title: Impact of PET/CT in comparison with same day contrast enhanced CT in breast cancer management.
abstract: OBJECTIVE
  To evaluate the impact of F-18 fluorodeoxyglucose (FDG) positron emission tomography with fused computerized tomography (PET/CT) in comparison with same day contrast enhanced CT (CE-CT) in breast cancer management.
  
  
  METHODS
  Seventy studies in 49 breast cancer patients, 17 for initial and 53 for restaging disease were included. All patients underwent PET/CT for diagnostic purposes followed by CE-CT scans of selected body regions. PET/CT was started approximately 90 minutes following IV injection of 10-15 mCi of F-18 FDG on a GE Discovery PET/CT system. Oral contrast was given before F-18 FDG injection. The CE-CT was performed according to departmental protocol.
  
  
  RESULTS
  Out of a total of 257 lesions, 210 were concordant between PET/CT and CE-CT. There were 47 discordant lesions, which were verified by either biopsy (35) or follow-up (12 PET positive CE-CT negative lesions). PET/CT correctly identified 25 true positive (TP). CE-CT identified 2 TP lesions missed by PET/CT which were false negatives (FNs): one liver metastasis with necrosis, which was nonavid to FDG uptake because of necrosis and a second one missed on abdominal metastatic node, which did not change staging or treatment. PET/CT incorrectly identified 2 false positive lesions while CE-CT incorrectly identified 18 false positive. TP recurrence of the disease was found by PET/CT in 44% (15/34 pts), whereas 56% (19/34 pts) were free of disease. The CE-CT described progression of the disease in 1 true negative PET/CT study and no progression in 2 TP PET/CT studies. The sensitivity, specificity, accuracy, positive productive value, and negative productive value for PET/CT were 97.8%, 93.5%, 97.3%, 99.1%, 85% and for CE-CT were 87.6%, 42%, 82.1%, 91.6%, 31.7%.
  
  
  CONCLUSIONS
  In this study, PET/CT played a more important role than CE-CT scans alone and provided an impact on the management of breast cancer patients.
authors.affiliation: Department of Nuclear Medicine and Cancer Center, St Vincent's Hospital and New York Medical College, New York, NY 10011, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Piperkova
authors.forename: Barbara
authors.initials: B
authors.lastname: Raphael
authors.forename: Mustafa E
authors.initials: ME
authors.lastname: Altinyay
authors.forename: Ivan
authors.initials: I
authors.lastname: Castellon
authors.forename: Richard
authors.initials: R
authors.lastname: Libes
authors.forename: Nick
authors.initials: N
authors.lastname: Sandella
authors.forename: Sherif
authors.initials: S
authors.lastname: Heiba
authors.forename: Hussein
authors.initials: H
authors.lastname: Abdel-Dayem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18