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
Breast

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.

Keywords

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

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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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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