Open AccessHigh‐Resolution Fluorodeoxyglucose Positron Emission Tomography with Compression (“Positron Emission Mammography”) is Highly Accurate in Depicting Primary Breast Cancer
Author(s) -
Berg Wendie A.,
Weinberg Irving N.,
Narayanan Deepa,
Lobrano Mary E.,
Ross Eric,
Amodei Laura,
Tafra Lorraine,
Adler Lee P.,
Uddo Joseph,
Stein William,
Levine Edward A.
Publication year - 2006
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/j.1075-122x.2006.00269.x
Subject(s) - medicine , breast cancer , positron emission tomography , fluorodeoxyglucose , mammography , lobular carcinoma , radiology , ductal carcinoma , cancer , nuclear medicine , standardized uptake value , histopathology , receiver operating characteristic , pathology
We sought to prospectively assess the diagnostic performance of a high‐resolution positron emission tomography (PET) scanner using mild breast compression (positron emission mammography [PEM]). Data were collected on concomitant medical conditions to assess potential confounding factors. At four centers, 94 consecutive women with known breast cancer or suspicious breast lesions received 18 F‐fluorodeoxyglucose (FDG) intravenously, followed by PEM scans. Readers were provided clinical histories and x‐ray mammograms (when available). After excluding inevaluable cases and two cases of lymphoma, PEM readings were correlated with histopathology for 92 lesions in 77 women: 77 index lesions (42 malignant), 3 ipsilateral lesions (3 malignant), and 12 contralateral lesions (3 malignant). Of 48 cancers, 16 (33%) were clinically evident; 11 (23%) were ductal carcinoma in situ (DCIS), and 37 (77%) were invasive (30 ductal, 4 lobular, and 3 mixed; median size 21 mm). PEM depicted 10 of 11 (91%) DCIS and 33 of 37 (89%) invasive cancers. PEM was positive in 1 of 2 T1a tumors, 4 of 6 T1b tumors, 7 of 7 T1c tumors, and 4 of 4 cases where tumor size was not available (e.g., no surgical follow‐up). PEM sensitivity for detecting cancer was 90%, specificity 86%, positive predictive value (PPV) 88%, negative predictive value (NPV) 88%, accuracy 88%, and area under the receiver‐operating characteristic curve ( A z ) 0.918. In three patients, cancer foci were identified only on PEM, significantly changing patient management. Excluding eight diabetic subjects and eight subjects whose lesions were characterized as clearly benign with conventional imaging, PEM sensitivity was 91%, specificity 93%, PPV 95%, NPV 88%, accuracy 92%, and A z 0.949 when interpreted with mammographic and clinical findings. FDG PEM has high diagnostic accuracy for breast lesions, including DCIS.