The diagnostic value of PET/CT in recurrence and distant metastasis in breast cancer patients and impact on disease free survival

Abo-Sheisha, Dina M.; Badawy, Manal Ezzat

doi:10.1016/j.ejrnm.2014.07.006

Cited by 14 publications

(8 citation statements)

References 16 publications

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“… 11 PET/computed tomography (PET/CT), as an integrated system combining PET and CT in the same session, has been proven to be a useful tool for improving the diagnostic performance of neoplasms. 12 Although the spatial and temporal resolution of PET may not be as impressive as other imaging modalities, its sensitivity is exquisite. 13 In terms of the VCFs, an increased FDG uptake can always be observed in the malignant fractures but not in the fractures caused by osteoporosis.…”

Section: Introductionmentioning

confidence: 99%

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

He¹,

Zhao²,

Guo³

et al. 2018

CMAR

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PurposeThe purpose of this study was to evaluate the differential diagnostic value of 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for benign and malignant vertebral compression fractures (VCFs), where the diagnostic accuracy of 18F-FDG PET/CT was compared with magnetic resonance imaging (MRI).Patients and methodsBetween 2015 and 2017, we retrospectively evaluated 87 patients with 116 VCFs. MRI was performed in all the 87 patients, whereas 18F-FDG PET/CT was executed in 51 patients. Three malignant features (convex posterior cortex, epidural mass formation, and pedicle enhancement) from MRI and the maximum standardized uptake value (SUVmax) from 18F-FDG PET/CT were evaluated in benign and malignant VCFs, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI and 18F-FDG PET/CT were compared in the differentiation of malignant from benign VCFs.ResultsThe results of our investigation showed that the sensitivity and specificity for predicting malignant VCFs were 75.6% and 77.3% for convex posterior cortex, 82.9% and 813% for epidural mass formation, and 85.7% and 70.8% for pedicle enhancement. 18F-FDG PET/CT demonstrated higher sensitivity (100%) but lower specificity (38.9%) as compared to MRI with regard to differentiation between benign and malignant VCFs. A significant difference in the SUVmax values was observed between the benign and malignant fractures (2.9 ± 1.0 vs 5.0 ± 1.8, P < 0.01). Besides the value of SUVmax, it has been noticed that the FDG uptake pattern differed in malignant and benign fractures.ConclusionSignificant MRI findings such as convex posterior cortex, epidural mass formation, and pedicle enhancement are highly suggestive of malignancy. 18F-FDG PET/CT reliably differentiated the fractures of malignant from benign based on both SUVmax and 18F-FDG uptake pattern. In a situation where MRI findings are not diagnostic, 18F-FDG PET/CT provides additional information as it has high sensitivity and is semiquantitative.

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Section: Introductionmentioning

confidence: 99%

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

He¹,

Zhao²,

Guo³

et al. 2018

CMAR

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“…Although 18 F-FDG is the most commonly used PET tracer in the clinic, the relationship between its uptake in tumors and changes in metabolic, gene, and protein effectors is not well understood (16). An additional caveat of 18 F-FDG is that this tracer can be avid for postsurgical inflammation, which can result in false-positive findings for nonmalignant regions of the breast (13,17). 18 F-FDG has been used to detect early metabolic response to neoadjuvant chemotherapy but cannot usually discriminate partial from total response-an ability that is critical for determining prognosis (18).…”

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confidence: 99%

Noninvasive ⁸⁹Zr-Transferrin PET Shows Improved Tumor Targeting Compared with ¹⁸F-FDG PET in MYC-Overexpressing Human Triple-Negative Breast Cancer

et al. 2017

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The current standard for breast PET imaging is F-FDG. The heterogeneity ofF-FDG uptake in breast cancer limits its utility, varying greatly among receptor status, histopathologic subtypes, and proliferation markers. F-FDG PET often exhibits nonspecific internalization and low specificity and sensitivity, especially with tumors smaller than 1 cm MYC is a protein involved in oncogenesis and is overexpressed in triple-negative breast cancer (TNBC). Increased surface expression of transferrin receptor (TfR) is a downstream event of MYC upregulation and has been validated as a clinically relevant target for molecular imaging. Transferrin labeled with Zr has successfully identified MYC status in many cancer subtypes preclinically and been shown to predict response and changes in oncogene status via treatment with small-molecule inhibitors that target MYC and PI3K signaling pathways. We hypothesized thatZr-transferrin PET will noninvasively detect MYC and TfR and improve upon the current standard of F-FDG PET for MYC-overexpressing TNBC. In this study, Zr-transferrin andF-FDG imaging were compared in preclinical models of TNBC. TNBC cells (MDA-MB-157, MDA-MB-231, and Hs578T) were treated with bromodomain-containing protein 4 (BRD4) inhibitors JQ1 and OTX015 (0.5-1 μM). Cell proliferation, gene expression, and protein expression were assayed to explore the effects of these inhibitors on MYC and TfR. Head-to-head comparison showed that Zr-transferrin targets TNBC tumors significantly better ( < 0.05-0.001) than F-FDG through PET imaging and biodistribution studies in MDA-MB-231 and MDA-MB-157 xenografts and a patient-derived xenograft model of TNBC. c-Myc and gene expression was decreased upon treatment with BRD4 inhibitors and small interfering RNA ( < 0.01-0.001 for responding cell lines), compared with vehicle treatment. MYC and TfR protein expression, along with receptor-mediated internalization of transferrin, was also significantly decreased upon drug treatment in MDA-MB-231 and MDA-MB-157 cells ( < 0.01-0.001). Zr-transferrin targets human TNBC primary tumors significantly better thanF-FDG, as shown through PET imaging and biodistribution studies. Zr-transferrin is a useful tool to interrogate MYC via TfR-targeted PET imaging in TNBC.

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“…[15][16][17][18] Moreover, PET/CT is considered to be more valuable in diagnosing skeletal metastasis compared with bone scintigraphy and predicting recurrence. [18][19][20][21][22][23][24] This study distinctly states that absence of FDG uptake in pleura or pleural effusion minimizes the risk of metastasis regarding that none of 15 patients with no avidity in PET/CT were diagnosed with a pleural malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies announced that PET/CT had demonstrated sensitivity ranging widely between 75% and 93%, also specificity between 88% and 96% in the identification of malignant pleural effusions. [20][21][22][25][26][27][28][29] This big difference may result from 60% mean sensitivity rate of pleural fluid cytology depending on the primary tumor, sample preparation and experience of the cytologist. 30 A review of 14 studies comprising 407 patients with malignant disease reported that PET/CT imaging had a sensitivity of 81% and specificity of 74% concluding that there was no basis for the inclusion of PET/CT in the diagnosis of malignant effusion.…”

Section: Discussionmentioning

confidence: 99%

F-18 fluorodeoxyglucose positron emission computed tomography in the diagnosis of pleural metastases from breast carcinoma

Sarıçam¹

2020

Int Surg J

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Background: This study aimed to investigate the feasibility of F-18 fluorodeoxyglucose (FDG) positron emission computed tomography (PET/CT) in identifying the pleural invasion of metastatic breast cancers.Methods: A retrospective study was conducted to include 75 patients with untreated breast cancer who had undergone thoracoscopy to drain pleural effusions and to perform pleural biopsies. Whole group of patients were evaluated in terms of age, type of primary breast cancer, macroscopic appearance of pleura during thoracoscopy, maximum standardized FDG uptake value (SUV) reported by PET/CT scan in addition to presence of malignancy detected in pleura and/or pleural effusion.Results: All of 75 patients were female and mean age was 56.12±11.70. Metastatic disease was diagnosed in the pleura of 40 (53.3%) and in the pleural effusion of 43 (57.3%) patients. The sensitivity and specificity of PET/CT in detecting pleural metastases of breast carcinoma was calculated as 88.2% and 96.2% whereas PET/CT demonstrated sensitivity of 91.9% and specificity of 91.3% in identifying malignant pleural effusion. Cut-off values of FDG uptake were 4.25 for pleural metastases and 3.85 for malignant pleural effusions. PET/CT also indicated a false negative rate of 12.5%, a false positive rate of 16.28% and an overall accuracy rate of 85.33% in the diagnosis of pleural metastasis of breast carcinoma.Conclusions: PET/CT reporting an FDG uptake over 4 in the pleura or pleural effusion is beneficial in managing the patients with the suspicion of pleural metastases from breast cancer.

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The diagnostic value of PET/CT in recurrence and distant metastasis in breast cancer patients and impact on disease free survival

Cited by 14 publications

References 16 publications

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

Noninvasive ⁸⁹Zr-Transferrin PET Shows Improved Tumor Targeting Compared with ¹⁸F-FDG PET in MYC-Overexpressing Human Triple-Negative Breast Cancer

F-18 fluorodeoxyglucose positron emission computed tomography in the diagnosis of pleural metastases from breast carcinoma

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The diagnostic value of PET/CT in recurrence and distant metastasis in breast cancer patients and impact on disease free survival

Cited by 14 publications

References 16 publications

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

Noninvasive 89Zr-Transferrin PET Shows Improved Tumor Targeting Compared with 18F-FDG PET in MYC-Overexpressing Human Triple-Negative Breast Cancer

F-18 fluorodeoxyglucose positron emission computed tomography in the diagnosis of pleural metastases from breast carcinoma

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Noninvasive ⁸⁹Zr-Transferrin PET Shows Improved Tumor Targeting Compared with ¹⁸F-FDG PET in MYC-Overexpressing Human Triple-Negative Breast Cancer