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Can positron emission mammography help to identify clinically significant breast cancer in women with suspicious calcifications on mammography?

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Abstract

Objective

To evaluate the diagnostic accuracy of positron emission mammography (PEM) for identifying malignant lesions in patients with suspicious microcalcifications detected on mammography.

Methods

A prospective, single-centre study that evaluated 40 patients with suspicious calcifications at mammography and indication for percutaneous or surgical biopsy, with mean age of 56.4 years (range: 28-81 years). Patients who agreed to participate in the study underwent PEM with 18F-fluorodeoxyglucose before the final histological evaluation. PEM findings were compared with mammography and histological findings.

Results

Most calcifications (n = 34; 85.0 %) were classified as BIRADS 4. On histology, there were 25 (62.5 %) benign and 15 (37.5 %) malignant lesions, including 11 (27.5 %) ductal carcinoma in situ (DCIS) and 4 (10 %) invasive carcinomas. On subjective analysis, PEM was positive in 15 cases (37.5 %) and most of these cases (n = 14; 93.3 %) were confirmed as malignant on histology. There was one false-positive result, which corresponded to a fibroadenoma, and one false negative, which corresponded to an intermediate-grade DCIS. PEM had a sensitivity of 93.3 %, specificity of 96.0 % and accuracy of 95 %.

Conclusion

PEM was able to identify all invasive carcinomas and high-grade DCIS (nuclear grade 3) in the presented sample, suggesting that this method may be useful for further evaluation of patients with suspected microcalcifications.

Key Points

• Many patients with suspicious microcalcifications at mammography have benign results at biopsy.

• PEM may help to identify invasive carcinomas and high-grade DCIS.

• Management of patients with suspicious calcifications can be improved.

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Abbreviations

95 % CI:

95 % confidence interval

AUC:

area under the curve

BIRADS:

Breast Imaging Report and Data System

CC:

craniocaudal

DCIS:

ductal carcinoma in situ

FDG:

18F-fluorodeoxyglucose

LTB:

lesion to background

MLO:

mediolateral oblique

NPV:

negative predictive value

PEM:

Positron emission mammography

PET/CT:

Positron emission tomography/computed tomography

PPV:

positive predictive value

PUVmax:

PEM uptake value

ROC:

receiver-operating characteristic

SE:

standard error

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Authors and Affiliations

  1. A C Camargo Cancer Center-Department of Imaging, R. Prof. Antônio Prudente, 211, São Paulo, SP, Brazil, 01509-010

    Almir G. V. Bitencourt, Eduardo N. P. Lima, Bruna R. C. Macedo, Jorge L. F. A. Conrado, Elvira F. Marques & Rubens Chojniak

Authors
  1. Almir G. V. Bitencourt
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  2. Eduardo N. P. Lima
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  3. Bruna R. C. Macedo
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  4. Jorge L. F. A. Conrado
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  5. Elvira F. Marques
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  6. Rubens Chojniak
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Correspondence to Almir G. V. Bitencourt.

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Bitencourt, A.G.V., Lima, E.N.P., Macedo, B.R.C. et al. Can positron emission mammography help to identify clinically significant breast cancer in women with suspicious calcifications on mammography?. Eur Radiol 27, 1893–1900 (2017). https://doi.org/10.1007/s00330-016-4576-z

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  • DOI: https://doi.org/10.1007/s00330-016-4576-z

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