Detection of metastases in breast cancer: Is whole body PET/MR better than PET/CT?

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 15-15
Author(s):  
Eleonora Teplinsky ◽  
Akshat Pujara ◽  
Francisco J. Esteva ◽  
Linda Moy ◽  
Amy Melsaether ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Response ◽  
Metastatic Lesion ◽  
Lesion Detection ◽  
Whole Body ◽  
Reference Standard ◽  
Therapeutic Implications ◽  
Metastatic Setting ◽  
Pet Ct ◽  
Pathology Reports

15 Background: Whole body PET/CT is commonly utilized in breast cancer (BC) patients (pts). Limitations include assessment of treatment response in bone metastases (mets), high physiologic uptake in brain and liver, and cumulative radiation exposure. The site of mets can have prognostic and therapeutic implications. PET/MR, an exciting new hybrid technology, delivers less radiation than PET/CT. Our aim was to compare the differences in metastatic lesion detection using PET/CT & PET/MR in all BC subtypes. Methods: After a single 18-FDG injection, pts had whole body PET/CT for staging and assessment of treatment response. They were transported to another NYU facility & then underwent whole body PET/MR. PET/MR & PET/CT images were each read by a radiologist blinded to prior exams or reports. Number of mets (up to 6) per organ was recorded. 2 experienced radiologists unblinded to imaging and pathology reports served as the “reference standard”. Results: Forty-eight BC pts underwent PET/CT & PET/MR (28 in metastatic setting, 5 for staging & 15 to rule out recurrence). Median age: 55; range 32-79 with 31 ER+/HER2-, 8 ER+/HER2+, 2 ER-/HER2+, 6 ER-/HER2+, 1 unknown. 20 pts had no distant mets on scan. In the remaining 28 pts, the reference standard detected 9 liver, 18 bone, 7 lung/pleura, 5 brain & 10 lymph node (LN) metastases; some patients had ≥1 metastatic site. PET/CT had more false positives (FP) and false negatives (FN) in the detection of mets (Table). PET/MR had 1 FP in the liver. PET/MR accurately detected 2 bone (ER+/HER2-), 3 liver (ER+/HER2-), 2 LN (1 ER+/HER2+; 1 ER+/HER2-) and 5 brain lesions (1 ER+/HER2-; 3 ER-/HER2+; 1 ER+/HER2+) in 10 unique pts that were not identified on PET/CT. 1 liver (ER+/HER2-) and 2 brain mets (ER-/HER2+) identified on PET/MR were previously unknown. Conclusions: Our preliminary data suggest that PET/MR outperformed PET/CT in detecting mets in the liver, brain, LN & possibly bone. Prospective studies of PET/MR are warranted to determine whether early detection of mets, including occult brain mets in HER2+ pts, impacts survival.[Table: see text]

Comparison of FDG-PET/CT and bone scintigraphy for detection of bone metastases in breast cancer

2011 ◽  
Vol 52 (9) ◽  
pp. 1009-1014 ◽  
Author(s):  
Steffen Hahn ◽  
Till Heusner ◽  
Sherko Kümmel ◽  
Angelika Köninger ◽  
James Nagarajah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastases ◽  
Bone Scintigraphy ◽  
Fdg Pet ◽  
Whole Body ◽  
Reference Standard ◽  
Breast Cancer Patients ◽  
Pet Ct ◽  
Fdg Pet Ct

Background Bone scintigraphy is the standard procedure for the detection of bone metastases in breast cancer patients. FDG-PET/CT has been reported to be a sensitive tool for tumor staging in different malignant diseases. However, its accuracy for the detection of bone metastases has not been compared to bone scintigraphy. Purpose To compare whole-body FDG-PET/CT and bone scintigraphy for the detection of bone metastases on a lesion basis in breast cancer patients. Material and Methods Twenty-nine consecutive women (mean age 58 years, range 35-78 years) with histologically proven breast cancer were assessed with bone scintigraphy and whole-body FDG-PET/CT. Twenty-one patients (72%) were suffering from primary breast cancer and eight patients (28%) were in aftercare with a history of advanced breast cancer. Both imaging procedures were assessed for bone metastases by a radiologist and a nuclear medicine physician. Concordant readings between bone scintigraphy and FDG-PET/CT were taken as true. Discordant readings were verified with additional MRI imaging in all patients and follow-up studies in most patients. Results A total of 132 lesions were detected on bone scintigraphy, FDG-PET/CT or both. According to the reference standard, 70/132 lesions (53%) were bone metastases, 59/132 lesions (45%) were benign, and three lesions (2%) remained unclear. The sensitivity of bone scintigraphy was 76% (53/70) compared to 96% (67/70) for FDG-PET/CT. The specificity of bone scintigraphy and FDG-PET/CT was 95% (56/59) and 92% (54/59), respectively. According to the reference standard bone metastases were present in eight out of the 29 patients (28%), whereas 20 patients (69%) were free of bone metastases. One (3%) patient had inconclusive readings on both modalities as well as on MRI and follow-up studies. Bone scintigraphy and FDG-PET/CT correctly identified seven out of eight patients with bone metastases and 20 out of 20 patients free of metastases. Conclusion On a lesion-basis whole-body FDG-PET/CT is more sensitive and equally specific for the detection of bone metastases compared with bone scintigraphy.

scholarly journals Evaluation of Whole Body DiffusionWeighted Imaging in the Staging and Treatment Response of Lymphoma Compared With Fluoride-Oxyglucose (FDG) PET/CT as a Reference Standard

2017 ◽  
Vol 2 (1) ◽  
pp. 17-25
Author(s):  
Tiffany Hennedige ◽  
◽  
David Chee Eng Ng ◽  
Miriam Tao ◽  
Richard Hong Hui Quek ◽  
...  
Keyword(s):  
Treatment Response ◽  
Fdg Pet ◽  
Whole Body ◽  
Reference Standard ◽  
Pet Ct ◽  
Fdg Pet Ct

scholarly journals Whole-body magnetic resonance/diffusion-weighted sequence with background signal suppression (WB-MR/DWIBS) vs. 18F-FDG PET/CT in diagnosis of lymphoma

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Gihan Hassan Gamal
Keyword(s):  
Fdg Pet ◽  
Lesion Detection ◽  
Whole Body ◽  
Reference Standard ◽  
Background Signal ◽  
Signal Suppression ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Background The purpose of this study was to compare the performance of whole-body magnetic resonance/diffusion-weighted imaging with background signal suppression (WB-MR/DWIBS) method, with that of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT), for lesion detection and initial staging of patients with lymphoma using the histopathologically diagnosis as a reference standard. Results Thirty-two patients with newly pathologically proven lymphoma were enrolled in this prospective study from May 2018 to January 2020 (27 males, 5 females). All patients underwent PET/CT followed by WB-MR/DWIBS as an attempt to compare the performance of both methods for lesion detection and initial staging in patients with lymphoma. The overall sensitivity, specificity, PPV, NPV, and accuracy of 18F-FDG-PET/CT vs WB-MR/DWIBS in correlation with reference standard data in detection of lymphoma were calculated for PET/CT 96%, 100%, 100%, 80%, and 97% while those of WB-MR/DWIBS were 93%, 76%, 96%, 61%, and 91%, respectively. Conclusion 18F-FDG PET/CT remains the standard reference of imaging in evaluation of lymphoma due to its higher sensitivity and specificity over WB-MR/DWIBS. Future studies with larger cohorts are necessary for better evaluation of the role of WB-MR/DWIBS in lymphoma patients. The current study highlights the potential complementary role of WB-MRI/DWIBS in the context of bone marrow involvement evaluation omitting unnecessary bone marrow biopsy.

25 Line of therapy adjustment in a patient with advanced triple-negative breast cancer (TNBC) by using personalized ctDNA test for treatment response monitoring

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A24-A24
Author(s):  
Georges Azzi ◽  
Shifra Krinshpun ◽  
Antony Tin ◽  
Allyson Malashevich ◽  
Meenakshi Malhotra ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Ct Scan ◽  
Treatment Response ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Bilateral Mastectomy ◽  
First Line ◽  
Pet Ct ◽  
Line Of Therapy ◽  
Pet Ct Scan

BackgroundTriple negative breast cancer (TNBC) is an aggressive form of breast cancer that is most difficult to treat due to the absence of hormone/growth factor receptors.1 2 Metastatic TNBC (mTNBC) is particularly challenging, given the limited efficacy and duration of response to chemotherapy.3 The repertoire of therapeutic options for mTNBC patients continues to increase with chemotherapeutic and immuno oncology based treatments and now includes sacituzumab govitecan, a novel antibody-chemotherapy conjugate.4MethodsHere we present a case study of a 40-year-old female who on biopsy of her left breast mass was diagnosed with TNBC. The patient underwent neoadjuvant chemotherapy with weekly administration of paclitaxel and carboplatin followed by dose-dense doxorubicin with cyclophosphamide. Following one-month, the patient underwent bilateral mastectomy, showing pathological staging ypT2 pN0. The patient underwent periodic radiological imaging along with the assessment of circulating tumor DNA in blood using a personalized and tumor-informed multiplex PCR, next-generation sequencing assay (Signatera bespoke, mPCR NGS assay) to identify the minimal residual disease (MRD) and treatment response.ResultsAfter surgery, MRD assessment revealed ctDNA positive status (0.41 MTM/mL) prompting PET/CT scan that revealed liver metastasis. Continued ctDNA monitoring showed continuous increase in ctDNA concentration (287.09 MTM/mL). Separate analyses indicated MSI-high and PD-L1 positive tumor status, leading to the initiation of the first line of therapy (nab-paclitaxel and Atezolizumab), which resulted in ctDNA decline (39.62 MTM/ml). Weekly ctDNA monitoring noted a rapid increase a month later (178 MTM/ml to 833.69 MTM/ml) within a 2-week interval, which corresponded to disease progression on imaging. Given non-responsiveness with the first-line therapy, the patient was initiated with sacituzumab govitecan. Following this, a rapid decline in the ctDNA level was observed within a week (364.07 MTM/mL) with a downward trend to 73.03 MTM/ml by two weeks. An interval PET/CT scan showed a mixed response. Continued monitoring of ctDNA demonstrated ctDNA levels <5MTM/mL for a period of two months before serially rising again (to 89.27 MTM/ml). PET-CT ordered in response to increasing ctDNA levels confirmed progression involving hepatic and lung lesions. A new line of therapy with nivolumab and ipilimumab was subsequently initiated.ConclusionsSerial monitoring of ctDNA enables early detection of therapy resistance and provides a rationale for treatment change/optimization/discontinuation as compared to periodic imaging that is currently the standard of care. The ease and convenience of using ctDNA-based testing as frequently as every week clearly identified earlier non-responsiveness to IO and also identified earlier acquired resistance to antibody-drug conjugate, enabling a prompt switch to alternative therapy.Ethics ApprovalN/AConsentN/AReferencesAnders C, Carey LA. Understanding and treating triple-negative breast cancer. Oncology (Williston Park). 2008;22(11):1233–1243.Mehanna J, Haddad FG, Eid R, Lambertini M, Kourie HR. Triple-negative breast cancer: current perspective on the evolving therapeutic landscape. Int J Womens Health2019;11:431–437. Published 2019 Jul 31. doi:10.2147/IJWH.S178349Treatment of Triple-negative Breast Cancer. American Cancer Society Website. Updated 2020. Accessed August 10, 2020. https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-triple-negative.htmlBardia A, Mayer IA, Vahdat LT, et al. Sacituzumab govitecan-hziy in refractory metastatic triple-negative breast cancer. N Engl J Med 2019;380(8):741–751. doi:10.1056/NEJMoa1814213

Evaluation of 18 F-FDG PET/MRI, 18 F-FDG PET/CT, MRI, and CT in whole-body staging of recurrent breast cancer

2016 ◽  
Vol 85 (2) ◽  
pp. 459-465 ◽  
Author(s):  
Lino M. Sawicki ◽  
Johannes Grueneisen ◽  
Benedikt M. Schaarschmidt ◽  
Christian Buchbender ◽  
James Nagarajah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Fdg Pet ◽  
Recurrent Breast Cancer ◽  
Whole Body ◽  
Pet Ct ◽  
Recurrent Breast ◽  
Fdg Pet Ct

scholarly journals A method for evaluation of patient-specific lean body mass from limited-coverage CT images and its application in PERCIST: comparison with predictive equation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Jingjie Shang ◽  
Zhiqiang Tan ◽  
Yong Cheng ◽  
Yongjin Tang ◽  
Bin Guo ◽  
...  
Keyword(s):  
Lean Body Mass ◽  
Body Mass ◽  
Whole Body ◽  
Patient Specific ◽  
Predictive Equation ◽  
Reference Standard ◽  
Pet Ct ◽  
Before And After ◽  
Percist 1.0 ◽  
Limited Coverage

Abstract Background Standardized uptake value (SUV) normalized by lean body mass ([LBM] SUL) is recommended as metric by PERCIST 1.0. The James predictive equation (PE) is a frequently used formula for LBM estimation, but may cause substantial error for an individual. The purpose of this study was to introduce a novel and reliable method for estimating LBM by limited-coverage (LC) CT images from PET/CT examinations and test its validity, then to analyse whether SUV normalised by LC-based LBM could change the PERCIST 1.0 response classifications, based on LBM estimated by the James PE. Methods First, 199 patients who received whole-body PET/CT examinations were retrospectively retrieved. A patient-specific LBM equation was developed based on the relationship between LC fat volumes (FVLC) and whole-body fat mass (FMWB). This equation was cross-validated with an independent sample of 97 patients who also received whole-body PET/CT examinations. Its results were compared with the measurement of LBM from whole-body CT (reference standard) and the results of the James PE. Then, 241 patients with solid tumours who underwent PET/CT examinations before and after treatment were retrospectively retrieved. The treatment responses were evaluated according to the PE-based and LC-based PERCIST 1.0. Concordance between them was assessed using Cohen’s κ coefficient and Wilcoxon’s signed-ranks test. The impact of differing LBM algorithms on PERCIST 1.0 classification was evaluated. Results The FVLC were significantly correlated with the FMWB (r=0.977). Furthermore, the results of LBM measurement evaluated with LC images were much closer to the reference standard than those obtained by the James PE. The PE-based and LC-based PERCIST 1.0 classifications were discordant in 27 patients (11.2%; κ = 0.823, P=0.837). These discordant patients’ percentage changes of peak SUL (SULpeak) were all in the interval above or below 10% from the threshold (±30%), accounting for 43.5% (27/62) of total patients in this region. The degree of variability is related to changes in LBM before and after treatment. Conclusions LBM algorithm-dependent variability in PERCIST 1.0 classification is a notable issue. SUV normalised by LC-based LBM could change PERCIST 1.0 response classifications based on LBM estimated by the James PE, especially for patients with a percentage variation of SULpeak close to the threshold.

scholarly journals Texture Analysis in the Diagnosis of Primary Breast Cancer: Comparison of High-Resolution Dedicated Breast Positron Emission Tomography (dbPET) and Whole-Body PET/CT

2020 ◽  
Vol 7 ◽  
Author(s):  
Yoko Satoh ◽  
Kenji Hirata ◽  
Daiki Tamada ◽  
Satoshi Funayama ◽  
Hiroshi Onishi
Keyword(s):  
Breast Cancer ◽  
Positron Emission Tomography ◽  
High Resolution ◽  
Texture Analysis ◽  
Texture Features ◽  
Emission Tomography ◽  
Whole Body ◽  
Tumor Characteristics ◽  
Positron Emission ◽  
Pet Ct

Objective: This retrospective study aimed to compare the ability to classify tumor characteristics of breast cancer (BC) of positron emission tomography (PET)-derived texture features between dedicated breast PET (dbPET) and whole-body PET/computed tomography (CT).Methods: Forty-four BCs scanned by both high-resolution ring-shaped dbPET and whole-body PET/CT were analyzed. The primary BC was extracted with a standardized uptake value (SUV) threshold segmentation method. On both dbPET and PET/CT images, 38 texture features were computed; their ability to classify tumor characteristics such as tumor (T)-category, lymph node (N)-category, molecular subtype, and Ki67 levels was compared. The texture features were evaluated using univariate and multivariate analyses following principal component analysis (PCA). AUC values were used to evaluate the diagnostic power of the computed texture features to classify BC characteristics.Results: Some texture features of dbPET and PET/CT were different between Tis-1 and T2-4 and between Luminal A and other groups, respectively. No association with texture features was found in the N-category or Ki67 level. In contrast, receiver-operating characteristic analysis using texture features' principal components showed that the AUC for classification of any BC characteristics were equally good for both dbPET and whole-body PET/CT.Conclusions: PET-based texture analysis of dbPET and whole-body PET/CT may have equally good classification power for BC.

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