Prevalence and clinical significance of incidental F18-FDG breast uptake: a systematic review and meta-analysis

Abstract

This review aims to analyse the published data on the prevalence and clinical significance of breast incidental F18-FDG uptake detected by PET or PET/CT (BIU). A comprehensive computer literature search of the PubMed/MEDLINE, Scopus and Embase databases for studies on BIU published through July 2013 was performed. Pooled prevalence and malignancy risk of BIU were calculated. The literature search revealed 42 articles, and 17 were selected. One study was excluded because of data overlap but four additional studies were found screening the references. Finally, 20 articles were included in the systematic review and 13 were eligible for a meta-analysis. The pooled prevalence of BIU on all scans was 0.4 % (95 % CI 0.23-0.61 %), the pooled prevalence on scans on female patients only was 0.82 % (95 % CI 0.51-1.2 %), the pooled risk of malignancy of BIU when further analysed was 48 % (95 % CI 38-58 %) and the pooled risk of malignancy of BIU with histological examination was 60 % (95 % CI 53-66 %). The most frequent malignant lesion detected was infiltrating ductal carcinoma. Despite being rare, the identification of BIU frequently signals the presence of an unsuspected subclinical lesion, which differs from the indicated reason for which the patient was initially scanned, and the risk of malignancy is very high.

Incidental 18F-FDG PET/CT bilateral breast uptake due to carcinoma

“…In differentiating benign from malignant lesion SUV max values showed a low accuracy and a cut-off value couldn't be considered [6,7]. A recently published revision of the literature suggest that prevalence of hypermetabolic lesions in the breast is between 0.36 and 1.84% and overall risk of malignancy is between 18 and 100% [6]. This case report suggests that every breast uptake need further imaging in order to rule out malignancy.…”

“…Since screening procedure for breast cancer started a reduction of mortality was observed and an extension of lives despite the overdiagnosis still represents a problem. Despite screening procedure for breast cancer the data available in literature report a small number of incidental breast uptakes in patients studied with 18 F-FDG PET/CT for non-breast-related oncological reasons, which suggest that some lesions are still missed during traditional screening procedures [5][6][7][8]. In differentiating benign from malignant lesion SUV max values showed a low accuracy and a cut-off value couldn't be considered [6,7].…”

“…Despite screening procedure for breast cancer the data available in literature report a small number of incidental breast uptakes in patients studied with 18 F-FDG PET/CT for non-breast-related oncological reasons, which suggest that some lesions are still missed during traditional screening procedures [5][6][7][8]. In differentiating benign from malignant lesion SUV max values showed a low accuracy and a cut-off value couldn't be considered [6,7]. A recently published revision of the literature suggest that prevalence of hypermetabolic lesions in the breast is between 0.36 and 1.84% and overall risk of malignancy is between 18 and 100% [6].…”

“…Breast incidentaloma is commonly considered a breast lesion incidentally and newly detected by imaging techniques performed for an unrelated purpose and especially not for investigating breast diseases. Moreover, unexpected focal 18 F-FDG uptakes can involve breast frequently revealing an unexpected breast cancer [5][6][7][8]; this means that, despite screening procedures, some lesions are still missed during traditional screening and could be incidentally revealed by 18 F-FDG positron emission tomography (PET).…”

Present and future role of FDG-PET/CT imaging in the management of breast cancer

“…However, when an unexpected focus of FDG uptake is detected in the breast during an FDG examination performed for other reasons, it is necessary to explore it with conventional imaging and possible biopsy because of the high risk of malignancy [5]. In a meta-analysis of 13 studies, Bertagna et al [5] reviewed the breast incidental FDG uptake (BIU) detected by PET or PET/CT and demonstrated that the pooled prevalence of BIU on all scans was 0.4 % [95 % confidence interval (CI) 0.23-0.61 %], the pooled prevalence on scans on female patients only was 0.82 % (95 % CI 0.51-1.2 %), the pooled risk of malignancy of BIU when further analyzed was 48 % (95 % CI 38-58 %) and the pooled risk of malignancy of BIU with histological examination was 60 % (95 % CI 53-66 %).…”