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Nuklearmedizin 2016; 55(01): 15-20
DOI: 10.3413/Nukmed-0753-15-07
Original article
Schattauer GmbH

Positron emission mammography in the diagnosis of breast cancer

Is maximum PEM uptake value a valuable threshold for malignant breast cancer detection?PET-Mammographie zur Diagnose von Brustkrebs Ist der maximale PEM-Uptake als Grenzwert zurErkennung von bösartigem Brustkrebs geeignet?
F. H. H. Müller
1   Radiology and Nuclear Medicine Ludwigshafen, Germany
,
J. Farahati
2   Clinic for Nuclear Medicine, Bethesda-Hospital, Duisburg, Germany
,
A. G. Müller
3   Faculty 08 Biology and Chemistry, Justus Liebig University Gießen, Germany
,
E. Gillman
2   Clinic for Nuclear Medicine, Bethesda-Hospital, Duisburg, Germany
,
M. Hentschel
4   Department of Nuclear Medicine, Inselspital Bern, Switzerland
› Author Affiliations
Further Information

Publication History

received: 01 July 2015

accepted in revised form: 30 October 2015

Publication Date:
19 December 2017 (online)

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Summary

Aim: To evaluate the diagnostic value (sensitivity, specificity) of positron emission mammography (PEM) in a single site non-interventional study using the maximum PEM uptake value (PUVmax). Patients, methods: In a singlesite, non-interventional study, 108 patients (107 women, 1 man) with a total of 151 suspected lesions were scanned with a PEM Flex Solo II (Naviscan) at 90 min p.i. with 3.5 MBq 18F-FDG per kg of body weight. In this ROI(region of interest)-based analysis, maximum PEM uptake value (PUV) was determined in lesions, tumours (PUVmaxtumour), benign lesions (PUVmaxnormal breast) and also in healthy tissues on the contralateral side (PUVmaxcontralateral breast). These values were compared and contrasted. In addition, the ratios of PUVmaxtumour / PUVmaxcontralateral breast and PUVmaxnormal breast / PUVmaxcontralateral breast were compared. The image data were interpreted independently by two experienced nuclear medicine physicians and compared with histology in cases of suspected carcinoma. Results: Based on a criteria of PUV>1.9, 31 out of 151 lesions in the patient cohort were found to be malignant (21%). A mean PUVmaxtumour of 3.78 ± 2.47 was identified in malignant tumours, while a mean PUVmaxnormal breast of 1.17 ± 0.37 was reported in the glandular tissue of the healthy breast, with the difference being statistically significant (p < 0.001). Similarly, the mean ratio between tumour and healthy glandular tissue in breast cancer patients (3.15 ± 1.58) was found to be significantly higher than the ratio for benign lesions (1.17 ± 0.41, p < 0.001). Conclusion: PEM is capable of differentiating breast tumours from benign lesions with 100% sensitivity along with a high specificity of 96%, when a threshold of PUVmax >1.9 is applied.

Zusammenfassung

Ziel: Die diagnostische Leistungsfähigkeit (Sensitivität, Spezifität) des Parameters des maximalen uptakes (PUVmax) in der Positronen Emissions Mammographie (PEM) sollte zur Detektion von Brustkrebs im Rahmen einer klinischen Anwendungsbeobachtung ermittelt werden. Patienten, Methoden: In einer Anwenderstudie einer Einrichtung wurde die PEM mit der PEM Flex Solo II (Naviscan) bei 108 Patienten (107 Frauen) mit 151 malignomverdächtigen Läsionen 90 Minuten p.i. mit 3,5 MBq 18F-FDG pro kg Körpergewicht durchgeführt. In der ROI(region of interest)-basierten Analyse wurden der maximale PEM Aktivitätswert in der Läsion, Tumor (PUVmaxtumour) oder benignen Läsion (PUVmaxnormal breast) und einer korrespondierenden Region auf der gesunden Gegenseite (PUVmaxcontralateral breast) bestimmt und verglichen. Zusätzlich wurden die Verhältnisse PUVmaxtumour / PUVmaxcontralateral breast und PUVmaxnormal breast / PUVmaxcontralateral breast berechnet und verglichen. Die Bilddaten wurden von zwei erfahrenen Ärzten unabhängig befundet und bei Karzinomverdacht mit der Histopathologie verglichen. Ergebnisse: Nach dem Kriterium PUV > 1,9 wurden 31 von 151 Läsionen als bösartige Tumoren (21%) detektiert. Der Mittelwert des PUVmaxtumour wurde mit 3,78 ± 2,47 in malignen Tumoren und PUVmaxnormal breast mit 1,17 ± 0,37 im Drüsengewebe der gesunden Brust ermittelt (p < 0,001). Ebenso war der Mittelwert der Verhältnisse zwischen Tumor und gesundem Drüsengewebe bei Brustkrebspatientinnen mit 3,15 ± 1,58 signifikant höher als bei den gutartigen Läsionen 1,17 ± 0,41 (p = 0,001). Schlussfolgerung: Mit Hilfe von PEM können Brustkrebstumoren von gutartigen Tumoren mit einer sehr hohen Sensitivität (100%) bei gleichzeitig hoher Spezifität (96%) unterschieden werden, wenn als Kriterium ein Schwellwert für das PUVmax > 1.9 verwendet wird.

Keywords

Positron emission tomography - breast cancer - malign tumours - benign tumours

Schlüsselwörter

PET - Brustkrebs - bösartige Tumore - gutartige Tumore
 

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