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Breast cancer detection using high-resolution breast PET compared to whole-body PET or PET/CT

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To compare the performance characteristics of positron emission mammography (PEM) with those of whole-body PET (WBPET) and PET/CT in women with newly diagnosed breast cancer.

Methods

A total of 178 women consented to PEM for presurgical planning in an IRB-approved protocol and also underwent either WBPET (n = 69) or PET/CT (n = 109) imaging, as per usual care at three centers. Tumor detection sensitivity, positive predictive values, and 18F-fluorodeoxyglucose (FDG) uptake were compared between the modalities. The effects of tumor size, type, and grade on detection were examined. The chi-squared or Fisher’s exact tests were used to compare distributions between groups, and McNemar’s test was used to compare distributions for paired data within subject groups, i.e. PEM versus WBPET or PEM versus PET/CT.

Results

The mean age of the women was 59 ± 12 years (median 60 years, range 26–89 years), with a mean invasive index tumor size of 1.6 ± 0.8 cm (median 1.5 cm, range 0.5–4.0 cm). PEM detected more index tumors (61/66, 92 %) than WBPET (37/66, 56 %; p < 0.001) or PET/CT (95/109, 87 % vs. 104/109, 95 % for PEM; p < 0.029). Sensitivity for the detection of additional ipsilateral malignancies was also greater with PEM (7/15, 47 %) than with WBPET (1/15, 6.7 %; p = 0.014) or PET/CT (3/23, 13 % vs. 13/23, 57 % for PEM; p = 0.003). Index tumor detection decreased with decreasing invasive tumor size for both WBPET (p = 0.002) and PET/CT (p < 0.001); PEM was not significantly affected (p = 0.20). FDG uptake, quantified in terms of maximum PEM uptake value, was lowest in ductal carcinoma in situ (median 1.5, range 0.7–3.0) and invasive lobular carcinoma (median 1.5, range 0.7–3.4), and highest in grade III invasive ductal carcinoma (median 3.1, range 1.4–12.9).

Conclusion

PEM was more sensitive than either WBPET or PET/CT in showing index and additional ipsilateral breast tumors and remained highly sensitive for tumors smaller than 1 cm.

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Financial relationships and conflicts of interest

This research was supported by the National Institutes of Health (grant 5 R44 CA103102-05) and Naviscan. Site principle investigators and coauthors (K. Schilling, M. Tartar, W. Berg) received payment to cover the research costs on a per patient enrolled basis. W. Berg also received payment for hours provided as Head Principal Investigator to oversee the study design and the site principle investigators. Her payment was not linked to outcome results. K. Madsen works for Certus, Intl, who was contracted by Naviscan Inc, to be the repository of the original data from the research sites and to provide independent statistical analysis. M. Narayanan was employed by Naviscan and holds stock options. J. Kalinyak was principle investigator of the NIH grant, was employed as Chief Medical Officer at Naviscan, and coordinated the study; however, the site principle investigators and Certus maintained complete control over the original data at all times and have participated and reviewed the results in all the resulting publications.

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Author notes

  1. Deepa Narayanan

    Present address: National Cancer Institute, Bethesda, MD, USA

Authors and Affiliations

  1. Naviscan Inc., 4401 Eastgate Mall, San Diego, CA, 92121, USA

    Judith E. Kalinyak & Deepa Narayanan

  2. Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Wendie A. Berg

  3. Boca Raton Regional Hospital, Boca Raton, FL, USA

    Kathy Schilling

  4. Certus International, Inc., St. Louis, MO, USA

    Kathleen S. Madsen

  5. Scripps Clinic, Scripps Green Hospital, La Jolla, CA, USA

    Marie Tartar

Authors
  1. Judith E. Kalinyak
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  2. Wendie A. Berg
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  4. Kathleen S. Madsen
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  5. Deepa Narayanan
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Correspondence to Judith E. Kalinyak.

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Presented at the 2010 Assembly of the Radiologic Society of North America, Chicago, IL

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Kalinyak, J.E., Berg, W.A., Schilling, K. et al. Breast cancer detection using high-resolution breast PET compared to whole-body PET or PET/CT. Eur J Nucl Med Mol Imaging 41, 260–275 (2014). https://doi.org/10.1007/s00259-013-2553-1

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  • DOI: https://doi.org/10.1007/s00259-013-2553-1

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