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European Radiology

, Volume 29, Issue 10, pp 5507–5516 | Cite as

A preliminary study to propose a diagnostic algorithm for PET/CT-detected incidental breast lesions: application of BI-RADS lexicon for US in combination with SUVmax

  • Mehrdad Bakhshayeshkaram
  • Yalda Salehi
  • Mehrshad Abbasi
  • Razieh Hashemi Beni
  • Sharareh Seifi
  • Maryam Hassanzad
  • Hamid Reza Jamaati
  • Farahnaz AghahosseiniEmail author
Breast
  • 113 Downloads

Abstract

Objectives

To develop a diagnostic algorithm for positron emission tomography (PET)–detected incidental breast lesions using both breast imaging reporting and data system (BI-RADS) and maximum standardized uptake value (SUVmax) criteria.

Methods

Fifty-six PET-detected incidental breast lesions from 51 patients, which were subsequently investigated by breast ultrasound within 1 month of the PET study, constituted the study cohort and they were finally verified by tissue diagnosis or a 2-year follow-up. Based on the maximum specificity with sensitivity > 60.0% and maximum sensitivity with specificity > 60.0%, two SUVmax cutoff values were calculated at 2 and 3.7. BI-RADS ≥ 4 was considered as highly suspicious for malignancy. The diagnostic accuracies were estimated for SUVmax levels above or below the cutoff points combined with the BI-RADS suspicion level.

Results

Overall, 46 benign and 10 malignant lesions were studied. The diagnostic characteristics of SUVmax ≥ 2, SUVmax ≥ 3.7, and BI-RADS ≥ 4 were 80.0%, 60.0%, and 80.0% for sensitivity, 73.9%, 95.7%, and 92.7% for specificity, and 75.0%, 89.3%, and 90.2% for accuracy, respectively. When the SUVmax threshold was set at 2, combined with BI-RADS suspicion level, the sensitivity, specificity, and accuracy were 100.0%, 69.6%, and 75.0%, respectively. The results for SUVmax threshold set at 3.7 combined with BI-RADS were 90.0%, 91.3%, and 91.1% for the sensitivity, specificity, and accuracy, respectively. A diagnostic algorithm was accordingly generated.

Conclusion

The need for biopsy should be justified in low BI-RADS lesions presenting with high SUVmax at 3.7 or higher. The biopsy of patients with high B-IRADS and low SUVmax could be preserved.

Key Points

• A diagnostic algorithm was developed for PET-detected incidental breast lesions using both BI-RADS and SUVmax criteria.

• Diagnostic performance was calculated separately and conjunctively for SUVmax ≥ 2, SUVmax ≥ 3.7, and BI-RADS ≥ 4.

• The need for biopsy can be justified in BI-RADS < 4 lesions with SUVmax ≥ 3.7. Lesions with BI-RADS < 4 and indeterminate SUVmax (2 < SUVmax < 3.7) benefit from a short-interval follow-up. BI-RADS < 4 lesions with SUVmax < 2 may confidently be scheduled for routine screening.

Keywords

Breast 18F-FDG PET-CT Diagnostic imaging 

Abbreviations

BI-RADS

Breast imaging reporting and data system

F-18 FDG PET/CT

F-18 fluorodeoxyglucose positron emission tomography/computed tomography

HD

High definition

PET

Positron emission tomography

ROC

Receiver operating characteristic

SUV

Standardized uptake volume

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Mehrdad Bakhshayeshkaram.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because the Review Board of Shahid Beheshti University of Medical Sciences waived the need for an informed consent.

Ethical approval

Institutional Review Board of Shahid Beheshti University of Medical Sciences approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Mehrdad Bakhshayeshkaram
    • 1
  • Yalda Salehi
    • 2
  • Mehrshad Abbasi
    • 2
  • Razieh Hashemi Beni
    • 1
  • Sharareh Seifi
    • 3
  • Maryam Hassanzad
    • 4
  • Hamid Reza Jamaati
    • 5
  • Farahnaz Aghahosseini
    • 1
    Email author
  1. 1.Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of RadiologyShahid Beheshti University of Medical SciencesTehranIran
  2. 2.Department of Nuclear Medicine, Vali-Asr HospitalTehran University of Medical SciencesTehranIran
  3. 3.Pediatric Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of OncologyShahid Beheshti University of Medical SciencesTehranIran
  4. 4.Pediatric Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of PaediatricsShahid Beheshti University of Medical SciencesTehranIran
  5. 5.Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of PulmonologyShahid Beheshti University of Medical SciencesTehranIran

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