European Radiology

, Volume 28, Issue 5, pp 1929–1937 | Cite as

18F-fluorodeoxyglucose specimen-positron emission mammography delineates tumour extension in breast-conserving surgery: Preliminary results

  • Gou Watanabe
  • M. Itoh
  • X. Duan
  • H. Watabe
  • N. Mori
  • H. Tada
  • A. Suzuki
  • M. Miyashita
  • N. Ohuchi
  • T. Ishida



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.

Key points

• 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.


Fluorodeoxyglucose 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.


This study received funding by JSPS KAKENHI Grant Number 15K10045.

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.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• diagnostic or prognostic study

• performed at one institution


  1. 1.
    Wilke LG, Czechura T, Wang C et al (2014) Repeat surgery after breast conservation for the treatment of stage 0 to II breast carcinoma: a report from the National Cancer Data Base, 2004-2010. JAMA Surg 149:1296–1305CrossRefPubMedGoogle Scholar
  2. 2.
    Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241CrossRefPubMedGoogle Scholar
  3. 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
  4. 4.
    van der Noordaa MEM, Vrancken Peeters MTFD, Rutgers EJT (2017) The intraoperative assessment of sentinel nodes – Standards and controversies. The Breast 34:S64–S69CrossRefPubMedGoogle Scholar
  5. 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. 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
  7. 7.
    Menes TS, Tartter PI, Bleiweiss I, Godbold JH, Estabrook A, Smith SR (2005) The consequence of multiple re-excisions to obtain clear lumpectomy margins in breast cancer patients. Ann Surg Oncol 12:881–885CrossRefPubMedGoogle Scholar
  8. 8.
    Russo AL, Arvold ND, Niemierko A et al (2013) Margin status and the risk of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy. Breast Cancer Res Treat 140:353–361CrossRefPubMedGoogle Scholar
  9. 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.
  10. 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
  11. 11.
    Berg WA, Madsen KS, Schilling K et al (2011) Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology 258:59–72CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Murthy K, Aznar M, Bergman AM et al (2000) Positron emission mammographic instrument: initial results. Radiology 215:280–285CrossRefPubMedGoogle Scholar
  13. 13.
    Eo JS, Chun IK, Paeng JC et al (2012) Imaging sensitivity of dedicated positron emission mammography in relation to tumor size. Breast 21:66–71CrossRefPubMedGoogle Scholar
  14. 14.
    Yoshikawa A, Yanagida T, Kamada K et al (2010) Positron emission mammography using Pr:LuAG scintillator – Fusion of optical material study and systems engineering. Optical Materials 32:1294–1297CrossRefGoogle Scholar
  15. 15.
    Chagpar AB, Killelea BK, Tsangaris TN et al (2015) A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer. N Engl J Med 373:503–510CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Riedl O, Fitzal F, Mader N et al (2009) Intraoperative frozen section analysis for breast-conserving therapy in 1016 patients with breast cancer. Eur J Surg Oncol 35:264–270CrossRefPubMedGoogle Scholar
  17. 17.
    Olson TP, Harter J, Munoz A, Mahvi DM, Breslin T (2007) Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol 14:2953–2960CrossRefPubMedGoogle Scholar
  18. 18.
    Cabioglu N, Hunt KK, Sahin AA et al (2007) Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol 14:1458–1471CrossRefPubMedGoogle Scholar
  19. 19.
    Ciccarelli G, Di Virgilio MR, Menna S et al (2007) Radiography of the surgical specimen in early stage breast lesions: diagnostic reliability in the analysis of the resection margins. Radiol Med 112:366–376CrossRefPubMedGoogle Scholar
  20. 20.
    Sebastian M, Akbari S, Anglin B, Lin EH, Police AM (2015) The impact of use of an intraoperative margin assessment device on re-excision rates. Springerplus 4:198CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Osborn JB, Keeney GL, Jakub JW, Degnim AC, Boughey JC (2011) Cost-effectiveness analysis of routine frozen-section analysis of breast margins compared with reoperation for positive margins. Ann Surg Oncol 18:3204–3209CrossRefPubMedGoogle Scholar
  22. 22.
    Schnabel F, Boolbol SK, Gittleman M et al (2014) A randomized prospective study of lumpectomy margin assessment with use of MarginProbe in patients with nonpalpable breast malignancies. Ann Surg Oncol 21:1589–1595CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Morrow M, Rademaker AW, Bethke KP et al (1999) Learning sentinel node biopsy: results of a prospective randomized trial of two techniques. Surgery 126:714–720 discussion 720-712CrossRefPubMedGoogle Scholar
  24. 24.
    Sugie T, Ikeda T, Kawaguchi A, Shimizu A, Toi M (2017) Sentinel lymph node biopsy using indocyanine green fluorescence in early-stage breast cancer: a meta-analysis. International Journal of Clinical Oncology 22:11–17CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Gou Watanabe
    • 1
  • M. Itoh
    • 2
  • X. Duan
    • 2
  • H. Watabe
    • 3
  • N. Mori
    • 4
  • H. Tada
    • 1
  • A. Suzuki
    • 5
  • M. Miyashita
    • 1
  • N. Ohuchi
    • 1
  • T. Ishida
    • 1
  1. 1.Division of Surgical OncologyTohoku University School of MedicineSendaiJapan
  2. 2.Sendai Medical Imaging CenterSendaiJapan
  3. 3.Cyclotron and Radioisotope CenterTohoku UniversitySendaiJapan
  4. 4.Division of Diagnostic RadiologyTohoku University School of MedicineSendaiJapan
  5. 5.Department of Breast and Endocrine SurgeryTohoku Medical and Pharmaceutical UniversitySendaiJapan

Personalised recommendations