TY - JOUR
T1 - Increased lesion detectability in patients with locally advanced breast cancer-A pilot study using dynamic whole-body [
18F]FDG PET/CT.
AU - Pedersen, Mette Abildgaard
AU - Dias, André H
AU - Hjorthaug, Karin
AU - Gormsen, Lars C
AU - Fledelius, Joan
AU - Johnsson, Anna Lyhne
AU - Borgquist, Signe
AU - Tramm, Trine
AU - Munk, Ole Lajord
AU - Vendelbo, Mikkel Holm
N1 - © 2024. The Author(s).
PY - 2024/3/25
Y1 - 2024/3/25
N2 - BACKGROUND: Accurate diagnosis of axillary lymph node (ALN) metastases is essential for prognosis and treatment planning in breast cancer. Evaluation of ALN is done by ultrasound, which is limited by inter-operator variability, and by sentinel lymph node biopsy and/or ALN dissection, none of which are without risks and/or long-term complications. It is known that conventional 2-deoxy-2-[
18F]fluoro-D-glucose ([
18F]FDG) positron emission tomography/computed tomography (PET/CT) has limited sensitivity for ALN metastases. However, a recently developed dynamic whole-body (D-WB) [
18F]FDG PET/CT scanning protocol, allowing for imaging of tissue [
18F]FDG metabolic rate (MR
FDG), has been shown to have the potential to increase lesion detectability. The study purpose was to examine detectability of malignant lesions in D-WB [
18F]FDG PET/CT compared to conventional [
18F]FDG PET/CT.
RESULTS: This study prospectively included ten women with locally advanced breast cancer who were referred for an [
18F]FDG PET/CT as part of their diagnostic work-up. They all underwent D-WB [
18F]FDG PET/CT, consisting of a 6 min single bed dynamic scan over the chest region started at the time of tracer injection, a 64 min dynamic WB PET scan consisting of 16 continuous bed motion passes, and finally a contrast-enhanced CT scan, with generation of MR
FDG parametric images. Lesion visibility was assessed by tumor-to-background and contrast-to-noise ratios using volumes of interest isocontouring tumors with a set limit of 50% of SUVmax and background volumes placed in the vicinity of tumors. Lesion visibility was best in the MR
FDG images, with target-to-background values 2.28 (95% CI: 2.04-2.54) times higher than target-to-background values in SUV images, and contrast-to-noise values 1.23 (95% CI: 1.12-1.35) times higher than contrast-to-noise values in SUV images. Furthermore, five imaging experts visually assessed the images and three additional suspicious lesions were found in the MR
FDG images compared to SUV images; one suspicious ALN, one suspicious parasternal lymph node, and one suspicious lesion located in the pelvic bone.
CONCLUSIONS: D-WB [
18F]FDG PET/CT with MR
FDG images show potential for improved lesion detectability compared to conventional SUV images in locally advanced breast cancer. Further validation in larger cohorts is needed.
CLINICAL TRIAL REGISTRATION: The trial is registered in clinicaltrials.gov, NCT05110443, https://www.CLINICALTRIALS: gov/study/NCT05110443?term=NCT05110443&rank=1 .
AB - BACKGROUND: Accurate diagnosis of axillary lymph node (ALN) metastases is essential for prognosis and treatment planning in breast cancer. Evaluation of ALN is done by ultrasound, which is limited by inter-operator variability, and by sentinel lymph node biopsy and/or ALN dissection, none of which are without risks and/or long-term complications. It is known that conventional 2-deoxy-2-[
18F]fluoro-D-glucose ([
18F]FDG) positron emission tomography/computed tomography (PET/CT) has limited sensitivity for ALN metastases. However, a recently developed dynamic whole-body (D-WB) [
18F]FDG PET/CT scanning protocol, allowing for imaging of tissue [
18F]FDG metabolic rate (MR
FDG), has been shown to have the potential to increase lesion detectability. The study purpose was to examine detectability of malignant lesions in D-WB [
18F]FDG PET/CT compared to conventional [
18F]FDG PET/CT.
RESULTS: This study prospectively included ten women with locally advanced breast cancer who were referred for an [
18F]FDG PET/CT as part of their diagnostic work-up. They all underwent D-WB [
18F]FDG PET/CT, consisting of a 6 min single bed dynamic scan over the chest region started at the time of tracer injection, a 64 min dynamic WB PET scan consisting of 16 continuous bed motion passes, and finally a contrast-enhanced CT scan, with generation of MR
FDG parametric images. Lesion visibility was assessed by tumor-to-background and contrast-to-noise ratios using volumes of interest isocontouring tumors with a set limit of 50% of SUVmax and background volumes placed in the vicinity of tumors. Lesion visibility was best in the MR
FDG images, with target-to-background values 2.28 (95% CI: 2.04-2.54) times higher than target-to-background values in SUV images, and contrast-to-noise values 1.23 (95% CI: 1.12-1.35) times higher than contrast-to-noise values in SUV images. Furthermore, five imaging experts visually assessed the images and three additional suspicious lesions were found in the MR
FDG images compared to SUV images; one suspicious ALN, one suspicious parasternal lymph node, and one suspicious lesion located in the pelvic bone.
CONCLUSIONS: D-WB [
18F]FDG PET/CT with MR
FDG images show potential for improved lesion detectability compared to conventional SUV images in locally advanced breast cancer. Further validation in larger cohorts is needed.
CLINICAL TRIAL REGISTRATION: The trial is registered in clinicaltrials.gov, NCT05110443, https://www.CLINICALTRIALS: gov/study/NCT05110443?term=NCT05110443&rank=1 .
KW - Breast cancer
KW - Dynamic imaging
KW - PET/CT
KW - Tumor detectability
UR - http://www.scopus.com/inward/record.url?scp=85188602365&partnerID=8YFLogxK
U2 - 10.1186/s13550-024-01096-4
DO - 10.1186/s13550-024-01096-4
M3 - Journal article
C2 - 38528239
SN - 2191-219X
VL - 14
SP - 31
JO - EJNMMI research
JF - EJNMMI research
IS - 1
M1 - 31
ER -