Background-Aim: To study the clinical-diagnostic meaning of ac- cidental breast uptake of 18F-FDG during PET performed for other diseases, mainly cancer, correlating with radiological imaging and histopathology. Methods: We retrospectively selected 43 patients (7 males and 36 females). They were investigated with mammary and axillary clinical examination, mammography (MMX), UltraSound (US) and/or Mag- netic Resonance (MRI). Cases suspected for breast malignancy were studied with US-guided macro-biopsy (USMB). Patients were primitively affected by lung cancer (15), NHD (8), melanoma (4), head-neck cancer (2), other diseases (13) as well as ampullary cancer, Burkitt’s lymphoma, CUP Syndrome, esophageal cancer, GIST, T lymphoma, occult tumour, sarcoma, thyroid cancer, tonsil cancer, rectal cancer, vasculitis. A correlation between PET (SUV), radiology (imaging and BI-RADS classification), age, histopathology was done. Results: Of 43 patients analyzed, 19 performed the deepening of mammary finding using US and MMX, 11 performed only US, 13 did not perform nothing because they did not carry on the follow-up. Of 11 patients who performed US, 6 did not perform the deepening USMB because unnecessary, instead 5 performed USMB. Eight pa- tients of 30 who carried out the study of the radiological findings on mammary gland did not show morphological abnormalities. Histo- pathology of 22 eligible patients showed: 9 infiltrating ductal carcinomas, 4 lymphomas (including 1 skin), 1 adenoidcystic cancer, 1 carcinomatous mastitis, 6 fibroadenomas and 1 phyllodes tumour. Thirteen patients did not keep on the follow-up because of death (4) or lost in time (9). Out of 22 patients studied, we found 7 with SUVmax [ 2.5 and 15 with SUVmax \ 2.5 (average SUV = 2.0233 ± 2:38 SD). There was not statistically significance (p = 0.361) between SUVmax and histology. The incidence of ma- lignancy was 68.2 %. The incidence of benignity was 31.8 %. We did not found a significant correlation (p \ 0.106) between SUVmax and radiological imaging. We did not see a significant correlation (p \ 0.356) between patient age and tumour characterization. BI- RADS classification (evaluated by CT images for attenuation cor- rection of PET) did not correlate with final histology. In 8 cases PET finding was not confirmed radiologically for the occurrence of arti- facts from breast movement during PET or physiological distribution of 18F-FDG in the mammary gland related to menstrual cycle. Conclusion: From our experience the identification of an accidental mammary uptake during PET may represent an ‘‘alarm bell’’ (68.2 % of malignancy) inducing to deepen PET findings. It seems to have a clinical implication because of the change of patient treatment. The diagnostic anticipation would have a favorable prognostic value and lead to a significant reduction in costs. Our data must be confirmed in a more large casuistic.

Clinical-diagnostic meaning of mammary uptake accidentally detected during 18F-FDG PET/CT (PET): comparison between radiological imaging and histopathology.

P. Carcoforo;S. Corcione;P. Querzoli;C. Cittanti;C. Peterle;V. De Cristofaro;L. Feggi
2015

Abstract

Background-Aim: To study the clinical-diagnostic meaning of ac- cidental breast uptake of 18F-FDG during PET performed for other diseases, mainly cancer, correlating with radiological imaging and histopathology. Methods: We retrospectively selected 43 patients (7 males and 36 females). They were investigated with mammary and axillary clinical examination, mammography (MMX), UltraSound (US) and/or Mag- netic Resonance (MRI). Cases suspected for breast malignancy were studied with US-guided macro-biopsy (USMB). Patients were primitively affected by lung cancer (15), NHD (8), melanoma (4), head-neck cancer (2), other diseases (13) as well as ampullary cancer, Burkitt’s lymphoma, CUP Syndrome, esophageal cancer, GIST, T lymphoma, occult tumour, sarcoma, thyroid cancer, tonsil cancer, rectal cancer, vasculitis. A correlation between PET (SUV), radiology (imaging and BI-RADS classification), age, histopathology was done. Results: Of 43 patients analyzed, 19 performed the deepening of mammary finding using US and MMX, 11 performed only US, 13 did not perform nothing because they did not carry on the follow-up. Of 11 patients who performed US, 6 did not perform the deepening USMB because unnecessary, instead 5 performed USMB. Eight pa- tients of 30 who carried out the study of the radiological findings on mammary gland did not show morphological abnormalities. Histo- pathology of 22 eligible patients showed: 9 infiltrating ductal carcinomas, 4 lymphomas (including 1 skin), 1 adenoidcystic cancer, 1 carcinomatous mastitis, 6 fibroadenomas and 1 phyllodes tumour. Thirteen patients did not keep on the follow-up because of death (4) or lost in time (9). Out of 22 patients studied, we found 7 with SUVmax [ 2.5 and 15 with SUVmax \ 2.5 (average SUV = 2.0233 ± 2:38 SD). There was not statistically significance (p = 0.361) between SUVmax and histology. The incidence of ma- lignancy was 68.2 %. The incidence of benignity was 31.8 %. We did not found a significant correlation (p \ 0.106) between SUVmax and radiological imaging. We did not see a significant correlation (p \ 0.356) between patient age and tumour characterization. BI- RADS classification (evaluated by CT images for attenuation cor- rection of PET) did not correlate with final histology. In 8 cases PET finding was not confirmed radiologically for the occurrence of arti- facts from breast movement during PET or physiological distribution of 18F-FDG in the mammary gland related to menstrual cycle. Conclusion: From our experience the identification of an accidental mammary uptake during PET may represent an ‘‘alarm bell’’ (68.2 % of malignancy) inducing to deepen PET findings. It seems to have a clinical implication because of the change of patient treatment. The diagnostic anticipation would have a favorable prognostic value and lead to a significant reduction in costs. Our data must be confirmed in a more large casuistic.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2382509
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