Diagnostic Performance of Proton Magnetic Resonance Spectroscopy and 18F-Fluorocholine PET to Differentiate Benign From Malignant Breast Lesions

Abstract

Purpose The aim of this study was to evaluate the diagnostic performance of the proton magnetic resonance spectroscopy (MRS) and 18F-fluorocholine (FCH) PET for suspicious breast findings on conventional imaging (mammography and breast ultrasound). Methods From September 2012 to December 2015, 37 women with 39 breast lesions on conventional imaging were enrolled and underwent proton MRS and FCH PET. The MRS parameters of choline signal-to-noise ratio (SNR), choline integral (I(cho)), and the PET parameters including SUVmax in the prone (SUV1) and supine (SUV2) positions were analyzed. Receiver operating characteristic curves with the area under the curve, sensitivity, and specificity under the optimal cutoff points for the different parameters were determined. Results Twenty-three lesions (59%) were malignant, and 16 (41.0%) were benign. The malignant lesions tended to show significantly higher MRS and PET parameters than benign lesions (choline SNR, P = 0.007; I(cho), P = 0.003; SUV1 and SUV2, P < 0.0001). Fair to moderate correlations were noted between the choline SNR and PET parameters (SUV1, Spearman rank correlation coefficient, ρ = 0.477; SUV2, ρ = 0.483), as well as I(cho) and PET parameters (SUV1, ρ = 0.493; SUV2, ρ = 0.549). The SUV2 showed the highest diagnostic performance (area under the curve, 0.918). Using 2.5 as the optimal cutoff point, the SUV2 yields 89.5% sensitivity and 87.5% specificity for differentiating malignant from benign lesions. Conclusion The MRS parameters were fairly to moderately correlated with FCH PET parameters, and both could differentiate malignant from benign breast lesions with SUV2 showing best diagnostic performance.

Evaluating Diagnostic Value of Magnetic Resonance Spectroscopy (Mrs) for Diagnosis of Malignant Breast Masses

“…It was found out that MRS results in higher accuracy, sensitivity and specificity regarding detection of malignant breast lesions. A study conducted by Wu L-A et al reported sensitivity and specificity of MRS in detecting breast malignancy to be 91% and 93% respectively (Wu et al, 2021). In a metaanalysis, data from 19 studies was pooled (Gu et al, 2022).…”

Breast PET/MRI Hybrid Imaging and Targeted Tracers

“… 40 In a recent study by Wu et al comparing MRS and 18 F‐choline uptake in 39 benign and malignant breast lesions, a moderate comparison was found between MRS and PET parameters. 41 Furthermore, in their study, the PET‐based standard uptake value (SUV) obtained with the patient in the supine position was shown to be the best performing parameter for breast cancer diagnosis, with an area under the curve (AUC), sensitivity, and specificity were 0.918, 89.5%, and 87.5%, respectively, using a cut‐off of 2.5. Clinical investigations for the feasibility and usefulness of 18 F‐choline PET/MRI of the breast are currently ongoing.…”

“…In regards to 18 F‐choline, one of the first evidence of its applicability in breast cancer assessment was the incidental invasive breast cancer finding in a male patient which showed high 18 F‐choline uptake during a prostate examination 40 . In a recent study by Wu et al comparing MRS and 18 F‐choline uptake in 39 benign and malignant breast lesions, a moderate comparison was found between MRS and PET parameters 41 . Furthermore, in their study, the PET‐based standard uptake value (SUV) obtained with the patient in the supine position was shown to be the best performing parameter for breast cancer diagnosis, with an area under the curve (AUC), sensitivity, and specificity were 0.918, 89.5%, and 87.5%, respectively, using a cut‐off of 2.5.…”

Prospective validation of 18F-Fluoroethylcholine as a tracer in PET/MRI for the evaluation of breast lesions and prediction of lymph node status

“…The role of 18F-FEC in breast lesions has been addressed by only few studies, which presented several limitations and included only malignant lesions [ 7 , 11 , 12 ]. A single work on 39 breast lesions showed the potential of 18F-FEC to differentiate benign from malignant breast lesions [ 13 ]. The full potential of 18F-FEC as an imaging biomarker for diagnostic purposes and prediction of breast cancer aggressiveness remains elusive.…”