Purpose To evaluate the breast cancer screening efficacy of mammography, ultrasound, and magnetic resonance imaging (MRI) in a high-risk population and in various population subgroups. Patients and Methods In a single-center, prospective, nonrandomized comparison study, BRCA mutation carriers and women with a high familial risk (>20% lifetime risk) for breast cancer were offered screening with mammography, ultrasound, and MRI every 12 months. Diagnostic performance was compared between individual modalities and their combinations. Further comparisons were based on subpopulations dichotomized by screening rounds, mutation status, age, and breast density. Results There were 559 women with 1,365 complete imaging rounds included in this study. The sensitivity of MRI (90.0%) was significantly higher (P<.001) than that of mammography (37.5%) and ultrasound (37.5%). Of 40 cancers, 18 (45.0%) were detected by MRI alone. Two cancers were found by mammography alone (a ductal carcinoma in situ [DCIS] with microinvasion and a DCIS with <10-mm invasive areas). This did not lead to a significant increase of sensitivity compared with using MRI alone (P =.15). No cancers were detected by ultrasound alone. Similarly, of 14 DCISs, all were detected by MRI, whereas mammography and ultrasound each detected five DCISs (35.7%). Age, mutation status, and breast density had no influence on the sensitivity of MRI and did not affect the superiority of MRI over mammography and ultrasound. Conclusion MRI allows early detection of familial breast cancer regardless of patient age, breast density, or risk status. The added value of mammography is limited, and there is no added value of ultrasound in women undergoing MRI for screening.

The aim of this study was to determine the feasibility of Cerenkov luminescence (CL) imaging of patients undergoing diagnostic 18F-FDG scans to detect nodal disease. Methods Patients undergoing routine 18F-FDG PET/CT for various malignancies consented to being scanned for CL. White-light and Cerenkov images (5-min acquisition) of the surface of the patient contralateral to and at the site of nodal 18F-FDG uptake were acquired using a cooled, intensified charge-coupled-device camera. Results The camera demonstrated linear correlation between activity and counts into the low nanocurie range using 18F-FDG. Imaging of patients revealed the presence of 18F-FDG uptake in nodes that demonstrated uptake on PET. A correlation between maximum standardized uptake value from PET and counting rate per area on the CL imaging was established. Conclusion CL imaging with diagnostic doses of 18F-FDG is feasible and can aid in detecting disease in the clinical setting.

Although guidelines such as those of the National Comprehensive Cancer Network consider 18F-FDG PET/CT for systemic staging of newly diagnosed stage III breast cancer patients, factors in addition to stage may influence the utility of PET/CT. Because invasive lobular carcinoma (ILC) is less conspicuous than invasive ductal carcinoma (IDC) on 18F-FDG PET, we hypothesized that tumor histology may be one such factor. We evaluated PET/CT systemic staging of patients newly diagnosed with ILC compared with IDC. Methods In this Institutional Review Board–approved retrospective study, our Hospital Information System was screened for ILC patients who underwent PET/CT in 2006–2013 before systemic or radiation therapy. Initial stage was determined from examination, mammography, ultrasound, MR, or surgery. PET/CT was performed to identify unsuspected distant metastases. A sequential cohort of stage III IDC patients was evaluated for comparison. Upstaging rates were compared using the Pearson χ2 test. Results The study criteria were fulfilled by 146 ILC patients. PET/CT revealed unsuspected distant metastases in 12 (8%): 0 of 8 with initial stage I, 2 of 50 (4%) stage II, and 10 of 88 (11%) stage III. Upstaging to IV by PET/CT was confirmed by biopsy in all cases. Three of 12 upstaged patients were upstaged only by the CT component of the PET/CT, as the metastases were not 18F-FDG–avid. In the comparison stage III IDC cohort, 22% (20/89) of patients were upstaged to IV by PET/CT. All 20 demonstrated 18F-FDG–avid metastases. The relative risk of PET/CT revealing unsuspected distant metastases in stage III IDC patients was 1.98 times (95% confidence interval, 0.98–3.98) that of stage III ILC patients (P = 0.049). For 18F-FDG–avid metastases, the relative risk of PET/CT revealing unsuspected 18F-FDG–avid distant metastases in stage III IDC patients was 2.82 times (95% confidence interval, 1.26–6.34) that of stage III ILC patients (P = 0.007). Conclusion 18F-FDG PET/CT was more likely to reveal unsuspected distant metastases in stage III IDC patients than in stage III ILC patients. In addition, some ILC patients were upstaged by non–18F-FDG-avid lesions visible only on the CT images. Overall, the impact of PET/CT on systemic staging may be lower for ILC patients than for IDC patients.

18 F-FDG PET has proven invaluable in the staging of patients with metastatic colorectal cancer. The aim of the current study was to determine whether this biologic scan would correlate with other cellular characteristics and the clinical behavior of tumors. Methods: Ninety patients with resectable colorectal cancer metastatic to the liver underwent 18 F-FDG PET before hepatectomy. At surgery, tumors were harvested and prepared for assessment by histology and immunohistochemistry. Expression of Ki67 (a marker for cell proliferation), GLUT1 and GLUT3 (markers for glucose transportation), p53 and p27 (markers for cell cycle control), and BCL-2 (a marker for apoptosis) was assessed by a pathologist who was unaware of the PET results and the clinical outcome. Patients were followed to determine outcome. Survival analysis was performed comparing patient outcome in groups segregated according to standardized uptake values (SUVs) greater or less than 5, 7, or 10. Results: Maximum SUV correlated with GLUT1 (P 5 0.03), Ki67 (P 5 0.026), and p53 (P 5 0.024) but did not correlate with p27, BCL-2, or GLUT3. Survival was significantly longer for patients with a low SUV than for patients with a high SUV, with P values of 0.014, 0.025, and 0.0095 for SUV cutoffs of 5, 7, and 10, respectively. Conclusion: 18 F-FDG PET is a biologic scan that predicts prognosis in patients with metastatic colorectal cancer. It is uncertain if this ability is due to cellular glucose metabolism or to a correlation with other cellular characteristics of aggressive tumors. PETusi ng 18 F-FDG has become an indispensable staging modality for many types of cancer, including colorectal cancer (1,2), esophageal cancer (3), melanoma (4), sarcoma (5), and lung cancer (6). This imaging technique detects glucose-avid cancer deposits and can enhance the detection of metastatic deposits, resulting in more complete tumor resections and preventing nontherapeutic laparotomies for patients with unresectable disease (7). The result of the application of this technique is more appropriate and more efficient clinical care, resulting in improved long-term outcome (1). This scanning technique is now standard in the preoperative work-up for many types of cancer.18 F-FDG PET is a biologic scanning technique that measures the glucose metabolism in a tumor. Enhanced glucose metabolism has been related to the aggressiveness of cancer cells. Thus, it is not surprising that in some types of cancer, such as esophageal cancer (8), lung cancer (9), and gastrointestinal stromal tumors (10), the quantity of 18 F-FDG uptake as assessed by PET correlates with outcome. Whether such a correlation exists for patients with colorectal cancer metastatic to the liver has not been reported and was the subject of the current prospective trial. Because this evaluation was prospective, we were able to secure freshly harvested tumors at resection. Molecular analysis of these tissues allowed an analysis of the correlation between 18 F-FDG uptake and those molecular markers thought to be importan...