Prone Versus Supine Breast FDG-PET/CT for Assessing Locoregional Disease Distribution in Locally Advanced Breast Cancer

Abstract

Rationale and Objectives Prone F-18 fluorodeoxyglucose (FDG)-PET/CT may have advantages for breast imaging due to improved separation of deep anatomical structures. There are limited data on whether prone and supine FDG-PET/CT provide similar information regarding breast and axillary disease in the setting of locally advanced breast cancer (LABC). The purpose of this study was to compare the information on locoregional disease distribution provided by prone versus supine FDG-PET in newly diagnosed LABC. Materials and Methods In an IRB-approved prospective trial, 24 patients with newly diagnosed LABC underwent both supine and prone FDG-PET/CT at the same scanning session. Three readers performed an independent review of all scans and categorized the locoregional disease distribution as breast only (BO)-unifocal, BO-multifocal, BO-multicentric, or breast+axillary involvement. For breast+axillary disease, the readers also assessed the number of involved axillary lymph nodes. Inter-observer discrepancies were resolved at a consensus reading session. Results Two scanning sessions were excluded because the prone scan had omitted part of the axilla from the field of view. In the remaining 22 patients, the consensus categorization of anatomical disease distribution was concordant between prone and supine scanning in 21 patients (linear kappa 0.91 [0.79 – 1]). In the 16 patients with breast+axillary disease, equal numbers of involved lymph nodes were identified on prone and supine scanning in 12 patients, while in the remaining four patients, prone scanning resulted in a higher number of visualized lymph nodes. Conclusions Prone and supine FDG-PET/CT provided statistically identical information on locoregional disease distribution in LABC. However, prone scanning may perform better than supine for assessing the number of involved lymph nodes. Prone FDG-PET/CT may be useful in future clinical and research efforts, including hybrid PET-MRI applications.

Comparison of prone versus supine 18F‐FDG‐PET of locally advanced breast cancer: Phantom and preliminary clinical studies

“…6 To our knowledge, the current study is the first to characterize the prone positioner and systematically measure-with assessment of and correction for withinpatient uptake time variability-differences, both in terms of two clinically relevant semiquantitative endpoints, SUV peak and SUV max , in 18F-FDG-PET/CT images acquired in the prone versus conventional supine orientations. Prone PET imaging, with the customized torso support device, is now validated for SUV measurements compared to prone imaging without the device.…”

“…4,5,7,8 We have recently completed a preliminary analysis comparing prone and supine PET in the qualitative categorization of the anatomical distribution of disease and in the assessment of the number of involved axillary lymph nodes in LABC patients. 6 As an extension of that effort, the current study was undertaken to quantitatively compare clinically relevant metrics (SUV peak , SUV max ) derived from prone versus supine PET. To accomplish this, we first set out to systematically examine the 18F-FDG-PET properties of a dedicated, custombuilt prone positioning device in conjunction with phantoms simulating conditions found in prone and supine patient PET/CT scans (Figs.…”

“…[1][2][3][4][5] Compared to supine, prone 18F-FDG-PET/CT provides statistically identical information on anatomical disease distribution in locally advanced breast cancer (LABC), with prone scanning performing better than supine at determining the number of involved lymph nodes. 6 In order to integrate information from different imaging modalities and/or to serially assess FDG-PET data from breast tissue at the voxel level, one must be able to spatially coregister the data obtained at each imaging session, a goal that is greatly facilitated by imaging the breast while patients lay in the prone position on a supportive device. 4,5,7,8 Quantitative evaluation of PET images to assess response to therapy should account for confounding effects.…”

Towards integration of 64Cu-DOTA-trastuzumab PET-CT and MRI with mathematical modeling to predict response to neoadjuvant therapy in HER2 + breast cancer

“…Images were collected using a Discovery STE clinical PET/CT scanner (GE Healthcare, Waukesha, WI, USA). Data were acquired in the prone position using a custom-built padded support [25][26][27][28] . A low-mAs CT scan was acquired using the smart mA setting for attenuation correction of the emission data.…”

Potential Clinical Applications of 18F-Fluorodeoxyglucose Positron Emission Tomography/Magnetic Resonance Mammography in Breast Cancer

“…FDG PET/CT mammography reportedly images a wider area of the axillary fossa so that the anatomic structures of the axilla can be more easily differentiated from one another than is possible using whole-body PET/CT, even though there were no significant differences in the number of metastatic axillary lymph nodes that could be detected between these two types of study [5,35,48]. Koolen et al [49] reported that combining prone and standard supine FDG PET/CT detected locoregional lymph node metastases with a sensitivity of 82 % and a specificity of 92 %, which changed the indication for radiotherapy in a substantial proportion of patients based on detection of occult N3 nodes.…”