Comparative Effectiveness of Positron Emission Mammography and MRI in the Contralateral Breast of Women With Newly Diagnosed Breast Cancer

Berg, Wendie A.; Madsen, Kathleen S.; Schilling, Kathy; Tartar, Marie; Pisano, Etta D.; Larsen, Linda Hovanessian; Narayanan, Deepa; Kalinyak, Judith E.

doi:10.2214/ajr.10.6342

Cited by 57 publications

(34 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the same series of 388 women, 15 (3.9%) had contralateral cancer identified after study entry, with 14 of 15 (93%) seen on MRI, only 3 of 15 (20%) prospectively seen on PEM, and only 11 of 15 (73%) visible even in retrospect on PEM. The PPV of PEMprompted contralateral biopsies (3 of 14, or 21%) was not different from that of MRI (15 of 54, or 28%) (P 5 0.58) (27).…”

Section: Extent Of Diseasementioning

confidence: 74%

“…PEM has been compared with MRI for assessing local disease extent in a prospective multicenter series of 388 women with newly diagnosed breast cancer (10,27). PEM showed comparable but complementary sensitivity in the ipsilateral breast and higher specificity than MRI, with a PPV of additional suspicious ipsilateral findings on PEM of 47 of 71 (66%) compared with 61 of 116 (53%) for MRI (P 5 0.016).…”

Section: Extent Of Diseasementioning

confidence: 99%

See 1 more Smart Citation

Nuclear Breast Imaging: Clinical Results and Future Directions

Berg

2016

J Nucl Med

Self Cite

View full text Add to dashboard Cite

Interest in nuclear breast imaging is increasing because of technical improvements in dedicated devices that allow the use of relatively low doses of radiotracers with high sensitivity for even small breast cancers. For women with newly diagnosed cancer, primary chemotherapy is often recommended, and improved methods of assessing treatment response are of interest. With widespread breast density notification, functional rather than anatomic methods of screening are of increasing interest as well. For a cancer imaging technology to be adopted, several criteria must be met that will be discussed: evidence of clinical benefit with minimal harm, standardized interpretive criteria, direct biopsy guidance, and acceptable cost-effectiveness. Twor adiotracers have been used widely to depict breast cancer: the g-emitting 99m Tc-sestamibi ( 99m Tc-methoxyisobutylisonitrile), 140 keV, half-life of 6 h, originally developed as a myocardial perfusion agent; and the positron-emitting glucose analog 18 F-FDG, 511 keV, half-life of 2 h. Standard lead shielding as is used in a mammography suite is sufficient when using 99m Tc-sestamibi. Using 18 F-FDG requires much more extensive shielding and may not be feasible because of workspaces above or below the planned unit. State licensing requirements for nuclear medicine must be considered; typically, a hot lab with oversight by a trained nuclear medicine technologist and a physicist is required (1).Both 99m Tc-sestamibi and 18 F-FDG were initially studied for breast cancer using whole-body scanners. Low sensitivity to invasive cancers smaller than 1 cm was observed with whole-body g-camera imaging in a prospective multicenter series at 48.2%, compared with 74.2% for larger tumors (2); detection of small cancers, particularly small invasive cancers, is a major goal of breast imaging. Similar results were observed with whole-body PET, with sensitivity to invasive tumors 2 cm or smaller of only 30 of 44 (68%) compared with 57 of 62 (92%) for larger cancers (3).Dedicated breast g-camera imaging can be performed with singledetector scintillating-crystal systems such as breast-specific g-imaging (BSGI) (Dilon Technologies) with a 20 · 15 cm field of view, 3.3-mm pixel size; or using dual-head cadmium-zinc-telluride detector systems, often referred to as molecular breast imaging (MBI) (GE Healthcare, with a 24 · 16 cm field of view and 2.5-mm pixel size; or Gamma Medica, Inc., with a 20 · 16 cm field of view and 1.6 mm pixel size). Both approaches use positioning similar to that of mammography, with the breast gently stabilized between a compression paddle and the detector (BSGI) or between 2 detectors (MBI). It is important to include mammographic technologists in the positioning of the patients, at least for a minimum number of cases (e.g., 25), to ensure full inclusion of posterior tissues for both a craniocaudal and a mediolateral oblique (MLO) acquisition. Particularly with the dualhead systems, it can be difficult to prevent skin folds or to ensure that the nipple is in profile becau...

show abstract

Section: Extent Of Diseasementioning

confidence: 74%

Section: Extent Of Diseasementioning

confidence: 99%

Nuclear Breast Imaging: Clinical Results and Future Directions

Berg

2016

J Nucl Med

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the same group of women, PEM, compared with MRI, showed significantly lower sensitivity (20.0% vs. 93.3%) for cancerous tumors found in the contralateral breast, although it showed higher specificity (95.2% vs. 89.5%) (34). Interestingly, some tumors in the central breast are visible on only one of the two mammographic views, an effect that may be caused by anisotropic spatial resolution in PEM systems.…”

Section: Tracer Development For Bd Radionuclide Imagingmentioning

confidence: 87%

Breast-Dedicated Radionuclide Imaging Systems

2016

View full text Add to dashboard Cite

Breast-dedicated radionuclide imaging systems show promise for increasing clinical sensitivity for breast cancer while minimizing patient dose and cost. We present several breast-dedicated coincidencephoton and single-photon camera designs that have been described in the literature and examine their intrinsic performance, clinical relevance, and impact. Recent tracer development is mentioned, results from recent clinical tests are summarized, and potential areas for improvement are highlighted. Br east cancer is the most common cancer in women worldwide, with 1.3 million cases diagnosed per year. The current standard of care in breast cancer management has challenges. Physical examinations often find palpable tumors that are already invasive and node-positive. Mammograms are well known for having low specificity and often being inconclusive for patients with dense breasts, leading to unnecessary surgical procedures and patient trauma. The use of noninvasive molecular imaging provides sensitive and specific cellular biologic information to aid in the diagnosis, staging, and treatment evaluation of breast cancer. PET and single-photon emission imaging have shown great diagnostic power in detection of malignant lesions in the body. The conventional systems sitting in the nuclear medicine clinic, however, are generalpurpose and have neither the photon sensitivity nor the spatial resolution required to affect earlier stages of breast cancer management. Technologic advances have enabled the creation of high-performance breast-dedicated (BD) radionuclide cameras that show promise for more sensitive cancer detection than standard clinical cameras while also providing better specificity than traditional anatomic imaging modalities such as x-ray mammography. This paper presents novel instrumentation from several different BD system designs that have been studied and evaluates the performance of different BD systems in the clinic. BD POSITRON EMISSION MAMMOGRAPHY (PEM) AND PET CAMERA DESIGNSSystem Configuration BD PET requires a field of view (FOV) large enough to be clinically relevant for breasts of all sizes, ranging from an average of 11.1-13.7 cm in diameter and 5.7-9.7 cm in length for bra cup sizes A-D (1). Detectors are typically arranged in a ring around the breast (annular systems), or in panels on 2 sides (dual-panel systems) or 4 sides (rectangular systems) of the breast. Translatable (2,3) and rotatable (4-7) detector heads can be used to extend the imaging FOV beyond the detector volume, but to date have had lower sensitivities than stationary systems with equivalent FOVs, and require longer scan times and more complex mechanical designs. For example, the sensitivity of the Shimadzu O-ring system is a factor of 5 higher than that of the Oncovision MAMMI system, which has a similar imaging FOV but uses translating heads (Table 1). Higher photon sensitivity generally allows for shorter scan times to achieve equivalent image quality, as seen with imaging protocols used for stationary (8) and translating systems ...

show abstract

“…7,8 Work from our laboratory has focused on MBI performed with a dual-head cadmium zinc telluride (CZT) detector and has demonstrated its potential to be a useful breast cancer screening modality. In women with mammographically dense breasts, MBI performed as an adjunct to screening mammography increased cancer detection sensitivity to 91% from 27% for mammography alone (p = 0.016).…”

Section: Introductionmentioning

confidence: 99%

Collimator design for a dedicated molecular breast imaging‐guided biopsy system: Proof‐of‐concept

et al. 2012

View full text Add to dashboard Cite

Purpose: Molecular breast imaging (MBI) is a dedicated nuclear medicine breast imaging modality that employs dual-head cadmium zinc telluride (CZT) gamma cameras to functionally detect breast cancer. MBI has been shown to detect breast cancers otherwise occult on mammography and ultrasound. Currently, a MBI-guided biopsy system does not exist to biopsy such lesions. Our objective was to consider the utility of a novel conical slant-hole (CSH) collimator for rapid (<1 min) and accurate monitoring of lesion position to serve as part of a MBI-guided biopsy system. Methods: An initial CSH collimator design was derived from the dimensions of a parallel-hole collimator optimized for MBI performed with dual-head CZT gamma cameras. The parameters of the CSH collimator included the collimator height, cone slant angle, thickness of septa and cones of the collimator, and the annular areas exposed at the base of the cones. These parameters were varied within the geometric constraints of the MBI system to create several potential CSH collimator designs. The CSH collimator designs were evaluated using Monte Carlo simulations. The model included a breast compressed to a thickness of 6 cm with a 1-cm diameter lesion located 3 cm from the collimator face. The number of particles simulated was chosen to represent the count density of a low-dose, screening MBI study acquired with the parallel-hole collimator for 10 min after a ∼150 MBq (4 mCi) injection of Tc-99m sestamibi. The same number of particles was used for the CSH collimator simulations. In the resulting simulated images, the count sensitivity, spatial resolution, and accuracy of the lesion depth determined from the lesion profile width were evaluated. Results: The CSH collimator design with default parameters derived from the optimal parallel-hole collimator provided 1-min images with error in the lesion depth estimation of 1.1 ± 0.7 mm and over 21 times the lesion count sensitivity relative to 1-min images acquired with the current parallel-hole collimator. Sensitivity was increased via more vertical cone slant angles, larger annular areas, thinner cone walls, shorter cone heights, and thinner radiating septa. Full width at half maximum trended in the opposite direction as sensitivity for all parameters. There was less error in the depth estimates for less vertical slant angles, smaller annular areas, thinner cone walls, cone heights near 1 cm, and generally thinner radiating septa. Conclusions: A Monte Carlo model was used to demonstrate the feasibility of a CSH collimator design for rapid biopsy application in molecular breast imaging. Specifically, lesion depth of a 1-cm diameter lesion positioned in the center of a typical breast can be estimated with error of less than 2 mm using circumferential count profiles of images acquired in 1 min.

show abstract

Comparative Effectiveness of Positron Emission Mammography and MRI in the Contralateral Breast of Women With Newly Diagnosed Breast Cancer

Cited by 57 publications

References 62 publications

Nuclear Breast Imaging: Clinical Results and Future Directions

Nuclear Breast Imaging: Clinical Results and Future Directions

Breast-Dedicated Radionuclide Imaging Systems

Collimator design for a dedicated molecular breast imaging‐guided biopsy system: Proof‐of‐concept

Contact Info

Product

Resources

About