Comparative study of the value of dual tracer PET/CT in evaluating breast cancer.
The present study was conducted to assess the relationship between tumor uptake and pathologic findings using dual-tracer PET/computed tomography (CT) in patients with breast cancer. Seventy-four patients with breast cancer (mean age 54 years) who underwent (11)C-choline and 2-[(18)F]fluoro-2-deoxy-d-glucose ((18)F-FDG) PET/CT prior to surgery on the same day were enrolled in the present study. Images were reviewed by a board-certified radiologist and two nuclear medicine specialists who were unaware of any clinical information and a consensus was reached. Uptake patterns and measurements of dual tracers were compared with the pathologic findings of resected specimens as the reference standard. Mean (±SD) tumor size was 5.9 ± 3.2 cm. All primary tumors were identified on (18)F-FDG PET/CT and (11)C-choline PET/CT. However, (18)F-FDG PET/CT demonstrated focal uptake of the primary tumor with (n = 38; 51%) or without (n = 36; 49%) diffuse background breast uptake. Of the pathologic findings, multiple logistic regression analysis revealed an independent association between fibrocystic change and diffuse background breast uptake (odds ratio [OR] 8.57; 95% confidence interval [CI] 2.86-25.66; P < 0.0001). Tumors with higher histologic grade, nuclear grade, structural grade, nuclear atypia, and mitosis had significantly higher maximum standardized uptake values (SUV(max)) and tumor-to-background ratios (TBR) for both tracers. Multiple logistic regression analysis revealed that only the degree of mitosis was independently associated with a high SUV(max) (OR 7.45; 95%CI 2.21-25.11; P = 0.001) and a high TBR (OR 5.41; 95%CI 1.13-25.96; P = 0.035) of (11)C-choline PET/CT. In conclusion, (11)C-choline may improve tumor delineation and reflect tumor aggressiveness on PET/CT in patients with breast cancer.
Department of Radiology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. utateish@yokohama-cu.ac.jp
Ukihide
U
Tateishi
Takashi
T
Terauchi
Sadako
S
Akashi-Tanaka
Takayuki
T
Kinoshita
Daisuke
D
Kano
Hiromitsu
H
Daisaki
Takeshi
T
Murano
Hitoshi
H
Tsuda
Homer A
HA
Macapinlac
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002794:Choline; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D019788:Fluorodeoxyglucose F18; D002794:Choline