False-Negative and False-Positive Results in FDG-PET and PET/CT in Breast Cancer

Abstract Abstract 5014 Introduction Risk of developing non Hodgkin lymphomas (NHL) is known to be increased among patients (pts) infected by HIV-1 and sporadic non-HIV related cases of Hodgking lymphomas (HL) are also described. HIV-positive pts also feature a virus-related systemic lymphoadenopathy which makes nodal involvement by lymphoma difficult to evaluate using conventional imaging. The role of positron-emission tomography using 18F-fluorodeoxyglucose (FDG-PET) in the staging and evaluation of response to treatment of pts with NHL and HL is well established in immunocompetent pts, while only limited information is available on lymphomas arising in the setting of HIV infection. We report on a retrospective analysis of FDG-PET results in a group of HIV pts with lymphoma, both NHL and HL, followed-up at our hospital. Patients and methods Twelve HIV-positive male pts with a diagnosis of lymphoma (7 high grade and 1 follicular NHL, 4 HL) underwent a total of 22 PET scans. PET results were compared with those obtained by computed tomography (CT). Nine PET were performed at staging, 7 at restaging following chemotherapy, and 6 at follow-up. At diagnosis of lymphoma: median CD4 count was 200 cells/mcL (range 98-451); HIV genome was undetectable in 5/9 pts, in the remaining 4 pts for whom the data was available viral loads ranged from 103 to 1,452,720 copies/mL; 10/12 pts were already receiving HAART, while the remaining 2 pts started treatment upon diagnosis of lymphoma. Results In the majority of cases (17/22 = 77%) results of PET, CT scan and clinical status were concordant, being diagnostic of either lymphoma presence (11/17) or absence (6/17). No false positive results were recorded at follow-up. In 5/22 cases (23%) PET and CT scan were discordant. In 4 cases PET yielded a false negative result; in 2 cases at diagnosis (2 pts with HL) and in 2 cases at follow-up (both in the pt with follicular lymphoma). In the remaining case, a PET-negative CT-positive adenopathy was demonstrated which proved to be reactive in nature at biopsy. Discussion Our results suggest that FDG-PET is useful in the evaluation of lymphoma in the setting of HIV infection, similarly to what has been observed among immunocompetent pts. Although the number of patients is limited, in our experience PET proved to be able to discriminate between reactive and lymphomatous involvement of lymphoid tissue as demonstrated by absence of false positive results in pts evaluated at follow-up. These results need to be confirmed by larger clinical trials. Disclosures No relevant conflicts of interest to declare.

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What are the Best Ways to Reduce the False-positive Rate of 18F-FDG PET/CT in Patients with Breast Cancer?

Nuclear Medicine and Molecular Imaging ◽

10.1007/s13139-010-0072-6 ◽

2011 ◽

Vol 45 (1) ◽

pp. 85-86

Author(s):

Laura Evangelista ◽

Zora Baretta ◽

Lorenzo Vinante ◽

Guido Sotti

Keyword(s):

Breast Cancer ◽

False Positive ◽

Fdg Pet ◽

False Positive Rate ◽

Pet Ct ◽

Positive Rate ◽

18F Fdg ◽

Fdg Pet Ct

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Selective Use of Intraoperative Touch Prep Analysis of Sentinel Nodes in Breast Cancer

The American Surgeon ◽

10.1177/000313480507101110 ◽

2005 ◽

Vol 71 (11) ◽

pp. 955-962 ◽

Cited By ~ 1

Author(s):

Rachel C. Forbes ◽

Clovis Pitchford ◽

Jean F. Simpson ◽

Glen C. Balch ◽

Mark C. Kelley

Keyword(s):

Breast Cancer ◽

Predictive Value ◽

False Positive ◽

False Negative ◽

Nodal Metastasis ◽

Axillary Lymph ◽

Sentinel Nodes ◽

Number Of Patients ◽

The Impact ◽

Positive Results

Imprint cytology (touch prep) is often used for intraoperative examination of sentinel nodes in breast cancer. This allows axillary lymph node dissection (ALND) to be performed immediately for tumor-positive nodes. We evaluated the accuracy of touch prep examination of sentinel nodes and its role in the surgical treatment of breast cancer. We analyzed 169 breast cancer patients who underwent 170 lymphatic mapping procedures with intraoperative touch prep examination. Results from the touch prep were correlated with histopathology and clinical variables. There were 115 true-negative, 35 true-positive, 15 false-negative, and 5 false-positive results. Touch prep had a sensitivity of 70 per cent and specificity of 96 per cent. Positive predictive value, negative predictive value, and diagnostic accuracy were all 88 per cent. The false-negative rate was 30 per cent and correlated with the size of the nodal metastasis and number of involved nodes, but not other patient factors. Touch prep is useful for the evaluation of sentinel nodes in breast cancer, but it has a lower sensitivity than initially reported, particularly in patients with micrometastases. False positive results occur, although they may be reduced after experience with the technique. We recommend that suspicious findings on touch prep should be confirmed by frozen section and that ALND only be performed for histologically documented metastases. We currently perform touch prep only in patients who are at high risk of nodal metastasis or will undergo mastectomy. This improves operative efficiency and limits the impact of false positive and negative results without dramatically increasing the number of patients who require a second surgical procedure.

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MRI in the Early Detection of Breast Cancer in Women with High Genetic Risk

Tumori Journal ◽

10.1177/030089160609200609 ◽

2006 ◽

Vol 92 (6) ◽

pp. 517-523 ◽

Cited By ~ 33

Author(s):

Giovanna Trecate ◽

Daniele Vergnaghi ◽

Siranuosh Manoukian ◽

Silvana Bergonzi ◽

Gianfranco Scaperrotta ◽

...

Keyword(s):

Breast Cancer ◽

Early Detection ◽

False Positive ◽

Genetic Risk ◽

Brca2 Mutation ◽

False Negative ◽

Conventional Imaging ◽

High Genetic Risk ◽

Second Look ◽

Positive Results

Aims and background Women with BRCA1 or BRCA2 germline mutations have an elevated risk of developing breast and/or ovarian cancer. Because of the early onset of the disease, screening of this group of women should start at an earlier age than in the general population. The association of breast magnetic resonance imaging (BMRI) and ultrasonography (US) with mammography (MX) and clinical breast examination (CBE) in the regular surveillance of these individuals has been proposed and seems to improve the early detection of breast cancer. Methods Within a multicenter study started by the Istituto Superiore di Sanita (Rome), at the Istituto Nazionale Tumori of Milan (INT) we enrolled 116 women at high genetic risk for breast cancer; they were either BRCA1 or BRCA2 mutation carriers or had a strong family history of breast cancer. They underwent CBE, MX, US and BMRI once a year. Results Between June 2000 and April 2005, at INT 12 cancers were detected among the 116 screened individuals (10%). In this subgroup, 1 patient refused BMRI and in 2 cases US was not performed. With BMRI we found 11 cancers and 6 of them were detectable only by this technique. In these 6 cases, the size of the disease was less than 1 cm and MX was false negative due to irregularly nodular parenchyma in 4 cases and scar tissue or prosthesis in the other 2. US was not performed in 2 cases and was false negative in 4 cases. Three false positive results were found with BMRI: 1 case was considered suspect but related to hormonal influences; 1 case with the same pattern was sent for second-look US, which gave a negative result and BMRI review after 6 months showed normalization of the parenchyma; in the third case histology revealed the presence of adenosis. No false positive results were registered for MX. Conclusions The aim of secondary prevention is the detection of cancer at its earliest stage. BMRI screening in women with BRCA1 or BRCA2 mutations or at high familiar risk appears to be highly sensitive and may detect mammographically occult disease. The accuracy of MR imaging is higher than that of conventional imaging but the technique is flawed by a lower specificity. In order to avoid unnecessary biopsies we believe that the combination of BMRI and conventional imaging can be very useful in screening women with a high genetic risk of breast cancer, especially with second-look evaluation by means of US when BMRI yields the only positive diagnostic result. Second-look US has been demonstrated to be of critical importance both in recognizing false positive BMRI results and in guiding biopsies, when necessary.

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Analysis of the causes of false negative and false positive results of preoperative axillary ultrasound in patients with early breast cancer – a single-centre study

Współczesna Onkologia ◽

10.5114/wo.2018.82644 ◽

2018 ◽

Vol 22 (4) ◽

pp. 247-251 ◽

Cited By ~ 1

Author(s):

Tomasz Nowikiewicz ◽

Adam Nowak ◽

Magdalena Wiśniewska ◽

Michał Wiśniewski ◽

Magdalena Nowikiewicz ◽

...

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

False Positive ◽

False Negative ◽

Axillary Ultrasound ◽

Single Centre ◽

Centre Study ◽

Single Centre Study ◽

Positive Results

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False-Positive Lesions Mimicking Breast Cancer on FDG PET and PET/CT

American Journal of Roentgenology ◽

10.2214/ajr.11.7130 ◽

2012 ◽

Vol 198 (3) ◽

pp. W304-W314 ◽

Cited By ~ 72

Author(s):

Margaret Adejolu ◽

Lei Huo ◽

Eric Rohren ◽

Lumarie Santiago ◽

Wei T. Yang

Keyword(s):

Breast Cancer ◽

False Positive ◽

Fdg Pet ◽

Pet Ct

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Co-existence of a giant cell tumour of the tendon sheath and schwannoma in a patient with bilateral breast cancer: A potential cause of false positive findings in 18F-FDG PET/CT studies

Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) ◽

10.1016/j.remnie.2016.05.002 ◽

2016 ◽

Vol 35 (6) ◽

pp. 411-412

Author(s):

A. Ortega Candil ◽

C. Rodríguez Rey ◽

M. García García-Esquinas ◽

M.N. Cabrera Martín ◽

R. Couto Caro ◽

...

Keyword(s):

Breast Cancer ◽

False Positive ◽

Fdg Pet ◽

Giant Cell Tumour ◽

Bilateral Breast Cancer ◽

Tendon Sheath ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Ct Studies

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Diagnostic and prognostic value of 99mTc-Tektrotyd scintigraphy and 18F-FDG PET/CT in a single-center cohort of neuroendocrine tumors

Archives of Medical Science ◽

10.5114/aoms/130996 ◽

2021 ◽

Author(s):

Jelena Saponjski ◽

Djuro Macut ◽

Nebojša Petrovic ◽

Sanja Ognjanovic ◽

Bojana Popovic ◽

...

Keyword(s):

False Positive ◽

Fdg Pet ◽

False Negative ◽

Progression Free Survival ◽

True Positive ◽

True Negative ◽

Free Survival ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

IntroductionThe aim was to assess the diagnostic value of 99mTc-Tektrotyd scintigraphy (TCT) and positron emission tomography/computed tomography using F-18 fluorodeoxyglucose (18F-FDG PET/CT) in the detection and follow-up of neuroendocrine tumors (NETs), and their predictive value for disease progression.Material and methodsIn this retrospective cohort, TCT and 18F-FDG PET/CT were performed in 90 patients (37 men, 53 women, mean age 52.7 ±15.1), with NET. Correlation of Ki67 and tumor grade versus Krenning score and SUVmax was assessed, Kaplan-Meier analysis was used for progression-free survival (PFS), and Cox regression analysis was performed to identify the association between progression-related factors and PFS.ResultsOut of 90, true positive TCT was detected in 56 (62.2%) patients, true negative in 19 (21.1%), false positive in 4 (4.4%), false negative in 11 (12.2%), while 18F-FDG PET/CT was true positive in 69 (76.7%) patients, true negative in 10 (11.1%), false positive in 5 (5.5%), false negative in 6 (6.7%). Mean 18F-FDG PET/CT SUVmax was 6.8 ±6.2. Diagnostic sensitivity of TCT was 83.6%, specificity 82.6%, accuracy 83.3% vs. 18F-FDG PET/CT sensitivity was 92.0%, specificity 66.7%, accuracy 87.8%. A significant correlation between Ki67 and SUVmax was found in positive 18F-FDG PET/CT findings, unlike the correlation between Ki67 and Krenning score. Median PFS was 25 months (95% CI: 18.2–31.8), in 18F-FDG PET/CT positive patients 23 months (95% CI: 16.3–29.7) and 18F-FDG PET/CT negative 26 months (p = 0.279). Progression-free survival predictors were SUVmax and Krenning score.ConclusionsIn our study, TCT and 18F-FDG PET/CT have high diagnostic accuracy in detection of NET. Higher Krenning score on TCT and SUVmax in positive 18F-FDG PET/CT findings are predictors of disease progression. 99mTc-Tektrotyd scintigraphy and 18F-FDG PET/CT can be useful complementary tools in management of patients with NETs and in predicting patients’ outcome.

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Diagnostic performance of [18F]FDG PET in staging grade 1-2, estrogen receptor positive breast cancer

10.21203/rs.3.rs-695998/v1 ◽

2021 ◽

Author(s):

Ramsha Iqbal ◽

Lemonitsa H Mammatas ◽

Tuba Aras ◽

Wouter V Vogel ◽

Tim van de Brug ◽

...

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

False Positive ◽

Fdg Pet ◽

Imaging Modality ◽

False Negative ◽

True Positive ◽

Histological Subtype ◽

Standardized Uptake Values ◽

Estrogen Receptor Positive

Abstract BackgroundAccurate staging of early breast cancer (BC) patients is essential for tailored treatment. Currently, the preferred imaging modality for staging is positron emission tomography with [18F]Fluorodeoxyglucose (FDG PET) combined with a diagnostic computed tomography (CT) scan of the thorax/abdomen. However, FDG PET might be insufficient for detection of malignant lesions in grade 1–2, estrogen receptor positive (ER+) BC, due to its low metabolic activity. The main aim of this study was to retrospectively investigate the diagnostic accuracy of FDG PET in this patient population.Methods74 patients diagnosed with grade 1–2, ER + clinical stage IIB/III or locoregional recurrent BC were included. Suspect tumor lesions detected on conventional imaging (mammography, ultrasound, magnetic resonance imaging, diagnostic CT, bone scintigraphy) and FDG PET were confirmed with pathology or follow-up. FDG PET-positive lesions were (semi)quantified with standardized uptake values (SUV) and total lesion glycolysis (TLG), and these FDG PET parameters were correlated with pathological features such as histological subtype, grade, ER, PR and HER2 expression and mitotic activity index.ResultsPre-operative imaging identified 155 lesions that were pathologically verified. Based on pathology, 115/155 (74.2%) lesions identified on FDG PET were classified as true positive, i.e. malignant (in 67 patients) and 17/155 (10.8%) lesions as false positive, i.e. benign (in 9 patients); 7/155 (4.5%) as false negative (in 7 patients) and 16/155 (10.3%) as true negative (in 14 patients). FDG PET incorrectly staged 16/70 (22.9%) patients: 3/70 (4.3%) were downstaged whereas 13/70 (18.6%) were upstaged. SUV did not help to discriminate between true- and false positive lesions (median SUVmax 4.23, IQR: 2.54–6.37 vs. 3.07, IQR: 2.14–5.58, P = 0.44 respectively). For true positive lesions, FDG uptake correlated with histological subtype, showing higher uptake in ductal carcinoma compared to lobular carcinoma (P < 0.05).ConclusionWithin this study FDG PET inadequately staged 22.9% of grade 1–2, ER + BC cases. Incorrect staging can lead to inappropriate treatment choices, potentially affecting survival and quality of life. Prospective studies investigating novel radiotracers are urgently needed.Trial registrationretrospectively registered.

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