Dual time point FDG-PET/CT imaging... Potential tool for diagnosis of breast cancer

A. A. Zytoon, K. Murakami, M. R. El-Kholy, E. El-Shorbagy

Research output: Contribution to journalArticle

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Abstract

Aim: This prospective study was designed to assess the utility of the dual time point imaging technique using 2- [18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) to detect primary breast cancer and to determine whether it is useful for the detection of small and non-invasive cancers, as well as cancers in dense breast tissue. Methods: One hundred and eleven patients with newly diagnosed breast cancer underwent two sequential PET/CT examinations (dual time point imaging) for preoperative staging. The maximum standardized uptake value (SUVmax) of FDG was measured from both time points. The percentage change in SUVmax (ΔSUVmax%) between time points 1 (SUVmax1) and 2 (SUVmax2) was calculated. The patients were divided into groups: invasive (n = 82), non invasive (n = 29); large (>10 mm; n = 80), small (≤10 mm; n = 31); tumours in dense breasts (n = 61), and tumours in non-dense breasts (n = 50). The tumour:background (T:B) ratios at both time points were measured and the ΔSUVmax%, ΔT:B% values were calculated. All PET study results were correlated with the histopathology results. Results: Of the 111 cancer lesions, 88 (79.3%) showed an increase and 23 (20.7%) showed either no change [10 (9%)] or a decrease [13 (11.7%)] in the SUVmax over time. Of the 111 contralateral normal breasts, nine (8.1%) showed an increase and 102 (91.9%) showed either no change [17 (15.3%)] or a decrease [85 (76.6%)] in the SUVmax over time. The mean ± SD of SUVmax1, SUVmax2, Δ%SUVmax were 4.9 ± 3.6, 6.0 ± 4.5, and 22.6 ± 13.1% for invasive cancers, 4.1 ± 3.8, 4.4 ± 4.8, and -2.4 ± 18.5% for non-invasive cancers, 2.3 ± 1.9, 2.7 ± 2.3, and 12.9 ± 21.1% for small cancers, 5.6 ± 3.7, 6.8 ± 4.8, and 17.3 ± 17.1% for large cancers, 4.9 ± 3.7, 5.8 ± 4.8, and 15.1 ± 17.6% for cancers in dense breast, and 4.5 ± 3.6, 5.4 ± 4.5, and 17.2 ± 19.2% for cancers in non-dense breast. The receiver-operating characteristic (ROC) analysis suggested ΔSUVmax% of 8% as the only significant cut-off for discrimination between invasive and non-invasive cancer (sensitivity 84.1%, specificity 75.9%, p < 0.0001). Conclusion: Dual time point FDG-PET/CT improves the discrimination between non-invasive and invasive cancers, and provided superior sensitivity for the detection of small cancers and cancers in dense breast.

Original languageEnglish
Pages (from-to)1213-1227
Number of pages15
JournalClinical Radiology
Volume63
Issue number11
DOIs
Publication statusPublished - 2008 Nov
Externally publishedYes

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Breast Neoplasms
Glucose
Neoplasms
Breast
Positron Emission Tomography Computed Tomography
ROC Curve
Prospective Studies
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Dual time point FDG-PET/CT imaging... Potential tool for diagnosis of breast cancer. / Zytoon, A. A.; Murakami, K.; El-Kholy, M. R.; El-Shorbagy, E.

In: Clinical Radiology, Vol. 63, No. 11, 11.2008, p. 1213-1227.

Research output: Contribution to journalArticle

Zytoon, AA, Murakami, K, El-Kholy, MR & El-Shorbagy, E 2008, 'Dual time point FDG-PET/CT imaging... Potential tool for diagnosis of breast cancer', Clinical Radiology, vol. 63, no. 11, pp. 1213-1227. https://doi.org/10.1016/j.crad.2008.03.014
Zytoon, A. A. ; Murakami, K. ; El-Kholy, M. R. ; El-Shorbagy, E. / Dual time point FDG-PET/CT imaging... Potential tool for diagnosis of breast cancer. In: Clinical Radiology. 2008 ; Vol. 63, No. 11. pp. 1213-1227.
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title = "Dual time point FDG-PET/CT imaging... Potential tool for diagnosis of breast cancer",
abstract = "Aim: This prospective study was designed to assess the utility of the dual time point imaging technique using 2- [18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) to detect primary breast cancer and to determine whether it is useful for the detection of small and non-invasive cancers, as well as cancers in dense breast tissue. Methods: One hundred and eleven patients with newly diagnosed breast cancer underwent two sequential PET/CT examinations (dual time point imaging) for preoperative staging. The maximum standardized uptake value (SUVmax) of FDG was measured from both time points. The percentage change in SUVmax (ΔSUVmax{\%}) between time points 1 (SUVmax1) and 2 (SUVmax2) was calculated. The patients were divided into groups: invasive (n = 82), non invasive (n = 29); large (>10 mm; n = 80), small (≤10 mm; n = 31); tumours in dense breasts (n = 61), and tumours in non-dense breasts (n = 50). The tumour:background (T:B) ratios at both time points were measured and the ΔSUVmax{\%}, ΔT:B{\%} values were calculated. All PET study results were correlated with the histopathology results. Results: Of the 111 cancer lesions, 88 (79.3{\%}) showed an increase and 23 (20.7{\%}) showed either no change [10 (9{\%})] or a decrease [13 (11.7{\%})] in the SUVmax over time. Of the 111 contralateral normal breasts, nine (8.1{\%}) showed an increase and 102 (91.9{\%}) showed either no change [17 (15.3{\%})] or a decrease [85 (76.6{\%})] in the SUVmax over time. The mean ± SD of SUVmax1, SUVmax2, Δ{\%}SUVmax were 4.9 ± 3.6, 6.0 ± 4.5, and 22.6 ± 13.1{\%} for invasive cancers, 4.1 ± 3.8, 4.4 ± 4.8, and -2.4 ± 18.5{\%} for non-invasive cancers, 2.3 ± 1.9, 2.7 ± 2.3, and 12.9 ± 21.1{\%} for small cancers, 5.6 ± 3.7, 6.8 ± 4.8, and 17.3 ± 17.1{\%} for large cancers, 4.9 ± 3.7, 5.8 ± 4.8, and 15.1 ± 17.6{\%} for cancers in dense breast, and 4.5 ± 3.6, 5.4 ± 4.5, and 17.2 ± 19.2{\%} for cancers in non-dense breast. The receiver-operating characteristic (ROC) analysis suggested ΔSUVmax{\%} of 8{\%} as the only significant cut-off for discrimination between invasive and non-invasive cancer (sensitivity 84.1{\%}, specificity 75.9{\%}, p < 0.0001). Conclusion: Dual time point FDG-PET/CT improves the discrimination between non-invasive and invasive cancers, and provided superior sensitivity for the detection of small cancers and cancers in dense breast.",
author = "Zytoon, {A. A.} and K. Murakami and El-Kholy, {M. R.} and E. El-Shorbagy",
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T1 - Dual time point FDG-PET/CT imaging... Potential tool for diagnosis of breast cancer

AU - Zytoon, A. A.

AU - Murakami, K.

AU - El-Kholy, M. R.

AU - El-Shorbagy, E.

PY - 2008/11

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N2 - Aim: This prospective study was designed to assess the utility of the dual time point imaging technique using 2- [18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) to detect primary breast cancer and to determine whether it is useful for the detection of small and non-invasive cancers, as well as cancers in dense breast tissue. Methods: One hundred and eleven patients with newly diagnosed breast cancer underwent two sequential PET/CT examinations (dual time point imaging) for preoperative staging. The maximum standardized uptake value (SUVmax) of FDG was measured from both time points. The percentage change in SUVmax (ΔSUVmax%) between time points 1 (SUVmax1) and 2 (SUVmax2) was calculated. The patients were divided into groups: invasive (n = 82), non invasive (n = 29); large (>10 mm; n = 80), small (≤10 mm; n = 31); tumours in dense breasts (n = 61), and tumours in non-dense breasts (n = 50). The tumour:background (T:B) ratios at both time points were measured and the ΔSUVmax%, ΔT:B% values were calculated. All PET study results were correlated with the histopathology results. Results: Of the 111 cancer lesions, 88 (79.3%) showed an increase and 23 (20.7%) showed either no change [10 (9%)] or a decrease [13 (11.7%)] in the SUVmax over time. Of the 111 contralateral normal breasts, nine (8.1%) showed an increase and 102 (91.9%) showed either no change [17 (15.3%)] or a decrease [85 (76.6%)] in the SUVmax over time. The mean ± SD of SUVmax1, SUVmax2, Δ%SUVmax were 4.9 ± 3.6, 6.0 ± 4.5, and 22.6 ± 13.1% for invasive cancers, 4.1 ± 3.8, 4.4 ± 4.8, and -2.4 ± 18.5% for non-invasive cancers, 2.3 ± 1.9, 2.7 ± 2.3, and 12.9 ± 21.1% for small cancers, 5.6 ± 3.7, 6.8 ± 4.8, and 17.3 ± 17.1% for large cancers, 4.9 ± 3.7, 5.8 ± 4.8, and 15.1 ± 17.6% for cancers in dense breast, and 4.5 ± 3.6, 5.4 ± 4.5, and 17.2 ± 19.2% for cancers in non-dense breast. The receiver-operating characteristic (ROC) analysis suggested ΔSUVmax% of 8% as the only significant cut-off for discrimination between invasive and non-invasive cancer (sensitivity 84.1%, specificity 75.9%, p < 0.0001). Conclusion: Dual time point FDG-PET/CT improves the discrimination between non-invasive and invasive cancers, and provided superior sensitivity for the detection of small cancers and cancers in dense breast.

AB - Aim: This prospective study was designed to assess the utility of the dual time point imaging technique using 2- [18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) to detect primary breast cancer and to determine whether it is useful for the detection of small and non-invasive cancers, as well as cancers in dense breast tissue. Methods: One hundred and eleven patients with newly diagnosed breast cancer underwent two sequential PET/CT examinations (dual time point imaging) for preoperative staging. The maximum standardized uptake value (SUVmax) of FDG was measured from both time points. The percentage change in SUVmax (ΔSUVmax%) between time points 1 (SUVmax1) and 2 (SUVmax2) was calculated. The patients were divided into groups: invasive (n = 82), non invasive (n = 29); large (>10 mm; n = 80), small (≤10 mm; n = 31); tumours in dense breasts (n = 61), and tumours in non-dense breasts (n = 50). The tumour:background (T:B) ratios at both time points were measured and the ΔSUVmax%, ΔT:B% values were calculated. All PET study results were correlated with the histopathology results. Results: Of the 111 cancer lesions, 88 (79.3%) showed an increase and 23 (20.7%) showed either no change [10 (9%)] or a decrease [13 (11.7%)] in the SUVmax over time. Of the 111 contralateral normal breasts, nine (8.1%) showed an increase and 102 (91.9%) showed either no change [17 (15.3%)] or a decrease [85 (76.6%)] in the SUVmax over time. The mean ± SD of SUVmax1, SUVmax2, Δ%SUVmax were 4.9 ± 3.6, 6.0 ± 4.5, and 22.6 ± 13.1% for invasive cancers, 4.1 ± 3.8, 4.4 ± 4.8, and -2.4 ± 18.5% for non-invasive cancers, 2.3 ± 1.9, 2.7 ± 2.3, and 12.9 ± 21.1% for small cancers, 5.6 ± 3.7, 6.8 ± 4.8, and 17.3 ± 17.1% for large cancers, 4.9 ± 3.7, 5.8 ± 4.8, and 15.1 ± 17.6% for cancers in dense breast, and 4.5 ± 3.6, 5.4 ± 4.5, and 17.2 ± 19.2% for cancers in non-dense breast. The receiver-operating characteristic (ROC) analysis suggested ΔSUVmax% of 8% as the only significant cut-off for discrimination between invasive and non-invasive cancer (sensitivity 84.1%, specificity 75.9%, p < 0.0001). Conclusion: Dual time point FDG-PET/CT improves the discrimination between non-invasive and invasive cancers, and provided superior sensitivity for the detection of small cancers and cancers in dense breast.

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