A Molecular Approach to Breast Imaging

Fowler, Amy M.

doi:10.2967/jnumed.113.126102

Cited by 68 publications

(37 citation statements)

References 24 publications

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“…Histologic and molecular characteristics of breast cancer have significant effects on therapeutic decisions as well as disease-free and overall survival (2). Mammography, ultrasound, and MRI form the backbone of breast imaging (3)(4)(5)(6). 18 F-FDG PET has also assumed an important role in wholebody staging, recurrent disease detection, and therapy response monitoring (7).…”

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confidence: 99%

“…18 F-FDG PET has also assumed an important role in wholebody staging, recurrent disease detection, and therapy response monitoring (7). Molecular breast imaging with 18 F-FDG positron emission mammography and 99m Tc-sestamibi are also being explored (3,8,9). These have limitations including differentiation of malignancy from posttherapy effects and challenges with certain histologic subtypes such as lobular cancer, which accounts for 10% of invasive breast cancers.…”

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Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

et al. 2016

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The purpose of this study was to explore the uptake of the synthetic amino acid analog PET radiotracer anti-3-18 F-FACBC ( 18 F-fluciclovine) in breast lesions with correlation to histologic and immunohistochemical characteristics. Methods: Twelve women with breast lesions underwent 45-min dynamic PET/CT of the thorax after intravenous administration of 366.3 ± 14.8 (337.44-394.05) MBq of 18 F-fluciclovine. Uptake in the primary lesions at 4 representative time points (5, 17, 29, and 41 min) after injection were correlated with histologic, imaging, and clinical findings. The significance of differences in SUV max and tumor-to-background ratios between malignant and benign tissue were calculated. Correlations of activity to histologic and immunohistochemical cancer subtypes were made including Ki-67 intensity and Nottingham grade (NG). Results: There were 17 breast lesions (4 benign, 13 malignant) including 7 of 13 invasive ductal, 5 of 13 invasive lobular, and 1 of 13 metaplastic carcinomas. There was a significant difference in mean SUV max ± SD of malignant (6.2 ± 3.2, 6.0 ± 3.2, 5.7 ± 2.8, and 5.6 ± 3.0) versus benign (1.3 ± 0.6, 1.2 ± 0.5, 1.2 ± 0.6, and 1.1 ± 0.5) lesions at 5, 17, 29, and 41 min, respectively (all P # 0.0001). Tumor-tobackground (aorta, normal breast, and marrow) ratios were also significantly higher in malignant than benign breast lesions (all P # 0.02). The highest 18 F-fluciclovine activity seems to be present in triplenegative and NG3 subtypes. . In 7 patients, 18 F-fluciclovine PET visualized locoregional and distant spread including that of lobular cancer, though identification of hepatic metastases was limited by physiologic background activity. Conclusion: The uptake characteristics of 18 F-fluciclovine are reflective of the histologic and immunohistochemical characteristics in suspected breast lesions with greater activity in malignant versus benign etiology. The data from this exploratory study may be useful to design future studies using 18 F-fluciclovine PET for breast tumor imaging as well as for detection of locoregional and distant spread.

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Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

et al. 2016

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“…Breast-specific g-imaging (BSGI) is a Food and Drug Administrationapproved radionuclide-based technique that can be used to detect breast cancer (5,6). A high-spatial-resolution, small-field-of-view g-camera detects and localizes g-ray energy emitted by the radiopharmaceutical 99m Tc-methoxyisobutylisonitrile (sestamibi), which preferentially accumulates in malignant breast cells with increased vascular supply and concentration of mitochondria compared with surrounding normal breast tissue.…”

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Molecular Imaging Approaches for Supplemental Screening in Women at Increased Breast Cancer Risk

Fowler¹

2016

J Nucl Med

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Mammography is an effective screening method that reduces breast cancer mortality (1). However, mammography is not a perfect test and its sensitivity is diminished in women with dense breast tissue (2). For women at increased breast cancer risk, the use of imaging modalities in addition to mammography, termed supplemental screening, can improve the overall cancer detection rate. Current guidelines recommend MRI for supplemental screening in women with greater than 20% lifetime risk of breast cancer (3). For women who cannot tolerate MRI, have mammographically dense breast tissue, or have an intermediate lifetime risk of breast cancer, screening ultrasound can be considered (3). However, these techniques have some drawbacks, which have fueled interest in alternative functional imaging-based methods for supplemental screening in high-risk women. In this issue of The Journal of Nuclear Medicine, Brem et al. investigate the diagnostic performance of a molecular imaging approach for supplemental breast cancer screening (4). See page 678Breast-specific g-imaging (BSGI) is a Food and Drug Administrationapproved radionuclide-based technique that can be used to detect breast cancer (5,6). A high-spatial-resolution, small-field-of-view g-camera detects and localizes g-ray energy emitted by the radiopharmaceutical 99m Tc-methoxyisobutylisonitrile (sestamibi), which preferentially accumulates in malignant breast cells with increased vascular supply and concentration of mitochondria compared with surrounding normal breast tissue. Images are acquired immediately after intravenous injection of the radiopharmaceutical, with the patient seated in standard mammographic views (craniocaudal and mediolateral oblique views) with the breast in mild compression for a total of approximately 40 min. Interpretation of breast-specific g-images follows a standardized lexicon and results in assessment categories and recommendations that parallel those of other imaging modalities outlined by the American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) (7-9).Although several studies have evaluated the performance of BSGI for diagnosing breast cancer in a heterogeneous mix of clinical indications (10), data regarding the application of BSGI for supplemental screening for women at increased breast cancer risk are sparse. The study by Brem et al. is a single-institution, retrospective review of asymptomatic, increased-risk women undergoing BSGI from 2010 to 2014 whose most recent screening mammogram showed no suspicious abnormalities (4). The study population consisted of 849 women ranging in age from 26 to 83 y with a personal history of treated breast cancer, a family history of breast cancer, a personal history of an atypical or high-risk breast biopsy result, or a known genetic predisposition to breast cancer development. BSGI detected 14 mammographically occult cancers in 849 women, resulting in a supplemental cancer detection rate of 16.5 per 1,000 women screened. Furthermore, mammographic breast density did not affe...

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“…Therefore, it is clear that PET, either as the hybrids PET/CT or PET/MRI, represents the most efficient way in humans to generate molecular images. Moreover, having the capability to determine an earlier diagnosis and/or to acquire pathophysiological information more strictly connected with prognosis and therapy [63].…”

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Basic Premises to Molecular Imaging and Radionuclide Therapy – Part 1

Mansi¹,

Kitson²,

Cuccurullo³

et al. 2014

J Diagn Imaging Ther

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This manuscript is a complementary article to an accompanying paper, published in a forthcoming issue, which will give an overview on the central role of chelation in labelling radiocompounds; either for imaging and/or for radionuclide therapy. In order to facilitate a better understanding of the importance of Chelator-Based Imaging & Therapy, we will briefly discuss in this publication -which is partially intended as an introduction to the second paper -which contains the major basic principles of molecular imaging and radionuclide therapy. Although these issues are of interest in the general field of Nuclear Medicine; since the chelation process involves the labelling with radiometals; we aim to highlight examples of this category in this paper which concern this class of nuclides in this particular issue.

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A Molecular Approach to Breast Imaging

Cited by 68 publications

References 24 publications

Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Molecular Imaging Approaches for Supplemental Screening in Women at Increased Breast Cancer Risk

Basic Premises to Molecular Imaging and Radionuclide Therapy – Part 1

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A Molecular Approach to Breast Imaging

Cited by 68 publications

References 24 publications

Anti-3-18F-FACBC (18F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Anti-3-18F-FACBC (18F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Molecular Imaging Approaches for Supplemental Screening in Women at Increased Breast Cancer Risk

Basic Premises to Molecular Imaging and Radionuclide Therapy – Part 1

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Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study

Anti-3-¹⁸F-FACBC (¹⁸F-Fluciclovine) PET/CT of Breast Cancer: An Exploratory Study