Comparison between 18F-FDG PET/CT and diffusion-weighted imaging in detection of invasive ductal breast carcinoma

Document Type : Original Article

Authors

1 Department of Nuclear Medicine, Istanbul Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

2 Department of Radiology, Istanbul Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

3 Department of Nuclear Medicine, Mugla Training and Research Hospital, Mugla Sıtkı Kocman University, Mugla, Turkey

4 Department of Nuclear Medicine, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

5 5Department of Pathology, Istanbul Bakırköy Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

6 Department of Pathology, Istanbul Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

7 Department of General Surgery, Istanbul Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey

8 Department of Radiology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey

Abstract

Objective(s): Breast carcinoma is the most common type of cancer in females. This study aims to compare fluorine-18-fluorodeoxyglucose (18F-FDG) uptake pattern and apparent diffusion coefficient (ADC) value for the detection of the primary tumour and axillary metastases of invasive ductal breast carcinoma.
Methods: This study included 40 breast carcinoma lesions taken from 39 patients. After staging by positron emission tomography-computed tomography (PET/CT) and diffusion-weighted magnetic resonance imaging (MRI), breast surgery with axillary lymph node dissection or sentinel lymph node biopsy was performed.
Results: Primary lesion detection rate for PET/CT and diffusion-weighted MRI was high with 39 of 40 lesions (97.5%). The sensitivity and specificity for the detection of metastatic lymph nodes in axilla were 40.9%, 88.9%, with 18F-FDG PET/CT scans and 40.9%, 83.3%, for dw-MRI, respectively. No significant correlation was detected between ADC and SUVmax or SUVmax ratios. Estrogen receptor (p=0.007) and progesterone receptor (p=0.036) positive patients had lower ADC values. Tumour SUVmax was lower in T1 than T2 tumour size (p=0.027) and progesterone receptor-positive patients (p=0.029). Tumour/background SUVmax was lower in progesterone receptor-positive patients (p=0.004). Tumour/liver SUVmax was higher in grade III patients (p=0.035) and progesterone receptor negative status (p=0.043).
Conclusions: This study confirmed the high detection rate of breast carcinoma in both modalities. They have same sensitivity for the detection of axillary lymph node metastases, whereas the PET/CT scan had higher specificity. Furthermore, ADC, SUVmax and SUVmax ratios showed some statistical significance among the patient groups according to different pathological parameters.

Keywords

Main Subjects


  1. Rim A, Chellman-Jeffers M. Trends in breast cancer screening and diagnosis. Cleve Clin J Med. 2008; 75:2-9.
  2. Van Goethem M, Schelfout K, Kersschot E, Colpaert C, Verslegers I, Biltijes W, et al. MR mammography is useful in the preoperative locoregional staging of breast carcinomas with extensive intraductal component. Eur J Radiol. 2007; 62(2):273-82.
  3. Biglia N, Mariani L, Sgro L, Mininanni P, Moggio G, Sismondi P. Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: implications for diagnosis, surgical and medical treatment. Endocr Relat Cancer. 2007; 14(3):549-67.
  4. Moon M, Cornfeld D, Weinreb, J. Dynamic contrast-enhanced breast MR imaging. Magn Reson Imaging Clin N Am. 2009; 17(2):351-362.
  5. Tamaki Y, Akashi-Tanaka S, Ishida T, Uematsu T, Sawai Y, Kusama M, et al. 3D imaging of intraductal spread of breast cancer and its clinical application for navigation surgery. Breast Cancer. 2002; 9(4):289-95.
  6. Siegmann KC, Müller-Schimpfle M, Schick F, Remy C, Fersis N, Ruck P, et al. MR imaging-detected breast lesions: histopathologic correlation of lesion characteristics and signal intensity data. AJR Am J Roentgenol. 2002; 178(6):1403-09.
  7. Koh DM, Takahara T, Imai Y, Collins DJ. Practical aspects of assessing tumors using clinical diffusion-weighted imaging in the body. Magn Reson Med Sci. 2007; 6(4):211-24.
  8. Hatakenaka M, Soeda H, Yabuuchi H, Matsuo Y, Kamitani T, Oda Y, et al. Apparent diffusion coefficients of breast tumors: clinical application. Magn Reson Med Sci. 2008; 7(1): 23-29.
  9. Woodhams R, Matsunaga K, Kan S, Hata H, Ozaki M, Iwabuchi K, et al. ADC mapping of benign and malignant breast tumors. Magn Reson Med Sci. 2005; 4(1):35-42.
  10. Eubank WB, Mankoff, DA. Evolving role of positron emission tomography in breast cancer imaging. Semin Nucl Med. 2005; 35(2):84-99.
  11. Buck A, Schirrmeister H, Kühn T, Shen C, Kalker T, Kotzerke J, et al. FDG uptake in breast cancer: correlation with biological and clinical prognostic parameters. Eur J Nucl Med Mol Imaging. 2002; 29(10):1317-23.
  12. Ekmekcioglu O, Aliyev A, Yilmaz S, Arslan E, Kaya R, Kocael P. Correlation of 18F fluoro-deoxyglucose uptake with histopatho-logical prognostic factors in breast carcinoma. Nucl Med Commun. 2013; 34(11):1055–67.
  13. Schnall MD, Blume J, Bluemke DA, DeAngelis G, DeBruhl N, Harms S, et al. Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology. 2006; 238(1):42-53.
  14. Ueda S, Tsuda H, Asakawa H, Shigekawa T,Fukatsu K, Kondo N, et al. Clinico-pathological and prognostic relevance of uptake level using 18F-fluorodeoxyglucose positron emission tomography/ computed tomography fusion imaging (18F-FDG PET/CT) in primary breast cancer. Jpn J Clin Oncol. 2008; 38(4):250-8.
  15. Van Goethem M, Tjalma W, Schelfout K, Verslegers I, Biltjes I, Parizel P. Magnetic resonance imaging in breast cancer. Eur J Surg Oncol. 2006; 32(9):901-10.
  16. Baba S, Isoda T, Maruoka Y, Kitamura Y, Sasaki M, Yoshida T, et al. Diagnostic and prognostic value of pretreatment SUV in 18F-FDG/PET in breast cancer: comparison with apparent diffusion coefficient from diffusion-weighted MR imaging. J Nucl Med. 2014; 55(5):736-42.
  17. Choi BB, Kim SH, Kang BJ, Lee JH, Song BJ, Jeong SH, et al. Diffusion-weighted imaging and FDG PET/CT: predicting the prognoses with apparent diffusion coefficient values and maximum standardized uptake values in patients with invasive ductal carcinoma. World J Surg Oncol. 2012; 10:126.
  18. Nakajo M, Kajiya Y, Kaneko T, Kaneko Y, Takasaki T, Tani A, et al. FDG PET/CT and diffusion-weighted imaging for breast cancer: prognostic value of maximum standardized uptake values and apparent diffusion coefficient values of the primary lesion. Eur J Nucl Med Mol Imaging. 2010; 37(11):2011-20.
  19. Kitajima K, Miyoshi Y, Yamano T, Odawara S, Higuchi T, Yamakado K. Prognostic value of FDG-PET and DWI in breast cancer. Ann Nucl Med. 2018; 32(1):44-53.
  20. Morawitz J, Kirchner J, Martin O, Bruckman N, Dietzel F, Li Y, et al. Prospective Correlation of Prognostic Immuno-histochemical Markers with SUV and ADC Derived From Dedicated Hybrid Breast 18F-FDG PET/MRI in Women With Newly Diagnosed Breast Cancer. Clin Nucl Med. 2021; 46(3):201-05.
  21. Lester SC, Bose S, Chen YY, Connoly J, Baca M, Fitzgibbons P, et al. Members of the Cancer Committee, College of American Pathologists. Protocol for the examination of specimens from patients with invasive carcinoma of the breast. Arch Pathol Lab Med. 2009; 133 (10):1515-38.
  22. Elston CW, Ellis IO, Pinder SE. Pathological prognostic factors in breast cancer. Crit Rev Oncol Hematol. 1999; 31(3):209-23.
  23. Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty K, Badve S, et al. American Society of Clinical Oncology; College of American Pathologists. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immune-histochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). Arch Pathol Lab Med. 2010; 134(7):e48-72.
  24. Caprio MG, Cangiano A, Imbriaco M, Soscia F, Martino GD, Farina A, et al. Dual-time-point [18F]-FDG PET/CT in the diagnostic evaluation of suspicious breast lesions. Radiol Med. 2010; 115(2):215-24.
  25. Boné B, Aspelin P, Bronge L, Isberg B, Perbeck L, Veress B. Sensitivity and Specificity of MR Mammography with Histopathological Correlation in 250 Acta Radiologica. 1996; 37(2):208-13.
  26. Choi YJ, Shin YD, Kang YH, Lee MS, Lee MK, Cho BS, et al. The Effects of Preoperative (18)F-FDG PET/CT in Breast Cancer Patients in Comparison to the Conventional Imaging Study. J Breast Cancer. 2012; 15(4):441-8.
  27. Garami Z, Hascsi Z, Varga J, Dinya T, Tanyi M, Garai I, et al. The value of 18-FDG PET/CT in early-stage breast cancer compared to traditional diagnostic modalities with an emphasis on changes in disease stage designation and treatment plan. Eur J Surg Oncol. 2012; 38(1):31-7.
  28. Berg WA, Madsen KS, Schilling K, Tartar M, Pisano E, Larsen LH, et al. Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology. 2011; 258(1):59-72.
  29. Machida Y, Kubota K, Katayama T, Toriihara A, Shibuya H. Diagnostic performance of fluoro-deoxyglucose-positron emission tomography/ computed tomography combined with ultrasonography-guided fine needle aspiration cytology for identifying axillary lymph node status in patients with breast cancer. Eur J Surg Oncol. 2013; 39(1):26-30.
  30. Cooper KL, Meng Y, Harnan S, Ward SE, Fitzgerald P, Papaioannou D, et al. Positron emission tomography (PET) and magnetic resonance imaging (MRI) for the assessment of axillary lymph node metastases in early breast cancer: systematic review and economic evaluation. Health Technol Assess. 2011; 15(4): iii-iv, 1-134.
  31. Kuhl CK. Concepts for differential diagnosis in breast MR imaging. Magn Reson Imaging Clin N Am. 2006; 14(3):305-28.
  32. Yoshikawa MI, Ohsumi S, Sugata S, Kataoka M, Takashima S, Mochizuki T, et al. Relation between cancer cellularity and apparent diffusion coefficient values using diffusion-weighted magnetic resonance imaging in breast cancer. Radiat Med. 2008; 26(4): 222-26.
  33. Bos R, van Der Hoeven, JJ, van Der Wall E, van Der Groep P, van Diest P, Comans E, et al. Biologic correlates of (18)fluoro-deoxyglucose uptake in human breast cancer measured by positron emission tomography. J Clin Oncol. 2002; 20(2):379-87.
  34. Grueneisen J, Beiderwellen K, Heusch P, Buderath P, Aktas B, Gratz M, et al. Correlation of standardized uptake value and apparent diffusion coefficient in integrated whole-body PET/MRI of primary and recurrent cervical cancer. PLoS One. 2014; 9(5):e96751.
  35. Sakane M, Tatsumi M, Kim T, Hori M, Onishi H, Nakamoto A, et al. Correlation between apparent diffusion coefficients on diffusion-weighted MRI and standardized uptake value on FDG-PET/CT in pancreatic adenocarcinoma. Acta Radiol. 2015; 56(9): 1034-41.
  36. Schaarschmidt BM, Buchbender C, Nensa F, Gruneinen J, Gomez B, Köhler J, et al. Correlation of the apparent diffusion coefficient (ADC) with the standardized uptake value (SUV) in lymph node metastases of non-small cell lung cancer (NSCLC) patients using hybrid 18F-FDG PET/MRI. PLoS One. 2015; 10(1): e0116277.
  37. Schwenzer NF, Schmidt H, Gatidis S, Brendle c, Müller M, Königsrainer I, et al. Measurement of apparent diffusion coefficient with simultaneous MR/positron emission tomography in patients with peritoneal carcinomatosis: comparison with 18F-FDG-PET. Journal of Magnetic Resonance Imaging: JMRI. 2014; 40(5): 1121-28.
  38. Kamitani T, Matsuo Y, Yabuuchi H, Fujita N, Nagao M, Jinnouchi M, et al. Correlations between apparent diffusion coefficient values and prognostic factors of breast cancer. Magn Reson Med Sci. 2013; 12(3):193-99.
  39. Ludovini V, Sidoni A, Pistola L, Bellezza G,De Angelis V, Gori S, et al. Evaluation of the prognostic role of vascular endothelial growth factor and microvessel density in stages I and II breast cancer patients. Breast Cancer Res Treat. 2003; 81(2):159-68.
  40. Razek AA, Gaballa G, Denewer A, Nada N. Invasive ductal carcinoma: correlation of apparent diffusion coefficient value with pathological prognostic factors. NMR Biomed. 2010; 23(6):619-23.