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Positron Emission Mammography May Find Breast Cancers at Earliest Stages

January 8, 2008
Written by: , Filed in: Breast Imaging
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From Positron Mammography.
C. Richard Goldfarb, MD, Special Presentation for Oakstone Medical Publishing and Practical Reviews in Radiology.
MRI is a primary adjunct to x-ray mammography and ultrasound in the workup of breast cancer. Cost of implementation, difficulty in interpretation, patient time and discomfort, and higher false-positive rates are serious limitations to MRI.
Alternatives are being sought, including scintimammography.
Positron emission mammography (PEM) involves high-resolution organ-specific PET scanners. It is most useful in staging women already diagnosed with breast cancer.
Like breast-specific gamma imaging (BSGI), it has high resolution, sensitivity, and specificity. Naviscan PET systems have developed organ-specific PET devices to image breast cancer with resolution capabilities of 1.5 to 2 mm, the best offered by any imaging modality.
The resolution enables the imaging of ductal carcinoma in situ, which is almost impossible with mammography, breast MRI, and other modalities. PEM resolution is in the range of ductal size. Currently, PEM is purely investigational.
Image acquisition is similar to mammography: breasts are imaged in the same projections as standard mammography, easing comparison from one imaging study to another.
The procedure is patient-friendly and takes <1 hour. The breasts are immobilized, but only slight compression is required. Also, PEM is a seated open examination, in contrast to MRI. PEM's advantages over conventional mammography include high resolution, improved specificity and sensitivity, and fewer false-positives. Results.
Efficient follow-up by whole-body PET allows two examinations with one injection, to exclude or reveal metastatic disease with relatively easy interpretation. With only 48 images (versus more with MRI), PEM is easy to implement, not needing a dedicated room as is needed with MRI.
It’s also easier to interpret than breast MRI images. Shilling and colleagues from Boca Raton compared breast PEM to breast MRI and whole-body PET in preoperative staging with recently diagnosed breast cancer.
The study, reported at this year’s meeting of the Society of Nuclear Medicine, showed that PEM was comparable to breast MRI and better than whole-body PET for preoperative surgical planning.
PEM resulted in fewer false-positive findings and was as sensitive in identifying breast cancer as breast MRI with better specificity. Also, PEM identifies areas of atypia better than breast MRI, which may assist in evaluating high-risk (BRCA1) patients.
By identifying areas of atypia, patients can have prophylactic medical or surgical therapies, so PEM could become an important tool to find the cancers at the earliest stages. In a center with a high-risk clinic, PEM may play a significant role.

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