Is there a difference in FDG PET findings of invasive ductal carcinoma of the breast with and without coexisting DCIS?

Document Type : Original Article


1 Kuwait University, Faculty of Medicine, Department of Nuclear Medicine, Kuwait

2 Trakya University, Faculty of Medicine, Department of Nuclear Medicine, Turkey

3 Kuwait University, Faculty of Medicine, Department of Community Medicine and Behavioral Sciences,Kuwait

4 Trakya University, Faculty of Medicine, Department of Pathology,Turkey

5 Trakya University, Faculty of Medicine, Department of Surgery, Turkey


Objective(s): Studies have reported that invasive ductal carcinoma (IDC) with coexisting ductal carcinoma in situ (DCIS) show lower metastatic potential and recurrence and better overall survival than pure IDC. In this study, we assessed F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imagesof patients with newly diagnosed IDC to determine if there is any difference in PET findings in IDC-DCIS and pure IDC cases.
Methods: FDG PET/CT images of patients with newly diagnosed IDC of the breast who subsequently   underwent breast surgery and had histopathology result in our records were further evaluated. Tumor grade, pathological staging, and presence of DCIS were noted from the histopathology results. Standardized uptake value (SUV) of the primary tumor (SUVmax and SULmax), other hypermetabolic foci in the breast, and   ipsilateral normal breast were measured. Presence of axillary and distant metastases was noted.  
Results: Fifty seven (57) patients with IDC were included. Coexisting DCIS was present in 44 (IDC-DCIS) and not present in 13 (pure IDC) cases.  Per histopathology, the primary tumor was unifocal in 33 IDC-DCIS (75%) and 12 pure IDC (92.3%) cases, and multifocal in 11 IDC-DCIS cases (25%), and 1 pure IDC case (7.7%). FDG uptake was multifocal in 20 IDC-DCIS cases (45.5%) and 1 pure IDC case (7.7%), and unifocal in 24 IDC-DCIS (54.5%), and 12 pure IDC (92.3%) cases. There was no significant difference in patient age, size of the primary tumor, SUVmax and SULmax of the primary tumor and SUVmax of the normal breast in IDC-DCIS and pure IDC cases (p>0.05). Pathology showed axillary metastasis in all 13 pure IDC (100%), and 27 IDC-DCIS (61.4%) cases. PET showed axillary uptake in 25 IDC-DCIS (56.8%), and 8 pure IDC (61.5%) cases, and abnormal/questionable distant uptake in 12 IDC-DCIS cases and 1 pure IDC case.
Conclusion: In our preliminary findings,multifocal breast FDG uptake and multifocal tumor appear to be more common inIDC-DCIS than pure IDC. There is no significant difference in SUV and size of the primary tumor in IDC-DCIS and pure IDC cases. Axillary metastases appear to be more common in pure IDC than IDC-DCIS cases.


Main Subjects

  1. Groheux D, Cochet A, Humbert O, Alberini JL, Hindié E, Mankoff D.  ¹⁸F-FDG PET/CT for Staging and Restaging of Breast Cancer.  J Nucl Med. 2016; 57 Suppl 1:17S-26S.
  2. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC Cancer Staging Manual and the future of TNM. Ann Surg Oncol. 2010; 17:1471–1474.
  3. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). National Comprehensive Cancer Network. Version 4.2017-February 7, 2018. 
  4. Groheux D, Moretti J-L, Baillet G, Espie M, Giacchetti S, Hindie E,et al. Effect of 18F-FDG PET/CT imaging in patients with clinical stage II and III breast cancer. Int J Radiat Oncol Biol Phys. 2008; 71:695–704.
  5. Segaert I, Mottaghy F, Ceyssens S, De Wever W, Stroobants S, Van Ongeval C, et al. Additional value of PET-CT in staging of clinical stage IIB and III breast cancer. Breast J. 2010; 16:617–624.
  6. Dieterich M, Hartwig F, Stubert J, Klöcking S, Kundt G, Stengel B, et al. Accompanying DCIS in breast cancer patients with invasive ductal carcinoma is predictive of improved local recurrence-free survival. Breast. 2014; 23:346-51.
  7. Wong H, Lau S, Yau T, Cheung P, Epstein RJ. Presence of an in situ component is associated with reduced biological aggressiveness of size-matched invasive breast cancer. Br J Cancer. 2010; 102: 1391-6.
  8. Farabegoli F, Champeme MH, Bieche I, Santini D, Ceccarelli C, Derenzini M,et    al. Genetic pathways in the evolution of breast ductal carcinoma in situ. J Pathol. 2002; 196: 280-6.
  9. Patla A, Rudnicka-Sosin L, Pawlega J, Stachura J. Prognostic significance of selected immunohistochemical parameters in patients with invasive breast carcinoma concomitant with ductal carcinoma in situ. Pol J Pathol. 2002; 53:25-7.
  10. Wong H, Lau S, Leung R, Chiu J, Cheung P, Wong TT, et al. Coexisting ductal carcinoma in situ independently predicts lower tumor aggressiveness in node-positive luminal breast cancer. Med Oncol. 2012; 29:1536-42.
  11. Chagpar AB, McMasters KM, Sahoo S, Edwards MJ.  Does ductal carcinoma in situ accompanying invasive carcinoma affect prognosis? Surgery. 2009; 146: 561–567.
  12. Mylonas I, Makovitzky J, Jeschke U, Briese V, Friese K, Gerber B. Expression of Her2/neu, steroid receptors (ER and PR), Ki67 and p53 in invasive mammary ductal carcinoma associated with ductal carcinoma in situ (DCIS) versus invasive breast cancer alone. Anticancer Res. 2005;25:1719-23
  13. Papantoniou V, Sotiropoulou E, Valsamaki P,  Tsaroucha A, Sotiropoulou M, Ptohis N, et al. Breast density, scintimammographic (99 m)Tc(V)DMSA uptake, and calcitonin gene related peptide (CGRP) expression in mixed invasive ductal associated with extensive in situ ductal carcinoma (IDC-DCIS) and pure invasive ductal carcinoma (IDC): correlation with estrogen receptor (ER) status, proliferation index Ki-67, and histological grade. Breast Cancer. 2011; 18:286-91.
  14. Mechera R, Viehl CT, Oertli D. Factors predicting in-breast tumor recurrence after breast-conserving surgery. Breast Cancer Res Treat. 2009; 116:171-7.
  15. Hume R. Prediction of lean body mass from height and weight. J Clin Pathol. 1966; 19:389-91.
  16. Groheux D, Giacchetti S, Moretti J-L, Porcher R, Espié M, Lehmann-Che J, et al. Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer. Eur J Nucl Med Mol Imaging. 2011; 8:426–435.
  17. Gil-Rendo A, Martínez-Regueira F, Zornoza G, García-Velloso MJ, Beorlegui C, Rodriguez-Spiteri N. Association between [18F]fluorodeoxyglucose uptake and prognostic parameters in breast cancer. Br J Surg. 2009; 96:166-170.
  18. Yoon HJ, Kang KW, Chun IK, Cho N, Im SA, Jeong S, et al. Correlation of breast cancer subtypes, basedon estrogen receptor, progesterone receptor, and HER2, with functional imaging parameters from ⁶⁸Ga-RGD PET/CT and ¹⁸F-FDG PET/CT. Eur J Nucl Med Mol Imaging. 2014; 41:1534-1543.
  19. Basu S, Chen W, Tchou J, Mavi A, Cermik T, Czerniecki B, et al. Comparison of triple-negative and estrogen receptor-positive/progesterone receptor-positive /HER2-negative breast carcinoma using quantitative fluorine-18 fluorodeoxyglucose/ positron emission tomography imaging parameters: a potentially useful method for disease characterization. Cancer. 2008; 112:995-1000.
  20. Avril N, Menzel M, Dose J, Schelling M, Weber W, Jänicke F, et al. Glucose metabolism of breast cancer assessed by 18F-FDG PET: histologic and immunohistochemical tissue analysis. J Nucl Med. 2001; 42:9-16.
  21. Fujioka T, Kubota K, Toriihara A, Machida Y, Okazawa K, Nakagawa T, et al. Tumor characteristics of ductal carcinoma in situ of breast visualized on [F-18] fluorodeoxyglucose-positron emission tomography/computed tomography: Results from a retrospective study. World J Radiol. 2016; 8:743-9.
  22. Azuma A, Tozaki M, Ito K, Fukuma E, Tanaka T, O'uchi T. Ductal carcinoma in situ: correlation between FDG-PET/CT and histopathology. Radiat Med. 2008; 26:488-93.
  23. Ruibal A, Maldonado A, Sánchez Salmón A, González-Alenda J, Barandela J. 18FDG-PET in patients with in situ breast carcinomas. A cause of false negative results. Med Clin (Barc). 2008; 130:332-3.
  24. Yoon HJ, Kim Y, Kim BS. Intratumoral metabolic heterogeneity predicts invasive components in breast ductal carcinoma in situ. Eur Radiol. 2015; 25:3648-58.
  25. Jo BH, Chun YK. Heterogeneity of invasive ductal carcinoma: proposal for a hypothetical classification. J Korean Med Sci. 2006; 21:460-8. 
  26. Logullo AF, Godoy AB, Mourão-Neto M, Simpson AJ, Nishimoto IN, Brentani MM. Presence of ductal carcinoma in situ confers an improved prognosis for patients with T1N0M0 invasive breast carcinoma. Braz J Med Biol Res. 2002; 35:913-9.
  27. Sarikaya I, Sarikaya A. Assessing (18) F-FDG Uptake in the Sentinel Lymph Node in Breast Cancer. J Nucl Med Technol. 2019; 47:149-153.
  28. Andersson Y, Frisell J, Sylvan M, de Boniface J, Bergkvist L. Causes of false- negative sentinel node biopsy in patients with breast cancer. Br J Surg. 2013; 100:775-83.
  29. Rath MG, Heil J, Domschke C, Topic Z, Schneider S, Sinn HP, et al. Predictors of resectability in breast-conserving therapy. Arch Gynecol Obstet. 2012; 286:1023-31.
  30. Dong A, Wang Y, Lu J, Zuo C.  Spectrum of the Breast Lesions with Increased 18F-FDG Uptake on PET/CT. Clin Nucl Med. 2016; 41:543-57.
  31. Lin CY, Ding HJ, Liu CS, Chen YK, Lin CC, Kao CH.  Correlation between the intensity of breast FDG uptake and menstrual cycle. Acad Radiol. 2007; 14:940-4.