Clinical and diagnostic value of preoperative MR mammography and FDG-PET in suspicious breast lesions

Abstract

Dynamic enhanced magnetic resonance (MR) mammography and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) of the breast were directly compared preoperatively in suspicious breast lesions. Forty-two breast lesions in 40 patients were examined with a three-dimensional dynamic MR imaging series and FDG-PET. The MR and PET examinations were evaluated separately and the results were compared with the histological findings. The sensitivity and specificity of each method were calculated. The diagnostic value of both modalities as single diagnostic tool and in combination was investigated. Nineteen malignant and 23 benign breast lesions were proven histologically. Magnetic resonance mammography and FDG-PET showed a sensitivity of 89 and 63%, respectively. The specificity was 74 and 91%, respectively. The combination of both imaging methods decreased the not-required biopsies from 55 to 17%. Only one false-negative finding-a patient pre-treated with chemotherapy-was observed in both methods. The combination of MR mammography and FDG-PET can help to decrease biopsies of benign breast lesions. Because of their high cost, these modalities should only be used in problematic cases to either rule out or to demonstrate malignancy. The best diagnostic strategy is achieved using MR mammography first. If the diagnosis is still questionable, FDG-PET can be performed.

Breast MRI and18F FDG PET/CT in the management of breast cancer

“…21 Walter et al agree, but suggest MR mammography first and PET if differentiation of benign vs. malignant is needed, to avoid the high costs of both of these examinations. 22 Evaluation of a larger patient population with prospective studies, with the addition of mammography and breast ultrasound is needed to further determine the precise role and timing of each imaging modality in breast cancer evaluation. Availability of dedicated breast PET units with improved spatial resolution will improve breast cancer detection and their role will need to be ascertained.…”

99mTc-Sestamibi Scintimammography

“…Furthermore, it has been reported that FDG PET may yield false-negative results following chemotherapy, which is mainly due to chemotherapy-induced changes in tumor metabolism. False negative results yielded by FDG PET were also reported for ductal carcinoma in situ, dependent of the tumor size, whereas falsepositive results were seen in cases of inflammation and fibrous dysplasia [122].…”

Breast Cancer Treatment in the Era of Molecular Imaging

“…Generally, MR imaging showed higher sensitivity, and PET showed higher specificity in the detection of axillary nodal disease. This is due to the lower spatial resolution of PET, and the missed foci were correspondingly below 15 mm in size [27]. While there seems to be consensus that FDG-PET alone is not yet sensitive enough to allow the avoidance of axillary node dissection (AND) in negative studies [28], potentially the combination of sentinel node biopsy with FDG-PET may prove to have enough sensitivity for this purpose.…”