for those whose tumors were missed by mammography--a new technique

[Lani]

ABSTRACT: High-Resolution Fluorodeoxyglucose Positron Emission Tomography with Compression ("Positron Emission Mammography") is Highly Accurate in Depicting Primary Breast Cancer [The Breast Journal; Subscribe]
We sought to prospectively assess the diagnostic performance of a high-resolution positron emission tomography (PET) scanner using mild breast compression (positron emission mammography [PEM]). Data were collected on concomitant medical conditions to assess potential confounding factors. At four centers, 94 consecutive women with known breast cancer or suspicious breast lesions received 18F-fluorodeoxyglucose (FDG) intravenously, followed by PEM scans. Readers were provided clinical histories and x-ray mammograms (when available). After excluding inevaluable cases and two cases of lymphoma, PEM readings were correlated with histopathology for 92 lesions in 77 women: 77 index lesions (42 malignant), 3 ipsilateral lesions (3 malignant), and 12 contralateral lesions (3 malignant). Of 48 cancers, 16 (33%) were clinically evident; 11 (23%) were ductal carcinoma in situ (DCIS), and 37 (77%) were invasive (30 ductal, 4 lobular, and 3 mixed; median size 21 mm). PEM depicted 10 of 11 (91%) DCIS and 33 of 37 (89%) invasive cancers. PEM was positive in 1 of 2 T1a tumors, 4 of 6 T1b tumors, 7 of 7 T1c tumors, and 4 of 4 cases where tumor size was not available (e.g., no surgical follow-up). PEM sensitivity for detecting cancer was 90%, specificity 86%, positive predictive value (PPV) 88%, negative predictive value (NPV) 88%, accuracy 88%, and area under the receiver-operating characteristic curve (Az) 0.918. In three patients, cancer foci were identified only on PEM, significantly changing patient management. Excluding eight diabetic subjects and eight subjects whose lesions were characterized as clearly benign with conventional imaging, PEM sensitivity was 91%, specificity 93%, PPV 95%, NPV 88%, accuracy 92%, and Az 0.949 when interpreted with mammographic and clinical findings. FDG PEM has high diagnostic accuracy for breast lesions, including DCIS.

[Bev]

Thanks Lani, BB

[Petesmom]

Lani,

My 44 year old sister-in-law was diagnosed with breast cancer two weeks ago in her left breast. She underwent PEM last week and they found two small cancers in the other breast. These did not show up on her mammogram. It sounds to me like this test is a good one.

Petesmom

[AlaskaAngel]

When I talked with my surgeon in Seattle about my upcoming imaging and raised the question of breast-specific gamma imaging, he suggested I have the PEM instead.

As a stage I NED at 6 years out, I have only had mammograms done since 2006. I think he was more or less on the fence, neither opposed to having additional imaging beyond a mammogram nor especially inclined to recommend it.

A.A.

[Petesmom]

Alaska Angel,

I am due for an annual mammogram in March. I wonder if I should be asking for this test also?

Petesmom