Summary
The present study was aimed to determine the clinicopathologic factors that predict false negative (FN) PET results in these patients.
Methods
A total of 116 breast lesions in 111 patients (pre-menopausal 45; perimenopausal 15; post-menopausal 51) with known or suspicious of breast cancer who underwent FDG–PET scans for staging, were included in this study. The median age was 52±11 years (range 32–79 years). All PET studies results were correlated with follow-up surgical pathology results. A cut off value of 2.5 was considered for positive or negative PET results. Univariate and multivariate analyses were performed to identify factors associated with FN results.
Results
Of 116 breast lesions, 85 were malignant and 31 were benign on histopathology. Of the 85 malignant lesions, 41 were true positive (TP) and 44 were FN. Among the 31 benign lesions, 30 were true negative and one was false positive. There was significant difference in the tumor size (p=0.003) and tumor grade (p=0.001) in patients with TP and FN PET results. Multivariate logistic regression demonstrated that tumor size (≤10 mm) and low tumor grade were independently associated with FN results. No significant relationship of FN PET results was found with age, menopausal status, tumor type, c-erbB-2, estrogen and progesterone receptors, sentinel lymph node or distant metastasis, parenchymal density and multifocality of primary breast tumor.
Conclusion
In present study, tumor size and tumor grade are independent factors that predict FDG–PET results. Smaller tumors (≤10 mm) and low-grade tumors are strong predictor of FN FDG–PET results.
Similar content being viewed by others
References
Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A, Feuer EF, Thun MJ, 2005 Cancer statistics, 2005 CA Cancer J Clin 55:10–30
Surveillance, Epidemiology, and End Results (SEER) Program (www. seer. cancer. gov) SEER Statistics Database: Incidence – SEE (1973–2000), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch
Rosenberg RD, Hunt WC, Williamson MR, Gilliland FD, Wiest PW, Kesely CA, Key CR, Linver MN., (1998). Effects of age, breast density, ethnicity, and estrogen replacement therapy on screening mammographic sensitivity and cancer stage at diagnosis: review of 183,134 screening mammograms in Albuquerque, New Mexico Radiology 209:511–18
Baines CJ, Miller AB, Wall C, McFarlane DV, Simor IS, Jong R, Shapiro BJ, Audet L, Petitclerc M, Ouimet-Oliva D, 1986 Sensitivity and specificity of first screen mammography in the Canadian National Breast Screening Study: a preliminary report from five centersRadiology. 160:295–98
Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S, 1993 Report of the International Workshop on Screening for Breast Cancer J Natl Cancer Inst 85:1644–1656
Frisell J, Klund G, Hellstrom L, 1991 Randomized study of mammography screening: preliminary report on mortality in the Stockholm trial Breast Cancer Res Treat 18:49–56
Kolb TM, Lichy J, Newhouse JH, 2002 Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations Radiology 225:165–175
Pisano ED, Yaffe MJ, 2005 Digital mammography Radiology 234:353–362
Kolb TM, Lichy J, Newhouse JH, 2002 Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations Radiology 225:165–175
Morrow M, 2004 Magnetic resonance imaging in the preoperative evaluation of breast cancer: primum non nocere J Am Coll Surg 198:240–241
Kumar R, Alavi A, 2004 Fluorodeoxyglucose–PET in the management of breast cancer Radiol Clin North Am 42:1113–1122
Wahl RL, Cody RL, Hutchins GD, Mudgett EE, 1991 Primary and metastatic breast carcinoma: initial clinical evaluation with PET with the radiolabeled glucose analogue 2-[F-18]-fluoro-2-deoxy-D-glucose Radiology 179:765–770
Adler LP, Crowe JP, al-Kaisi NK, Sunshine JL, 1993 Evaluation of breast masses and axillary lymph nodes with [F-18] 2-deoxy-2-fluoro-D-glucose PET Radiology 187:743–750
Avril N, Rose CA, Schelling M, Dose J, Kuhn W., Bense S, Weber W, Ziegler S, Graeff H, Schwaiger M. 2000 Breast imaging with positron emission tomography and fluorine-18 fluorodeoxyglucose: use and limitations. J Clin Oncol 18:3495–502
Eubank WB, Mankoff DA, 2005 Evolving role of positron emission tomography in breast cancer imaging Semin Nucl Med 35:84–99
Avril N, Menzel M, Dose J, Schelling M, Weber W, Janicke F, Nathrath W, Schwaiger M, 2001 Glucose metabolism of breast cancer assessed by 18F-FDG PET: histologic and immunohistochemical tissue analysis. J Nucl Med 42:9–16
Buck A, Schirrmeister H, Kuhn T, Shen C, Kalker T, Kotzerke J, Dankerl A, Glatting G, Reske S, Mattfeldt T., 2002 FDG uptake in breast cancer: correlation with biological and clinical prognostic parameters. Eur J Nucl Med Mol Imaging 29:1317–23
Bos R, van Der Hoeven JJ, van Der Wall E, van Der Grope P, van Diest PJ, Comans EF, Joshi U, Semenza GL, Hoekstra OS, Lammertsma AA, Molthoff CF, 2002 Biologic correlates of (18)fluorodeoxyglucose uptake in human breast cancer measured by positron emission tomography. J Clin Oncol 20:379–87
Buck AK, Schirrmeister H, Mattfeldt T, Reske SN, 2004 Biological characterisation of breast cancer by means of PET Eur J Nucl Med Mol Imaging 31(Suppl1):S80–S87
Avril N, Bense S, Ziegler SI, et al., 1997 Breast imaging with fluorine-18-FDG PET: quantitative image analysis J Nucl Med 38:1186–1191
Torizuka T, Zasadny KR, Recker B, Wahl RL, 1998 Untreated primary lung and breast cancers: correlation between F-18 FDG kinetic rate constants and findings of in vitro studies Radiology 207:767–774
Lee FY, Yu J, Chang SS, Fawwaz R, Parisien MV, 2004 Diagnostic value and limitations of fluorine-18 fluorodeoxyglucose positron emission tomography for cartilaginous tumors of bone J Bone Joint Surg Am 86-A:2677–2685
Borgwardt L, Hojgaard L, Carstensen H, Dose J, Weber W, Laubenbacher C, Romer W, Janicke F, Schwaiger M, 2005 Increased fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG) uptake in childhood CNS tumors is correlated with malignancy grade: a study with FDG positron emission tomography/magnetic resonance imaging coregistration and image fusion. J Clin Oncol 23:3030–37
Crippa F, Seregni E, Agresti R, Chiesa C, Pascali C, Bogni A, Decise D, De Sanctis V, Greco M, Daidone MG, Bombardieri E., 1998 Association between [18F]fluorodeoxyglucose uptake and postoperative histopathology, hormone receptor status, thymidine labelling index and p53 in primary breast cancer: a preliminary observation. Eur J Nucl Med 25:1429–34
Acknowledgements
This work was supported by Public Health Services Research Grant M01-RR00040 from NIH. Rakesh Kumar, MD, was financially supported by UICC (International Union Against Cancer) Geneva, Switzerland under ACSBI fellowship.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kumar, R., Chauhan, A., Zhuang, H. et al. Clinicopathologic factors associated with false negative FDG–PET in primary breast cancer. Breast Cancer Res Treat 98, 267–274 (2006). https://doi.org/10.1007/s10549-006-9159-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-006-9159-2