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Annals of Nuclear Medicine
Published in: Annals of Nuclear Medicine 10/2018

01-12-2018 | Original Article

F-18 fluoride uptake in primary breast cancer

Authors: Ismet Sarikaya, Prem Sharma, Ali Sarikaya

Published in: Annals of Nuclear Medicine | Issue 10/2018

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Abstract

Objective

Bone-specific radiotracers are known to accumulate in breast lesions. Tc-99m diphosphonates have been widely studied in differentiating breast lesions. In this retrospective study, we aimed to assess the uptake of the bone-specific PET radiotracer, F-18 fluoride (NaF), in primary breast cancers to determine its sensitivity and to identify any differences in NaF uptake between calcified and non-calcified tumors, histological subtypes, and patients with or without axillary lymphadenopathy.

Methods

NaF positron emission tomography/computed tomography (PET/CT) images of 69 newly diagnosed breast cancer patients were reviewed. F-18 fluoride uptake as maximum standardized uptake value (NaF SUVmax) was measured in the primary tumor, enlarged axillary lymph nodes and contralateral normal/non-tumoral breast tissue. Low-dose CT images were reviewed to locate the primary tumor and grossly assess its calcification and check for ipsilateral axillary lymphadenopathy. Whole body NaF PET/CT images were reviewed to search for bone metastases. Eighteen patients also underwent F-18 fluorodeoxyglucose (FDG) PET/CT study.

Results

The primary breast tumor was clearly seen as focal or diffuse uptake on NaF PET images in 27 of 69 patients (39%) (mean NaF SUVmax: 2.0 ± 1.0). In the rest, there was only mild bilateral diffuse breast uptake. When analyzing images per histological subtype (42 patients, 43 tumors), 14 of 31 invasive ductal carcinomas (IDC) (45%) and 3 of 4 ductal carcinoma in situ (DCIS) were visible on PET. Five invasive lobular carcinomas, 2 invasive mammary carcinomas, and 1 mucinous carcinoma were not visible on PET. Mean NaF SUVmax of contralateral normal/non-tumoral breast tissue was 1.0 ± 0.4. There was no significant difference in mean NaF SUVmax of primary tumor in cases with and without calcification or with and without axillary lymphadenopathy (p 0.892 and 0.957). There was no correlation between NaF SUVmax and FDG SUVmax values of the primary tumors (r 0.072, p 0.797, Pearson correlation).

Conclusion

NaF PET has relatively low sensitivity in detecting breast cancer. However, abnormal breast uptake on NaF PET requires further evaluation. F-18 fluoride uptake in the primary breast tumor does not seem to be correlated with axillary lymphadenopathy (metastasis potential), gross tumor calcification or metabolic activity of the tumor.
Literature
1.
Berg GR. Kalisher L. Osmond JD. Pendergrass HP, Potsaid MS. Technetium-99m diphosphonate concentration in primary breast carcinoma. Radiology. 1973;109:393–4.CrossRef
2.
Ross McDougall I, Pistcnma DA. Concentration of technetium-99m diphoshonate in breast tissue. Radiology 1974;112:655–657.CrossRef
3.
Schmitt GH, Holmes RA, Isitman AT, Hensley GT, Lewis JD. A proposed mechanism for 99mTc-labeled polyphosphate and diphosphonate uptake by human breast tissue. Radiology. 1974;112:733–5.CrossRef
4.
Khayat G, Achram M, Rizk G. The role of breast scintigraphy in detecting breast masses. Br J Radiol. 1985;58:721–4.CrossRef
5.
Raskin MM, Zand LC, Serafini AN. Scintigraphy of breast masses. Radiology. 1975;114:465–7.CrossRef
6.
Serafini AN, Raskin MM, Zard LC, Watson DD. Radionuclide breast scanning in carcinoma of the breast. J Nuc Med 1974;15:1149–1152.
7.
Lee JK, Kao CH, Sun SS. Technetium-99m methylene diphosphonate scintimammography for evaluation of palpable breast masses. Oncol Rep. 1999;6:659–63.PubMed
8.
Piccolo S, Lastoria S, Mainolfi C, Muto P. Bazzicalupo L, Salvatore M. Technetium-99m-MDP scintamammography to image primary breast cancer. J Nuc Med 1995:36:718–724.
9.
Piccolo S, Lastoria S, Muto P, Bazzicalupo L, Bartiromo A, Salvatore M. Scintimammography with 99mTc-MDP in the detection of primary breast cancer. Q J Nucl Med. 1997;41:225–30.PubMed
10.
Turhal NS, Dane F, Dede F, Gumus M, Yumuk PF, Cakalagaoglu F, et al. 99 m-Tc-MDP-Scintimammography in the evaluation of breast masses or tumor angiogenesis. Anticancer Res. 2004;24:1999–2006.PubMed
11.
Atasever T, Ozdemir A, Turkölmez S, Altinok M, Isik S. Tc-99m MDP scintimammography in palpable and nonpalpable breast lesions: comparison with mammographic probability of malignancy. Anticancer Res. 1999;19:3601–6.PubMed
12.
Burnett KR, Lyons KP, Brown WT. Uptake of osteotropic radionuclides in the breast. Semin Nucl Med. 1984;14:48–9.CrossRef
13.
Worsley DF, Lentle BC. Uptake of technetium-99m MDP in primary amyloidosis with a review of the mechanisms of soft tissue localization of bone seeking radiopharmaceuticals. J Nucl Med. 1993;34:1612–5.PubMed
14.
Uno K, Uchida Y, Sakata S, Minoshima S, Okada J, Yoshikawa K, et al. Visualization of the female breast in bone scintigraphy. Kaku Igaku. 1992;29:1201–6.PubMed
15.
Demetri-Lewis A, Slanetz PJ, Eisenberg RL. Breast calcifications: the focal group. AJR Am J Roentgenol. 2012;198:W325-43.CrossRef
16.
Gülsün M, Demirkazik FB, Ariyürek M. Evaluation of breast microcalcifications according to breast imaging reporting and data system criteria and Le Gal’s classification. Eur J Radiol. 2003;47:227–31.CrossRef
17.
Haka AS, Shafer-Peltier KE, Fitzmaurice M, Crowe J, Dasari RR, Feld MS. Identifying microcalcifications in benign and malignant breast lesions by probing differences in their chemical composition using Raman spectroscopy. Cancer Res. 2002;62:5375–80.PubMed
18.
Baker R, Rogers KD, Shepherd N, Stone N. New relationships between breast microcalcifications and cancer. Br J Cancer. 2010;103:1034–9.CrossRef
19.
Van den Wyngaert T, Strobel K, Kampen WU, Kuwert T, van der Bruggen W, Mohan HK, EANM Bone and Joint Committee and the Oncology Committee et al. The EANM practice guidelines for bone scintigraphy. Eur J Nucl Med Mol Imaging. 2016;43:1723–38.CrossRef
20.
Blau M, Ganatra R, Bender MA. 18 F-fluoride for bone imaging. Semin Nucl Med. 1972;2:31–7.CrossRef
21.
Grynpas MD. Fluoride effects on bone crystals. J Bone Miner Res. 1990;5(Suppl 1):S169–75.
22.
Hawkins RA, Choi Y, Huang SC, Hoh CK, Dahlbom M, Schiepers C, et al. Evaluation of the skeletal kinetics of fluorine-18-fluoride ion with PET. J Nucl Med. 1992;33:633–42.PubMed
23.
Cox RF, Morgan MP. Microcalcifications in breast cancer: lessons from physiological mineralization. Bone. 2013;53(2):437–50.CrossRef
24.
Wilson GH 3rd, Gore JC, Yankeelov TE, Barnes S, Peterson TE, True JM, et al. An approach to breast cancer diagnosis via PET imaging of microcalcifications using (18)F-NaF. J Nucl Med. 2014;55:1138–43.CrossRef
25.
Jang BS. MicroSPECT and MicroPET imaging of small animals for drug development. Toxicol Res. 2013;29:1–6.CrossRef
26.
Jan ML, Ni YC, Chuang KS, Liang HC, Fu YK. Detection-ability evaluation of the PEImager for positron emission mammography applications. Phys Med. 2006;21(Suppl 1):109–13.CrossRef
27.
28.
Tsuchiya A, Kanno M, Hara K, Kimijima I, Abe R. The evaluation of mammographic as biological malignancy in breast cancer. Fukushima J Med Sci. 1996;42:17–22.PubMed
29.
Holme TC, Reis MM, Thompson A, Robertson A, Parham D, Hickman P, et al. Is mammographic microcalcification of biological significance? Eur J Surg Oncol. 1993;19:250–3.PubMed
30.
Morgan MP, Cooke MM, Christopherson PA, Westfall PR, McCarthy GM. Calcium hydroxyapatite promotes mitogenesis and matrix metalloproteinase expression in human breast cancer cell lines. Mol Carcinog. 2001;32:111–7.CrossRef
31.
Cox RF, Hernandez-Santana A, Ramdass S, McMahon G, Harmey JH, Morgan MP. Microcalcifications in breast cancer: novel insights into the molecular mechanism and functional consequence of mammary mineralisation. Br J Cancer. 2012;106:525–37.CrossRef
32.
O’Grady S, Morgan MP. Microcalcifications in breast cancer: from pathophysiology to diagnosis and prognosis. Biochim Biophys Acta. 2018;1869:310–20.
33.
Qi X, Chen A, Zhang P, Zhang W, Cao X, Xiao C. Mammographic calcification can predict outcome in women with breast cancer treated with breast-conserving surgery. Oncol Lett. 2017;14:79–88.CrossRef
34.
Månsson E, Bergkvist L, Christenson G, Persson C, Wärnberg F. Mammographic casting-type calcifications is not a prognostic factor in unifocal small invasive breast cancer: a population-based retrospective cohort study. J Surg Oncol. 2009;100:670–4.CrossRef
35.
Rauch GM, Hobbs BP, Kuerer HM, Scoggins ME, Benveniste AP, Park YM, et al. Microcalcifications in 1657 patients with pure ductal carcinoma in situ of the breast: correlation with clinical, histopathologic, biologic features, and local recurrence. Ann Surg Oncol. 2016;23:482–9.CrossRef
36.
Tabar L, Tony Chen HH, Amy Yen MF, Tot T, Tung TH, Chen LS, et al. Mammographic tumor features can predict long-term outcomes reliably in women with 1–14-mm invasive breast carcinoma. Cancer. 2004;101:1745–59.CrossRef
37.
Shin SU, Lee J, Kim JH, Kim WH, Song SE, Chu A, et al. Gene expression profiling of calcifications in breast cancer. Sci Rep. 2017;7:11427.CrossRef
38.
Tabar L, Chen HH, Duffy SW, Yen MF, Chiang CF, Dean PB, et al. A novel method for prediction of long-term outcome of women with T1a, T1b, and 10–14 mm invasive breast cancers: a prospective study. Lancet. 2000;355:429–33.CrossRef
Metadata
Title
F-18 fluoride uptake in primary breast cancer
Authors
Ismet Sarikaya
Prem Sharma
Ali Sarikaya
Publication date
01-12-2018
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 10/2018
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-018-1294-4

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