European Radiology

, Volume 27, Issue 5, pp 1893–1900 | Cite as

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

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



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


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.


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 %.


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.


Breast neoplasms Carcinoma ductal in situ Mammography Fluorodeoxyglucose F18 Positron emission tomography 


95 % CI

95 % confidence interval


area under the curve


Breast Imaging Report and Data System




ductal carcinoma in situ




lesion to background


mediolateral oblique


negative predictive value


Positron emission mammography


Positron emission tomography/computed tomography


positive predictive value


PEM uptake value


receiver-operating characteristic


standard error


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Almir G. V. Bitencourt
    • 1
  • Eduardo N. P. Lima
    • 1
  • Bruna R. C. Macedo
    • 1
  • Jorge L. F. A. Conrado
    • 1
  • Elvira F. Marques
    • 1
  • Rubens Chojniak
    • 1
  1. 1.A C Camargo Cancer Center-Department of ImagingSão PauloBrazil

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