Breast cancer with low FDG uptake

Characterization by means of dual-time point FDG-PET/CT

Ashraf Anas Zytoon, Koji Murakami, Mohamed Ramdan El-Kholy, Emad El-Shorbagy, Osama Ebied

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Malignant breast lesions usually are differentiated by FDG-PET with a semiquantitative FDG standardized uptake value (SUV) of 2.5. However, the frequency of breast cancer with an SUV of less than or equal to 2.5 is noteworthy, and often present diagnostic challenges. This study was undertaken to evaluate the accuracy of dual-time point FDG-PET/CT with FDG standardized uptake value (SUV) calculation in the characterization of such breast tumors. Methods: Forty-nine female patients with newly diagnosed breast cancer were found to have primary breast cancer with minimally increased FDG uptake and met the criteria for inclusion in this study by having borderline levels of increased FDG uptake (SUVmax less than or equal to 2.5) in the initial FDG-PET/CT images. Consequently, they underwent further delayed phase FDG-PET/CT scan for better evaluation of the disease. Results: Of the 49 cancer lesions; the majority were found to have rising or unvarying dual-time changes in SUVmax (75.5%). The median value of SUVmax increases by 25% between the early and delayed scan. The means ± S.D. of the SUVmax1, the SUVmax2, and the ΔSUVmax% were 1.2 ± 0.6%, 1.3 ± 0.9%, and 5.1 ± 22.4%, respectively. The receiver-operating-characteristic (ROC) analysis proved that the highest accuracy for characterization of malignant breast lesions was obtained when a ΔSUVmax% cut-off value 0.0% was used as criteria for malignant FDG uptake-change over time with sensitivity 75.5%, and false-positive rate 20.4%. Conclusion: These results suggested that dual-time FDG-PET/CT imaging with standardized uptake value (SUV) estimation can improve the accuracy of the test in the evaluation of breast cancer with low FDG uptake.

Original languageEnglish
Pages (from-to)530-538
Number of pages9
JournalEuropean Journal of Radiology
Volume70
Issue number3
DOIs
Publication statusPublished - 2009 Jun
Externally publishedYes

Fingerprint

Breast Neoplasms
Breast
ROC Curve
Neoplasms

Keywords

  • Breast cancer
  • Delayed imaging
  • Dual-time point imaging
  • FDG-PET/CT
  • Standardized uptake value (SUV)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Breast cancer with low FDG uptake : Characterization by means of dual-time point FDG-PET/CT. / Zytoon, Ashraf Anas; Murakami, Koji; El-Kholy, Mohamed Ramdan; El-Shorbagy, Emad; Ebied, Osama.

In: European Journal of Radiology, Vol. 70, No. 3, 06.2009, p. 530-538.

Research output: Contribution to journalArticle

Zytoon, Ashraf Anas ; Murakami, Koji ; El-Kholy, Mohamed Ramdan ; El-Shorbagy, Emad ; Ebied, Osama. / Breast cancer with low FDG uptake : Characterization by means of dual-time point FDG-PET/CT. In: European Journal of Radiology. 2009 ; Vol. 70, No. 3. pp. 530-538.
@article{97986fa5daad40449a2f9ed6c905f313,
title = "Breast cancer with low FDG uptake: Characterization by means of dual-time point FDG-PET/CT",
abstract = "Background: Malignant breast lesions usually are differentiated by FDG-PET with a semiquantitative FDG standardized uptake value (SUV) of 2.5. However, the frequency of breast cancer with an SUV of less than or equal to 2.5 is noteworthy, and often present diagnostic challenges. This study was undertaken to evaluate the accuracy of dual-time point FDG-PET/CT with FDG standardized uptake value (SUV) calculation in the characterization of such breast tumors. Methods: Forty-nine female patients with newly diagnosed breast cancer were found to have primary breast cancer with minimally increased FDG uptake and met the criteria for inclusion in this study by having borderline levels of increased FDG uptake (SUVmax less than or equal to 2.5) in the initial FDG-PET/CT images. Consequently, they underwent further delayed phase FDG-PET/CT scan for better evaluation of the disease. Results: Of the 49 cancer lesions; the majority were found to have rising or unvarying dual-time changes in SUVmax (75.5{\%}). The median value of SUVmax increases by 25{\%} between the early and delayed scan. The means ± S.D. of the SUVmax1, the SUVmax2, and the ΔSUVmax{\%} were 1.2 ± 0.6{\%}, 1.3 ± 0.9{\%}, and 5.1 ± 22.4{\%}, respectively. The receiver-operating-characteristic (ROC) analysis proved that the highest accuracy for characterization of malignant breast lesions was obtained when a ΔSUVmax{\%} cut-off value 0.0{\%} was used as criteria for malignant FDG uptake-change over time with sensitivity 75.5{\%}, and false-positive rate 20.4{\%}. Conclusion: These results suggested that dual-time FDG-PET/CT imaging with standardized uptake value (SUV) estimation can improve the accuracy of the test in the evaluation of breast cancer with low FDG uptake.",
keywords = "Breast cancer, Delayed imaging, Dual-time point imaging, FDG-PET/CT, Standardized uptake value (SUV)",
author = "Zytoon, {Ashraf Anas} and Koji Murakami and El-Kholy, {Mohamed Ramdan} and Emad El-Shorbagy and Osama Ebied",
year = "2009",
month = "6",
doi = "10.1016/j.ejrad.2008.01.045",
language = "English",
volume = "70",
pages = "530--538",
journal = "Journal of Medical Imaging",
issn = "0720-048X",
publisher = "Elsevier Ireland Ltd",
number = "3",

}

TY - JOUR

T1 - Breast cancer with low FDG uptake

T2 - Characterization by means of dual-time point FDG-PET/CT

AU - Zytoon, Ashraf Anas

AU - Murakami, Koji

AU - El-Kholy, Mohamed Ramdan

AU - El-Shorbagy, Emad

AU - Ebied, Osama

PY - 2009/6

Y1 - 2009/6

N2 - Background: Malignant breast lesions usually are differentiated by FDG-PET with a semiquantitative FDG standardized uptake value (SUV) of 2.5. However, the frequency of breast cancer with an SUV of less than or equal to 2.5 is noteworthy, and often present diagnostic challenges. This study was undertaken to evaluate the accuracy of dual-time point FDG-PET/CT with FDG standardized uptake value (SUV) calculation in the characterization of such breast tumors. Methods: Forty-nine female patients with newly diagnosed breast cancer were found to have primary breast cancer with minimally increased FDG uptake and met the criteria for inclusion in this study by having borderline levels of increased FDG uptake (SUVmax less than or equal to 2.5) in the initial FDG-PET/CT images. Consequently, they underwent further delayed phase FDG-PET/CT scan for better evaluation of the disease. Results: Of the 49 cancer lesions; the majority were found to have rising or unvarying dual-time changes in SUVmax (75.5%). The median value of SUVmax increases by 25% between the early and delayed scan. The means ± S.D. of the SUVmax1, the SUVmax2, and the ΔSUVmax% were 1.2 ± 0.6%, 1.3 ± 0.9%, and 5.1 ± 22.4%, respectively. The receiver-operating-characteristic (ROC) analysis proved that the highest accuracy for characterization of malignant breast lesions was obtained when a ΔSUVmax% cut-off value 0.0% was used as criteria for malignant FDG uptake-change over time with sensitivity 75.5%, and false-positive rate 20.4%. Conclusion: These results suggested that dual-time FDG-PET/CT imaging with standardized uptake value (SUV) estimation can improve the accuracy of the test in the evaluation of breast cancer with low FDG uptake.

AB - Background: Malignant breast lesions usually are differentiated by FDG-PET with a semiquantitative FDG standardized uptake value (SUV) of 2.5. However, the frequency of breast cancer with an SUV of less than or equal to 2.5 is noteworthy, and often present diagnostic challenges. This study was undertaken to evaluate the accuracy of dual-time point FDG-PET/CT with FDG standardized uptake value (SUV) calculation in the characterization of such breast tumors. Methods: Forty-nine female patients with newly diagnosed breast cancer were found to have primary breast cancer with minimally increased FDG uptake and met the criteria for inclusion in this study by having borderline levels of increased FDG uptake (SUVmax less than or equal to 2.5) in the initial FDG-PET/CT images. Consequently, they underwent further delayed phase FDG-PET/CT scan for better evaluation of the disease. Results: Of the 49 cancer lesions; the majority were found to have rising or unvarying dual-time changes in SUVmax (75.5%). The median value of SUVmax increases by 25% between the early and delayed scan. The means ± S.D. of the SUVmax1, the SUVmax2, and the ΔSUVmax% were 1.2 ± 0.6%, 1.3 ± 0.9%, and 5.1 ± 22.4%, respectively. The receiver-operating-characteristic (ROC) analysis proved that the highest accuracy for characterization of malignant breast lesions was obtained when a ΔSUVmax% cut-off value 0.0% was used as criteria for malignant FDG uptake-change over time with sensitivity 75.5%, and false-positive rate 20.4%. Conclusion: These results suggested that dual-time FDG-PET/CT imaging with standardized uptake value (SUV) estimation can improve the accuracy of the test in the evaluation of breast cancer with low FDG uptake.

KW - Breast cancer

KW - Delayed imaging

KW - Dual-time point imaging

KW - FDG-PET/CT

KW - Standardized uptake value (SUV)

UR - http://www.scopus.com/inward/record.url?scp=67349287013&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67349287013&partnerID=8YFLogxK

U2 - 10.1016/j.ejrad.2008.01.045

DO - 10.1016/j.ejrad.2008.01.045

M3 - Article

VL - 70

SP - 530

EP - 538

JO - Journal of Medical Imaging

JF - Journal of Medical Imaging

SN - 0720-048X

IS - 3

ER -