Positron Emission Mammography: Correlation of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 Status and <sup>18</sup>F-FDG

Wang, Carolyn L.; MacDonald, L.R.; Rogers, James V.; Aravkin, Aleksandr Y.; Haseley, David; Beatty, J. David

doi:10.2214/ajr.11.6478

Cited by 59 publications

(39 citation statements)

References 36 publications

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“…The trends were similar when analyzed by lesion pathology type. The differences between lesion types observed here are consistent with prior studies of 18 F-FDG in breast lesions of differing pathology (17,23,24). In this study, the LBR was lower in ILC (P 5 0.4) and in DCIS (P , 0.02), relative to IDC.…”

Section: Discussionsupporting

confidence: 91%

“…Additional control images were taken from a database of prior institutional review board-approved PEM studies (unmatched controls) (17). We included the additional controls to better balance the ratio of disease-to-normal scans.…”

Section: Patient Cohortmentioning

confidence: 99%

“…Unmatched controls taken from the earlier study followed a protocol specified for that earlier study in which PEM scanning followed a clinically ordered WB PET/CT. That protocol specified A inj 5 592 MBq, PEM acquisition of T s 5 7 min, and variable T up due to the PEM scan after a WB PET/CT examination (17).…”

Section: Pem Scanningmentioning

confidence: 99%

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Positron Emission Mammography Image Interpretation for Reduced Image Count Levels

et al. 2015

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We studied the effects of reduced 18 F-FDG injection activity on interpretation of positron emission mammography (PEM) images and compared image interpretation between 2 postinjection imaging times. Methods: We performed a receiver-operating-characteristic (ROC) study using PEM images reconstructed with different count levels expected from injected activities between 23 and 185 MBq. Thirty patients received 2 PEM scans at postinjection times of 60 and 120 min. Half of the patients were scanned with a standard protocol; the others received one-half of the standard activity. Images were reconstructed using 100%, 50%, and 25% of the total counts acquired. Eight radiologists used a 5-point confidence scale to score 232 PEM images for the presence of up to 3 malignant lesions. Paired images were analyzed with conditional logistic regression and ROC analysis to investigate changes in interpretation.Results: There was a trend for increasing lesion detection sensitivity with increased image counts: odds ratios were 2.2 (P 5 0.01) and 1.9 (P 5 0.04) per doubling of image counts for 60-and 120-min uptake images, respectively, without significant difference between time points (P 5 0.7). The area under the ROC curve (AUC) was highest for the 100%-count, 60-min images (0.83 vs. 0.75 for 50%-counts, P 5 0.02). The 120-min images had a similar trend but did not reach statistical significance (AUC 5 0.79 vs. 0.73, P 5 0.1). Our data did not yield significant trends between specificity and image counts. Lesion-to-background ratios increased between 60-and 120-min scans (P , 0.001). Conclusion: Reducing the image counts relative to the standard protocol decreased diagnostic accuracy. The increase in lesion-to-background ratio between 60-and 120-min uptake times was not enough to improve detection sensitivity in this study, perhaps in part due to fewer counts in the later scan. Mot ivated by remaining challenges in diagnosis, staging, and management of breast cancer, small, high-resolution PET scanners dedicated to breast imaging have been investigated since the 1990s (1-13). Dedicated breast PET systems (positron emission mammography [PEM]) have spatial resolutions better than whole-body (WB) PET scanners by factors of 2-4 and are much smaller than WB PET scanners, allowing placement of the detectors close to the breast, thus increasing geometric detection efficiency for annihilation photons relative to WB PET. In theory, increased detector efficiency allows for lower injected activities or shorter scan times while maintaining a fixed image noise level.Increased detector efficiency adds to the number of detected coincidence counts during a scan, which is the underlying metric determining inherent image noise. The activity injected into the patient (A inj ), uptake time (T up ), scan duration (T s ), and detector efficiency are the primary factors determining the number of PEM scan counts. The PEM Flex Solo II scanner (PEM Flex; CMR Naviscan) consists of 2 bar detectors (6 · 16 cm imaging area) that scan in unison along the 6-cm ...

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Section: Discussionsupporting

confidence: 91%

Section: Patient Cohortmentioning

confidence: 99%

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Positron Emission Mammography Image Interpretation for Reduced Image Count Levels

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“…Explanation of exclusion reasons, b e.g., reviews, editorials, guidelines, and perspectives; c e.g., optical imaging and scintimammography; Table 1. Characteristics of studies reporting on mammography, breast ultrasound, MRI, and (17,18,70,87,91,(93)(94)(95)(96)(97)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107). Of these, eight articles reported on two imaging modalities: five on both breast ultrasound and mammography (28,33,41,52,56), and three on both 18 F-FDG PET and DWI (70,87), or MRS (91).…”

Section: Resultsmentioning

confidence: 99%

Imaging Features of HER2 Overexpression in Breast Cancer: A Systematic Review and Meta-analysis

Elias

Adams

Wisner

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Breast cancer imaging phenotype is diverse and may relate to molecular alterations driving cancer behavior. We systematically reviewed and meta-analyzed relations between breast cancer imaging features and human epidermal growth factor receptor type 2 (HER2) overexpression as a marker of breast cancer aggressiveness. MEDLINE and EMBASE were searched for mammography, breast ultrasound, magnetic resonance imaging (MRI), and/or [ 18 F]fluorodeoxyglucose positron emission tomography studies through February 2013. Of 68 imaging features that could be pooled (85 articles, 23,255 cancers; random-effects meta-analysis), 11 significantly related to HER2 overexpression. Results based on five or more studies and robustness in subgroup analyses were as follows: the presence of microcalcifications on mammography [pooled odds ratio (pOR), 3.14; 95% confidence interval (CI), 2.46-4.00] or ultrasound (mass-associated pOR, 2.95; 95% CI, 2.34-3.71), branching or fine linear microcalcifications (pOR, 2.11; 95% CI, 1.07-4.14) or extremely dense breasts on mammography (pOR, 1.37; 95% CI, 1.07-1.76), and washout (pOR, 1.57; 95% CI, 1.11-2.21) or fast initial kinetics (pOR, 2.60; 95% CI, 1.43-4.73) on MRI all increased the chance of HER2 overexpression. Maximum [ 18 F]fluorodeoxyglucose standardized uptake value (SUV max ) was higher upon HER2 overexpression (pooled mean difference, þ0.76; 95% CI, 0.10-1.42). These results show that several imaging features relate to HER2 overexpression, lending credibility to the hypothesis that imaging phenotype reflects cancer behavior. This implies prognostic relevance, which is especially relevant as imaging is readily available during diagnostic work-up. Cancer Epidemiol Biomarkers Prev; 23(8); 1464-83. Ó2014 AACR.

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“…Many groups have demonstrated good correlations between primary tumor FDG uptake on PET/CT, expressed as the maximum standardized uptake value (SUV max ), and clinicopathological findings that are known to be important prognostic indicators in breast cancer patients [10][11][12][13][14][15][16][17]. A higher SUV max is reported to be significantly associated with estrogen receptor (ER) negativity, progesterone receptor (PR) negativity, human epidermal growth factor receptor 2 (HER2) positivity, a high Ki-67 index, a bigger tumor size, a higher histological grade, presence of axillary lymph node (LN) metastasis, and a higher stage.…”

Section: Factors Correlated With Fdg Uptake In Primary Breast Tumorsmentioning

confidence: 99%

Present and future role of FDG-PET/CT imaging in the management of breast cancer

Kitajima

Miyoshi

2016

Jpn J Radiol

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by malignant cells, opened a new field in clinical oncologic imaging. Recently, integrated positron emission tomography/computed tomography (PET/CT), in which a full-ringdetector clinical PET scanner and multidetector-row helical CT scanner are combined, has made it possible to acquire both metabolic and anatomic imaging data using a single device in a single diagnostic session, and provides precise anatomic localization of suspicious areas of increased FDG uptake. When used in a clinical setting, FDG-PET/CT leads to a significant improvement in diagnostic accuracy and has had a considerable impact on patient management, including diagnosis, initial staging, optimization of treatment, restaging, monitoring of the response to therapy, and prognostication of various malignant tumors. We herein review the current and future roles of FDG-PET/CT in the management of breast cancer, discussing its usefulness and limitations for imaging in these patients. DiagnosisFDG-PET imaging has poor sensitivity (<50 %) for subcentimeter breast cancers [9,10]. This is due to the limited spatial resolution of PET and, in some cases, by tumor characteristics (e.g., low FDG avidity in grade 1 cancer, ductal carcinoma in situ, or lobular carcinoma) [1,2]. Specificity can also be altered by variations of FDG uptake in certain benign conditions, such as infection, fibroadenoma, ductal adenoma, inflammatory granulomatous mastitis, and fibrocystic changes [3].In order to improve specificity, some authors would obtain a second series of PET images centered on the breast approximately 2 h after FDG injection (dual-time imaging) [4]. Indeed, FDG uptake seems to increase with time in the case of malignancy, while some inflammatory lesions show stable or decreasing uptake [4]. However, dual-time Abstract Integrated positron emission tomography/computed tomography (PET/CT) with 2-[18F]fluoro-2-deoxyd-glucose (FDG) is a useful tool for acquisition of both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session, and has opened a new field in clinical oncologic imaging. FDG-PET/CT has been used successfully for the diagnosis, initial staging, restaging, early treatment response assessment, evaluation of metastatic disease response, and prognostication of breast cancer as well as various malignant tumors. We herein review the current place and role of FDG-PET/CT in the management of breast cancer, focusing on its usefulness and limitations in the imaging of these patients.

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Positron Emission Mammography: Correlation of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 Status and ¹⁸F-FDG

Abstract: This study shows a correlation between PEM FDG uptake values and the prognostic factors that have been shown to predict breast cancer survival.

Cited by 59 publications

References 36 publications

Positron Emission Mammography Image Interpretation for Reduced Image Count Levels

Positron Emission Mammography Image Interpretation for Reduced Image Count Levels

Imaging Features of HER2 Overexpression in Breast Cancer: A Systematic Review and Meta-analysis

Present and future role of FDG-PET/CT imaging in the management of breast cancer

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Positron Emission Mammography: Correlation of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 Status and 18F-FDG

Abstract: This study shows a correlation between PEM FDG uptake values and the prognostic factors that have been shown to predict breast cancer survival.

Cited by 59 publications

References 36 publications

Positron Emission Mammography Image Interpretation for Reduced Image Count Levels

Positron Emission Mammography Image Interpretation for Reduced Image Count Levels

Imaging Features of HER2 Overexpression in Breast Cancer: A Systematic Review and Meta-analysis

Present and future role of FDG-PET/CT imaging in the management of breast cancer

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Positron Emission Mammography: Correlation of Estrogen Receptor, Progesterone Receptor, and Human Epidermal Growth Factor Receptor 2 Status and ¹⁸F-FDG