Images obtained in a 50-year-old patient with a new malignant lesion proven by biopsy in the left breast. (A) Cranio-caudal mammogram of the right breast shows no lesions. (B) The malignant lesion corresponds to a 7.0 cm irregular, spiculated mass on the left craniocaudal mammogram. Ultrasound-guided core biopsy revealed grade 2 invasive lobular carcinoma. (C) Bilateral positron emission mammographic craniocaudal color image obtained 1 hour after intravenous injection of 185 MBq of fluorine-18 labeled fluorodeoxyglucose (18F-FDG) shows a mass with intense uptake in the left breast with known cancer and no abnormal uptake in the right breast. Craniocaudal positron emission mammographic images of the left breast obtained (D) 1 hour and (E) 4 hours after intravenous injection of 185 MBq of 18F-FDG shows no substantial visual difference in uptake in known cancer. (F) Axial, fat-saturated, subtracted, T1-weighted MRI image with maximum intensity projection reconstruction, obtained 90 seconds after intravenous injection of 0.1 mmol of gadolinium contrast material by kilogram of body weight, also shows the enhanced mass corresponding to a known malignancy. (arrow) and marked bilateral background parenchymal enhancement, with multiple foci of nonspecific enhancement in the contralateral breast. The patient opted for bilateral mastectomy, which confirmed malignancy on the left side and no malignancy in the contralateral breast. Credit: Radiological Society of North America
An innovative breast imaging technique provides high sensitivity for detecting cancer while significantly reducing the risk of false-positive results, according to a study published in Radiology: Cancer imaging. The researchers said the technique could potentially offer more reliable breast cancer screening to a wider range of patients.
Mammography is an effective screening tool for early detection of breast cancer, but its sensitivity is reduced in dense breast tissue. This is due to the masking effect of the overlying dense fibroglandular tissue. Because nearly half of the screened population has dense breasts, many of these patients require additional breast imaging, often with MRI, after mammography.
Low-dose positron emission mammography (PEM) is a new molecular imaging technique that offers improved diagnostic performance at a radiation dose comparable to mammography.
For the study, 25 women, median age 52 years, recently diagnosed with breast cancer, underwent low-dose PEM with the radiotracer fluordeoxyglucose labeled with fluorine 18 (18F-FDG). Two breast radiologists reviewed the PEM images taken one and four hours later 18Injection of F-FDG and correlated the results with laboratory results.
PEM displayed comparable performance to MRI, identifying 24 of 25 invasive cancers (96%). Its false positive rate was only 16%, compared to 62% for MRI.
Images obtained in an 85-year-old patient with a new malignant lesion proven by biopsy in the right breast. (A) The malignant lesion corresponds to a 3.0 cm slightly irregular mass of equal density on the right craniocaudal mammogram. Ultrasound-guided core biopsy revealed grade 3 invasive intracystic papillary carcinoma. (B) Right craniocaudal positron emission mammographic color image obtained 1 hour after intravenous injection of 74 MBq of fluorine-18 labeled fluorodeoxyglucose (18F-FDG) presents a 3.2 cm mass (known cancer) with intense uptake. Left (C) mediolateral oblique and (D) craniocaudal PEM color images obtained 1 hour after intravenous injection of 74 MBq of 18F-FDG shows no abnormal absorption. Right craniocaudal PEM images obtained (E) 1 hour and (F) 4 hours after intravenous injection of 74 MBq of 18F-FDG shows no substantial visual difference in uptake in known cancer. (G,H) Axial fat-saturated, subtracted, T1-weighted MRI images with maximum intensity projection reconstruction, obtained 90 seconds after intravenous injection of 0.1 mmol of gadolinium contrast material per kilogram of body weight, also show the enhanced mass corresponding to known malignancy and multiple foci of nonspecific enhancement in the contralateral breast, the largest in the left central breast with washout kinetics (H-shaped arrow). MRI-guided biopsy of the left side confirmed a benign intraductal papilloma. The patient underwent right lumpectomy with sentinel lymph node biopsy. The final pathological result confirmed a 3.2 cm grade 3 invasive intracystic papillary carcinoma with negative sentinel lymph node biopsy. Credit: Radiological Society of North America
In addition to its high sensitivity and low false positive rate, PEM could potentially reduce downstream healthcare costs, as this study shows that it can avoid unnecessary additional examinations compared to MRI. Additionally, the technology is designed to deliver a radiation dose comparable to that of traditional mammography without requiring breast compression, which can often be uncomfortable for patients.
“The integration of these features – high sensitivity, lower false positive rates, cost-effectiveness, acceptable radiation levels without compression, and independence of breast density – positions this emerging imaging modality as a potential revolutionary advance in the early detection of breast cancer. breast cancer,” said the study’s lead author, Vivianne Freitas, MD, M.Sc., assistant professor at the University of Toronto.
“As such, it promises to transform breast cancer diagnosis and screening in the near future, complementing or even improving current imaging methods, marking a significant advancement in breast cancer care. “
Low-dose PEM offers potential clinical uses in screening and diagnostic settings, according to Dr. Freitas.
“For screening, its ability to work effectively regardless of breast density potentially addresses a significant gap in mammography, particularly in detecting cancers in dense breasts where lesions may be masked,” she said. declared. “It also presents a viable option for high-risk patients who are claustrophobic or have contraindications to MRI.”
Images obtained in a 69-year-old patient with a new malignant lesion proven by biopsy in the left breast. (A, B) The malignant lesion corresponds to a 2.5 cm irregular, spiculated mass (arrow) and an additional oval, circumscribed mass (double arrows) on left mediolateral oblique and craniocaudal point compression mammographic views. Ultrasound-guided core biopsy revealed grade 3 invasive ductal carcinoma (arrow) and fibroadenoma (double arrow). Left positron emission mammographic (PEM) color images (C) craniocaudal and (D) mediolateral oblique obtained 1 hour after intravenous injection of 74 MBq of fluorine-18 labeled fluorodeoxyglucose (18F-FDG) show a mass (known cancer) with intense uptake and no uptake in the biopsy-proven fibroadenoma. Right (E) craniocaudal and (F) mediolateral oblique PEM color images obtained 1 hour after intravenous injection of 74 MBq of 18F-FDG shows no abnormal absorption. Left craniocaudal PEM images obtained (G) 1 hour and (H) 4 hours after intravenous injection of 74 MBq of 18F-FDG shows no substantial visual difference in uptake in known cancer. (I) Axial, fat-saturated, subtracted, T1-weighted MRI image with maximum intensity projection reconstruction, obtained 90 seconds after intravenous injection of 0.1 mmol of gadolinium contrast material by kilogram of body weight, also shows the left-sided enhanced mass (arrow) corresponding to a known malignancy and biopsy-proven fibroadenoma (double arrows), as well as multiple foci of nonspecific enhancement in the contralateral breast, one being the most visible (arrow). The patient underwent bilateral lumpectomy. Final pathological findings in the left breast confirmed grade 3 invasive ductal carcinoma and revealed atypical ductal hyperplasia in the right breast. Credit: Radiological Society of North America
The technology could also play a crucial role in interpreting uncertain mammogram results, assessing response to chemotherapy, and determining the extent of disease in newly diagnosed breast cancer, including involvement of the other breast.
Dr. Freitas, who is also a radiologist in the Division of Breast Imaging at the Joint Department of Medical Imaging at Toronto, University Health Network, Sinai Health System and Women’s College Hospital, is currently studying the ability of PEM to reduce high rates of false positives generally associated. with MRI scans.
If PEM were successful in reducing these rates, it could significantly reduce emotional distress and anxiety related to false positives, Dr. Freitas said. Additionally, it could lead to a reduction in unnecessary biopsies and treatments.
Further studies are needed to determine the exact role and effectiveness of low-dose PEM in the clinical setting.
“Although the full integration of this imaging method into clinical practice remains to be confirmed, the preliminary results of this research are promising, including demonstrating the ability to detect invasive breast cancer with low doses of labeled FDG to fluorine 18″, said Dr. » said Freitas.
“This marks a crucial first step in its potential future implementation in clinical practice.”
More information:
Breast cancer detection using a low-dose digital positron emission mammography system, Radiology Imaging Cancer (2024).
Provided by the Radiological Society of North America
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