From the Temerty Faculty of Medicine, Joint Department of Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Ave, Toronto, ON, Canada M5G 2M9 (V.F., A.S., F.A., S.K., S.G.); Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada (X.L.); Thunder Bay Regional Health Research Institute, Thunder Bay, Canada (S.T., O.B., A.R.); Lakehead University, Thunder Bay, Canada (O.B., B.B., A.R.); Radialis Inc, Thunder Bay, Canada (O.B., B.B., B.K., S.P., C.A.M., M.W., K.O.O.); Institute of Biomedical Engineering, University of Toronto, Toronto, Canada (C.A.M.); and Posluns Centre for Image-Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, Toronto, Canada (C.A.M.).
Radiol Imaging Cancer. 2024 Mar;6(2):e230020. doi: 10.1148/rycan.230020.
Purpose To investigate the feasibility of low-dose positron emission mammography (PEM) concurrently to MRI to identify breast cancer and determine its local extent. Materials and Methods In this research ethics board-approved prospective study, participants newly diagnosed with breast cancer with concurrent breast MRI acquisitions were assigned independently of breast density, tumor size, and histopathologic cancer subtype to undergo low-dose PEM with up to 185 MBq of fluorine 18-labeled fluorodeoxyglucose (F-FDG). Two breast radiologists, unaware of the cancer location, reviewed PEM images taken 1 and 4 hours following F-FDG injection. Findings were correlated with histopathologic results. Detection accuracy and participant details were examined using logistic regression and summary statistics, and a comparative analysis assessed the efficacy of PEM and MRI additional lesions detection (ClinicalTrials.gov: NCT03520218). Results Twenty-five female participants (median age, 52 years; range, 32-85 years) comprised the cohort. Twenty-four of 25 (96%) cancers (19 invasive cancers and five in situ diseases) were identified with PEM from 100 sets of bilateral images, showcasing comparable performance even after 3 hours of radiotracer uptake. The median invasive cancer size was 31 mm (range, 10-120). Three additional in situ grade 2 lesions were missed at PEM. While not significant, PEM detected fewer false-positive additional lesions compared with MRI (one of six [16%] vs eight of 13 [62%]; = .14). Conclusion This study suggests the feasibility of a low-dose PEM system in helping to detect invasive breast cancer. Though large-scale clinical trials are essential to confirm these preliminary results, this study underscores the potential of this low-dose PEM system as a promising imaging tool in breast cancer diagnosis. ClinicalTrials.gov registration no. NCT03520218 Positron Emission Digital Mammography, Invasive Breast Cancer, Oncology, MRI © RSNA, 2024 See also commentary by Barreto and Rapelyea in this issue.
目的 旨在探究低剂量正电子发射型乳腺断层摄影术（PEM）与 MRI 联合应用于乳腺癌患者的可行性，以确定其病变范围。
材料与方法 在这项经研究伦理委员会批准的前瞻性研究中，新诊断为乳腺癌的患者，按纳入顺序，在接受乳腺 MRI 检查的同时，无论乳腺密度、肿瘤大小或组织病理类型如何，均接受氟-18 标记的氟代脱氧葡萄糖（F-FDG）[18 F]FDG 放射性药物剂量不超过 185MBq 的低剂量 PEM 检查。两名乳腺放射科医生在不知道癌症位置的情况下，对注射 F-FDG 后 1 小时和 4 小时进行的 PEM 图像进行了评估。将检查结果与组织病理学结果进行了相关性分析。采用逻辑回归和汇总统计方法对检测准确性和患者信息进行了评估，同时还进行了对比分析，以评估 PEM 和 MRI 对附加病变的检测效能（ClinicalTrials.gov 注册号：NCT03520218）。
结果 该研究共纳入 25 名女性患者（中位年龄 52 岁，范围 32-85 岁）。在 25 例患者的 25 对（100 套）双侧图像中，均使用 PEM 检出了 24 例（96%）癌症（19 例浸润性癌和 5 例原位癌），即使在 3 小时后放射性药物摄取时，PEM 也能获得相当的检测效能。浸润性癌的中位大小为 31mm（范围 10-120mm）。在 PEM 检查中，有 3 例 2 级原位癌漏诊。虽然差异无统计学意义，但 PEM 检出的假阳性附加病变数少于 MRI（6 例中 1 例[16%]，13 例中 8 例[62%]； =.14）。
结论 本研究提示低剂量 PEM 系统有助于发现浸润性乳腺癌，具有一定的可行性。尽管需要开展大规模临床试验来证实这些初步结果，但本研究强调了这种低剂量 PEM 系统作为一种有前途的乳腺癌诊断成像工具的潜力。ClinicalTrials.gov 注册号：NCT03520218 正电子发射型乳腺断层摄影术，浸润性乳腺癌，肿瘤学，磁共振成像 © RSNA，2024 本期亦见 Barreto 和 Rapelyea 的评论文章。
