title: Positron emission mammography in the diagnosis of breast cancer. Is maximum PEM uptake value a valuable threshold for malignant breast cancer detection?
abstract: OBJECTIVE
  To evaluate the diagnostic value (sensitivity, specificity) of positron emission mammography (PEM) in a single site non-interventional study using the maximum PEM uptake value (PUVmax).
  
  
  METHODS
  In a singlesite, non-interventional study, 108 patients (107 women, 1 man) with a total of 151 suspected lesions were scanned with a PEM Flex Solo II (Naviscan) at 90 min p.i. with 3.5 MBq 18F-FDG per kg of body weight. In this ROI(region of interest)-based analysis, maximum PEM uptake value (PUV) was determined in lesions, tumours (PUVmaxtumour), benign lesions (PUVmaxnormal breast) and also in healthy tissues on the contralateral side (PUVmaxcontralateral breast). These values were compared and contrasted. In addition, the ratios of PUVmaxtumour / PUVmaxcontralateral breast and PUVmaxnormal breast / PUVmaxcontralateral breast were compared. The image data were interpreted independently by two experienced nuclear medicine physicians and compared with histology in cases of suspected carcinoma.
  
  
  RESULTS
  Based on a criteria of PUV>1.9, 31 out of 151 lesions in the patient cohort were found to be malignant (21%). A mean PUVmaxtumour of 3.78 ± 2.47 was identified in malignant tumours, while a mean PUVmaxnormal breast of 1.17 ± 0.37 was reported in the glandular tissue of the healthy breast, with the difference being statistically significant (p < 0.001). Similarly, the mean ratio between tumour and healthy glandular tissue in breast cancer patients (3.15 ± 1.58) was found to be significantly higher than the ratio for benign lesions (1.17 ± 0.41, p < 0.001).
  
  
  CONCLUSIONS
  PEM is capable of differentiating breast tumours from benign lesions with 100% sensitivity along with a high specificity of 96%, when a threshold of PUVmax >1.9 is applied.
authors.affiliation: Dr. Frank H. H. Müller, Radiologie und Nuklearmedizin Ludwigshafen, Otto-Stabel-Str. 2-4, 67059 Ludwigshafen, Tel. +49/(0)621/51 00 21, Fax +49/(0)621/51 00 25, dr.frank.h.h.mueller@t-online.de.
authors.forename: F H H
authors.initials: FH
authors.lastname: Müller
authors.forename: J
authors.initials: J
authors.lastname: Farahati
authors.forename: A G
authors.initials: AG
authors.lastname: Müller
authors.forename: E
authors.initials: E
authors.lastname: Gillman
authors.forename: M
authors.initials: M
authors.lastname: Hentschel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Positron emission tomography; benign tumours; breast cancer; malign tumours