AIM: to investigate the clinical-diagnostic meaning of accidental breast uptake of 18F-FDG during PET/CT performed for other pathology, mainly cancer, correlating with radiological imaging and histopathology. METHODS AND MATERIALS: we retro- spectively selected 43 patients (7 male, 36 female, mean age 66.28±14.7y/o) investigated for breast uptake of 18F-FDG, suc- cessively examined with mammography (MMX), UltraSound (US) and, if necessary, Magnetic Resonance (MR). Cases suspected for breast malignancy were studied with US-guided macro-biopsy (USMB). Patients were primitively affected by lung cancer (15), NHD (8), melanoma (4), head-neck cancer (2), other diseases (13) as well as ampullary cancer, Burkitt's lymphoma, CUP Syndrome, esophageal cancer, GIST, T lymphoma, occult tumour, sarcoma, thyroid cancer, tonsil cancer, rectal cancer, vasculitis. A correla- tion between PET/CT (SUV), radiology (imaging and BI-RADS classification), age, histopathology was done. PET/CT images were interpreted by one radiologist and one nuclear physician together. RESULTS: Of 43 patients analyzed, 19 performed US and MMX, 11 performed only US, 13 did not perform nothing because they did not carry on the follow-up. Of 11 patients who performed US, 6 did not perform USMB because unnecessary. Eight patients of 30 who carried out the study of the radiological findings on mammary gland did not show morphological abnor- malities. Histopathology of 22 eligible patients showed: 9 infil- trating ductal carcinomas, 4 lymphomas (including 1 skin), 1 adenoidcystic cancer, 1 carcinomatous mastitis, 6 fibroadenomas and 1 phyllodes tumour. About 22 patients studied, we found 7 with SUVmax >2.5 and 15 with SUVmax <2.5 (average SUV= 2.0233±2:38SD). There was not statistically significance (p=0.361) between SUVmax and histology. The incidence of ma- lignancy was 68.2%. The incidence of benignity was 31.8%. We did not found a significant correlation (p< 0.106) between SUVmax and radiological imaging. We did not see a significant correlation (p<0.356) between patient age and tumour characteri- zation. BI-RADS classification did not correlate with final histol- ogy. In 8 cases PET finding was not confirmed radiologically for the occurrence of artifacts from breast movement during PET or physiological distribution of 18F-FDG in the mammary gland re- lated to menstrual cycle. CONCLUSIONS: The identification of an accidental mammary uptake during PET may represent an "alarm bell" inducing to deepen PET findings. It seems to have a clinical implication because the change of patient treatment. The diagnostic anticipation would have a favorable prognostic value and lead to a significant reduction in costs. Data must be con- firmed in a more large casuistic.
Clinical-diagnostic implication of incidental mammary 18F-FDG up- take during PET/CT performed for other pathology
P. Carcoforo;P. Querzoli;C. Cittanti
2016
Abstract
AIM: to investigate the clinical-diagnostic meaning of accidental breast uptake of 18F-FDG during PET/CT performed for other pathology, mainly cancer, correlating with radiological imaging and histopathology. METHODS AND MATERIALS: we retro- spectively selected 43 patients (7 male, 36 female, mean age 66.28±14.7y/o) investigated for breast uptake of 18F-FDG, suc- cessively examined with mammography (MMX), UltraSound (US) and, if necessary, Magnetic Resonance (MR). Cases suspected for breast malignancy were studied with US-guided macro-biopsy (USMB). Patients were primitively affected by lung cancer (15), NHD (8), melanoma (4), head-neck cancer (2), other diseases (13) as well as ampullary cancer, Burkitt's lymphoma, CUP Syndrome, esophageal cancer, GIST, T lymphoma, occult tumour, sarcoma, thyroid cancer, tonsil cancer, rectal cancer, vasculitis. A correla- tion between PET/CT (SUV), radiology (imaging and BI-RADS classification), age, histopathology was done. PET/CT images were interpreted by one radiologist and one nuclear physician together. RESULTS: Of 43 patients analyzed, 19 performed US and MMX, 11 performed only US, 13 did not perform nothing because they did not carry on the follow-up. Of 11 patients who performed US, 6 did not perform USMB because unnecessary. Eight patients of 30 who carried out the study of the radiological findings on mammary gland did not show morphological abnor- malities. Histopathology of 22 eligible patients showed: 9 infil- trating ductal carcinomas, 4 lymphomas (including 1 skin), 1 adenoidcystic cancer, 1 carcinomatous mastitis, 6 fibroadenomas and 1 phyllodes tumour. About 22 patients studied, we found 7 with SUVmax >2.5 and 15 with SUVmax <2.5 (average SUV= 2.0233±2:38SD). There was not statistically significance (p=0.361) between SUVmax and histology. The incidence of ma- lignancy was 68.2%. The incidence of benignity was 31.8%. We did not found a significant correlation (p< 0.106) between SUVmax and radiological imaging. We did not see a significant correlation (p<0.356) between patient age and tumour characteri- zation. BI-RADS classification did not correlate with final histol- ogy. In 8 cases PET finding was not confirmed radiologically for the occurrence of artifacts from breast movement during PET or physiological distribution of 18F-FDG in the mammary gland re- lated to menstrual cycle. CONCLUSIONS: The identification of an accidental mammary uptake during PET may represent an "alarm bell" inducing to deepen PET findings. It seems to have a clinical implication because the change of patient treatment. The diagnostic anticipation would have a favorable prognostic value and lead to a significant reduction in costs. Data must be con- firmed in a more large casuistic.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
