PT  - JOURNAL ARTICLE
AU  - Yuge, Shunsuke
AU  - Miyake, Kanae
AU  - Kataoka, Masako
AU  - Ishimori, Takayoshi
AU  - Yakami, Masahiro
AU  - Isoda, Hiroyoshi
AU  - Takada, Masahiro
AU  - Matsumoto, Yoshiaki
AU  - Toi, Masakazu
AU  - Nakamoto, Yuji
TI  - <strong>Comparison of diagnostic performance of dedicated breast PET and tomosynthesis in opportunistic breast cancer screening</strong>
DP  - 2022 Aug 01
TA  - Journal of Nuclear Medicine
PG  - 2974--2974
VI  - 63
IP  - supplement 2
4099  - http://jnm.snmjournals.org/content/63/supplement_2/2974.short
4100  - http://jnm.snmjournals.org/content/63/supplement_2/2974.full
SO  - J Nucl Med2022 Aug 01; 63
AB  - 2974 Introduction: The incidence and mortality rates of breast cancer in Japan have been increasing over several decades. Breast cancer is now the most common cancer among Japanese woman, and about 94,400 new case of breast cancer are expected to be diagnosed in 2021. The 5-year and 10-year relative survival rates for TNM stage I cancers are 98% or more, thus early detection of breast cancer is essential to improve the mortality. From a perspective of preemptive medicine, whole-body FDG PET cancer screening as an opportunistic screening program has been performed in our institution since 2016. For women, dedicated breast PET (dbPET) examination with or without other tests is added to improve breast cancer detection. The aim of this study was to evaluate the diagnostic performance of dbPET in breast cancer screening, as compared with tomosynthesis (3D-mammogram, 3D-MMG), for each year.Methods: This retrospective study included all examinations of dbPET plus 3D-MMG from July 2016 to December 2020. DbPET scans evaluated by two board-certified experienced nuclear medicine physicians independently, and 3D-MMG was rated by an experienced breast surgeon. The results of each modality were classified as following five diagnostic categories; category A = normal, B = mild abnormality, C = need for follow-up, D = recommend further examination, E = under treatment or follow-up. Only category D was regarded as positive in this study. Final diagnosis was determined by pathologic evaluation with biopsies or surgical resections. In the absence of pathological diagnosis, follow-up results of clinical/imaging were regarded as final diagnosis. Screening-detected cancer was defined as a diagnosis of invasive breast cancer or ductal carcinoma in situ (DCIS) during the 1 year after the screening study. The number of examinations, recall rate (RC), follow-up rate (FR), cancer detection rate (CDR), positive predictive value of positive screening results (PPV1), positive predictive value of biopsies performed (PPV3) by year were calculated. Results: The cumulative total of 2,782 screening examinations were included. The mean age of examinees was 54.3±11.1 years. The number of examinations in 2016 to 2020 was 280, 584, 612, 691, and 615, respectively. Overall, 15 breast cancers were detected by either dbPET or 3D-MMG in the whole periods. First, RC, FR, CDR, PPV1, and PPV3 of dbPET for each year were as follows: 28.6%, 92.5%, 7.1 per 1000, 2.5%, and 22.2% (2016), 22.1%, 93.8%, 3.4 per 1000, 2.3%, and 14.3% (2017), 16.3%, 93.0%, 9.8 per 1000, 6.0%, and 31.6% (2018), 13.3%, 98.9%, 1.4 per 1000, 1.1%, and 7.7% (2019), 10.9%, 94.0%, 1.6 per 1000, 1.5%, and 11.1% (2020). The indicators of 3D-MMG for each year were as follows: 16.1%, 95.6%, 10.7 per 1000, 6.7%, and 37.5% (2016), 14.7%, 93.0%, 3.4 per 1000, 2.3%, and 14.3% (2017), 19.3%, 94.9%, 9.8 per 1000, 5.1%, and 35.3% (2018), 18.7%, 93.8%, 2.9 per 1000, 1.6%, and 11.1% (2019), 14.8%, 96.7%, 1.6 per 1000, 1.1%, and 10.0% (2020). The 15 screening-detected breast cancers included DCIS (n = 5), StageⅠ invasive carcinoma (n = 8), and StageⅡ invasive carcinoma (n = 2) . 3D-MMG detected 14 of the 15 cancers. On dbPET, 12 were positive, and 3 were negative. However, 2 of the 3 dbPET-negative cancers had abnormal FDG uptake in retrospect. Conclusions: CDR and PPVs of dbPET appeared relatively close to those of 3D-MMG, likely suggesting acceptable diagnostic performance of dbPET. RC of dbPET decreased year by year and was lower than that of 3D-MMG in the last 3 years, indicating the advantage of dbPET over 3D-MMG. Our study suggests that dbPET is a potential screening modality for breast cancers in the opportunistic whole-body FDG PET cancer screening program. With the optimization of interpretational criteria, further studies are warranted to determine the roles of dbPET screening.