American Radiology Services, Johns Hopkins Green Spring, Lutherville, MD, USA.
Radiology. 2011 Jan;258(1):59-72. doi: 10.1148/radiol.10100454. Epub 2010 Nov 12.
To determine the performance of positron emission mammography (PEM), as compared with magnetic resonance (MR) imaging, including the effect on surgical management, in ipsilateral breasts with cancer.
Four hundred seventy-two women with newly diagnosed breast cancer who were offered breast-conserving surgery consented from September 2006 to November 2008 to participate in a multicenter institutional review board-approved, HIPAA-compliant protocol. Participants underwent contrast material-enhanced MR imaging and fluorine 18 fluorodeoxyglucose PEM in randomized order; resultant images were interpreted independently. Added biopsies and changes in surgical procedure for the ipsilateral breast were correlated with histopathologic findings. Performance characteristics were compared by using the McNemar test and generalized estimating equations.
Three hundred eighty-eight women (median age, 58 years; age range, 26-93 years; median estimated tumor size, 1.5 cm) completed the study. Additional cancers were found in 82 (21%) women (82 ipsilateral breasts; median tumor size, 0.7 cm). Twenty-eight (34%) of the 82 breasts were identified with both PEM and MR imaging; 21 (26%) breasts, with MR imaging only; 14 (17%) breasts, with PEM only; and seven (8.5%) breasts, with mammography and ultrasonography. Twelve (15%) cases of additional cancer were missed at all imaging examinations. Integration of PEM and MR imaging increased cancer detection-to 61 (74%) of 82 breasts versus 49 (60%) of 82 breasts identified with MR imaging alone (P < .001). Of 306 breasts without additional cancer, 279 (91.2%) were correctly assessed with PEM compared with 264 (86.3%) that were correctly assessed with MR imaging (P = .03). The positive predictive value of biopsy prompted by PEM findings (47 [66%] of 71 cases) was higher than that of biopsy prompted by MR findings (61 [53%] of 116 cases) (P = .016). Of 116 additional cancers, 61 (53%) were depicted by MR imaging and 47 (41%) were depicted by PEM (P = .043). Fifty-six (14%) of the 388 women required mastectomy: 40 (71%) of these women were identified with MR imaging, and 20 (36%) were identified with PEM (P < .001). Eleven (2.8%) women underwent unnecessary mastectomy, which was prompted by only MR findings in five women, by only PEM findings in one, and by PEM and MR findings in five. Thirty-three (8.5%) women required wider excision: 24 (73%) of these women were identified with MR imaging, and 22 (67%) were identified with PEM.
PEM and MR imaging had comparable breast-level sensitivity, although MR imaging had greater lesion-level sensitivity and more accurately depicted the need for mastectomy. PEM had greater specificity at the breast and lesion levels. Eighty-nine (23%) participants required more extensive surgery: 61 (69%) of these women were identified with MR imaging, and 41 (46%) were identified with PEM (P = .003). Fourteen (3.6%) women had tumors seen only at PEM.
与磁共振成像（MR）相比，确定正电子发射乳房摄影术（PEM）在同侧乳房癌症中的表现，包括对手术管理的影响。
2006 年 9 月至 2008 年 11 月，472 名新诊断为乳腺癌的女性同意参加多中心机构审查委员会批准的、符合 HIPAA 规定的协议，她们有接受保乳手术的意愿。参与者随机接受对比增强磁共振成像和氟 18 氟脱氧葡萄糖 PEM 检查；结果图像由独立解读。同侧乳房的附加活检和手术程序的改变与组织病理学发现相关。采用 McNemar 检验和广义估计方程比较性能特征。
388 名女性（中位年龄 58 岁；年龄范围 26-93 岁；中位估计肿瘤大小 1.5cm）完成了研究。82 名女性（82 侧乳房；中位肿瘤大小 0.7cm）发现了额外的癌症。28 （34%）侧乳房在 PEM 和 MR 成像中均有发现；21 （26%）侧乳房仅在 MR 成像中发现；14 （17%）侧乳房仅在 PEM 中发现；7 （8.5%）侧乳房仅在乳房 X 线摄影和超声中发现。在所有影像学检查中，有 12 （15%）例额外癌症漏诊。将 PEM 和 MR 成像相结合，提高了癌症的检出率，达到 61 （82 侧乳房中的 74%），而单独使用 MR 成像的检出率为 49 （82 侧乳房中的 60%）（P <.001）。在 306 例无额外癌症的乳房中，279 例（91.2%）的 PEM 评估结果正确，而 264 例（86.3%）的 MR 成像评估结果正确（P =.03）。PEM 检查结果提示活检的阳性预测值（71 例中的 47 例[66%]）高于 MR 检查结果提示活检的阳性预测值（116 例中的 61 例[53%]）（P =.016）。在 116 例额外癌症中，61 例（53%）在 MR 成像中显示，47 例（41%）在 PEM 中显示（P =.043）。56 名（14%）女性需要进行乳房切除术：40 名（71%）女性在 MR 成像中发现，20 名（36%）女性在 PEM 中发现（P <.001）。有 11 名（2.8%）女性进行了不必要的乳房切除术，其中 5 名仅依据 MR 检查结果进行，1 名仅依据 PEM 检查结果进行，5 名依据 PEM 和 MR 检查结果进行。33 名（8.5%）女性需要更广泛的切除：24 名（73%）女性在 MR 成像中发现，22 名（67%）女性在 PEM 中发现。
PEM 和 MR 成像在乳房水平的敏感性相当，尽管 MR 成像具有更高的病变水平敏感性，并更准确地显示需要乳房切除术。PEM 在乳房和病变水平具有更高的特异性。89 名（23%）参与者需要更广泛的手术：61 名（69%）女性在 MR 成像中发现，41 名（46%）女性在 PEM 中发现（P =.003）。14 名（3.6%）女性的肿瘤仅在 PEM 中可见。
