18F-fluorodeoxyglucose specimen-positron emission mammography delineates tumour extension in breast-conserving surgery: Preliminary results
- 107 Downloads
We aimed to determine whether high-resolution specimen-positron emission mammography (PEM) using fluorodeoxyglucose (18F-FDG) can reveal extension of breast cancer in breast-conserving surgery (BCS), and assess the safety of radiation exposure to medical staff.
Sixteen patients underwent positron emission tomography, and then BCS with intraoperative frozen section analysis on the same day. Resected specimens with remaining 18F-FDG accumulation were scanned by high-resolution PEM. At least 1 day after surgery, tumour extension was evaluated by three independent experienced readers and by binarized images from the specimen-PEM data. Intraoperative exposure of medical staff to 18F-FDG was measured.
Specimen-PEM evaluations of binarized images and the three investigators detected all (100 %, 12/12) invasive lesions and 94.4 % (17/18) of in situ lesions using both methods. The positive predictive value of the accumulated lesions was 74.4 % (29/39) for the binarized images and 82.9 % (29/35) for the three investigators. Analysis of intraoperative frozen sections detected 100 % (2/2) of the margin-positive cases, also detected by both specimen-PEM evaluation methods with no false-positive margin cases. The mean exposure of the medical staff to 18F was 18 μSv.
Specimen-PEM detected invasive and in situ lesions with high accuracy and allowable radiation exposure.
• Specimen-PEM detected invasive and in situ lesions with high accuracy.
• Specimen-PEM predicted complete resection with the same accuracy as frozen section analysis.
• Breast-conserving surgery after fluorodeoxyglucose injection was performed with low medical staff exposure.
KeywordsFluorodeoxyglucose Positron emission mammography Breast-conserving surgery Surgical margin Frozen section analysis
The authors thank Mika Watanabe, MD, PhD, and Saki Nakagawa, MD, PhD, of Tohoku University Hospital, Sendai, Japan, for their pathological work.
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Takanori Ishida.
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
- 3.Krag DN, Anderson SJ, Julian TB et al (2010) Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. The Lancet Oncology 11:927–933CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Krag DN, Anderson SJ, Julian TB et al (2007) Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial. Lancet Oncol 8:881–888CrossRefPubMedGoogle Scholar
- 6.Hartmann-Johnsen OJ, Karesen R, Schlichting E, Nygard JF (2017) Better survival after breast-conserving therapy compared to mastectomy when axillary node status is positive in early-stage breast cancer: a registry-based follow-up study of 6387 Norwegian women participating in screening, primarily operated between 1998 and 2009. World J Surg Oncol 15:118CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Gombos EC, Jayender J, Richman DM et al (2016) Intraoperative Supine Breast MR Imaging to Quantify Tumor Deformation and Detection of Residual Breast Cancer: Preliminary Results. Radiology. https://doi.org/10.1148/radiol.2016151472:151472
- 10.Schnitt SJ, Moran MS, Houssami N, Morrow M (2015) The Society of Surgical Oncology-American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer: Perspectives for Pathologists. Arch Pathol Lab Med 139:575–577CrossRefPubMedGoogle Scholar