Purpose: Whole-body silicon photomultiplier positron emission tomography (WB SiPM PET) could be used to diagnose breast cancer spread before lumpectomy. We aimed to investigate the method of measuring the tumor size by WB SiPM PET as a basis for diagnosing breast cancer spread in the breast.
Methods: We retrospectively reviewed 24 breast cancer lesions in 21 patients who underwent WB SiPM PET/CT in the prone position as preoperative breast cancer examinations from September 2020 to March 2022.
In all cases, a 20-mm spherical VOI was placed in the normal mammary gland to measure the mean standardised uptake value (SUVmean) and the standard deviation (SD) of 18F-fluorodeoxyglucose (FDG) uptake. We prepared four types of candidates (SUVmean + 2 SD, SUVmean + 3 SD, 1.5 SUVmean + 2 SD, 1.5 SUVmean + 3 SD) for thresholds for delineating tumor contours on PET images. On the semiautomatic viewer soft, the maximum tumor sizes were measured at each of the four thresholds and compared with the pathological sizes, including EIC.
Results: The lesion detection sensitivity was 96% for WB SiPM PET. PET detected 23 lesions, excluding 4-mm ductal carcinomas in situ (DCIS). PET measurements at the threshold ‘1.5 SUVmean + 2 SD’ demonstrated the highest correlation coefficient (rs) with the pathologic sizes, including EIC (rs = 0.722). Moreover, ‘1.5 SUVmean + 2 SD’ had the highest concordance (62.5%).
Conclusions: By using ‘1.5 SUVmean + 2 SD’ of the normal mammary gland as a patient-specific threshold, we were able to evaluate the tumor size, including EIC.
We present a case of a 35-year-old woman with breast cancer in lactation 3 months after childbirth, in which a lactation inhibitor was useful for 18F-FDG PET/CT examination. Via ultrasonography and biopsy with histopathology, we diagnosed the lesion in the upper region of the left breast as invasive ductal carcinoma. She stopped breastfeeding and was administered cabergoline to suppress lactation. Two days after the administration, 18F-FDG PET/CT revealed segmental uptake (10 cm in diameter) and no lactation-related uptakes. Dynamic MRI also revealed a segmental enhancement of the same size as 18F-FDG PET/CT. The lactation inhibitor was useful to delineate the extent of the lesion during the 18F-FDG PET/CT examination.
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