2003;180:333–41.PubMed

47.

Han BK, Schnall MD, Orel SG, Rosen M. Outcome of MRI-guided breast biopsy. AJR Am J Roentgenol 2008;191:1798–809.CrossRefPubMed

48.

Schell AM, Rosenkranz K, Lewis PJ. Role of breast MRI in the preoperative evaluation of patients with newly diagnosed breast cancer. AJR Am J Roentgenol 2009;192:1438–44.CrossRefPubMed

49.

Raylman RR, Majewski S, Smith MF, Proffitt J, Hammond W, Srinivasan A, et al. The positron emission mammography/tomography breast imaging and biopsy system (PEM/PET): design, construction and phantom-based measurements. Phys Med Biol 2008;53:637–53.CrossRefPubMed

50.

Brem RF, Petrovitch I, Rapelyea JA, Young H, Teal C, Kelly T. Breast-specific gamma imaging with 99mTc-sestamibi and magnetic resonance imaging in the diagnosis of breast cancer—a comparative study. Breast J 2007;13:465–9.CrossRefPubMed

51.

Brem RF, Floerke AC, Rapelyea JA, Teal C, Kelly T, Mathur V. Breast-specific gamma imaging as an adjunct imaging modality for the diagnosis of breast cancer. Radiology 2008;247(3):651–7.CrossRefPubMed

Title: Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging
Authors: Kathy Schilling
Deepa Narayanan
Judith E. Kalinyak
Juliette The
Maria Victoria Velasquez
Simone Kahn
Matthew Saady
Ravinder Mahal
Larraine Chrystal
Publication date: 01-01-2011
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 1/2011
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-010-1588-9

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Springer Medicine

Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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