Clinical relevance of incidental focal breast uptake on fluorine-18 fluorodeoxyglucose PET/computed tomography studies: an experience in a high-load center of Spain. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Wakfie-Corieh, Cristina Gamila; Rodríguez Rey, Cristina; Ortega Candil, Aida; Ferrando-Castagnetto, Federico; Valhondo-Rama, Raquel; Ruiz Tolón, Mercedes; Pascual Martin, Alejandro; Carreras Delgado, José Luis
• Is Part Of: Nuclear medicine communications. Volume 42:Issue 6(2021)
• Publication Date: 2021-06
• Subjects: breast incidental uptake -- breast cancer -- fluorine-18 fluorodeoxyglucose -- PET/computed tomography; Nuclear medicine -- Periodicals; 616.07575
• DOI: 10.1097/MNM.0000000000001369
• Languages: English
• ISSNs: 0143-3636

Abstract

Abstract : Aim: We aimed to determine the frequency and clinical significance of breast incidental uptake (BIU) detected through fluorine-18 fluorodeoxyglucose ( 18 F-FDG) PET/computed tomography (CT) in a single, high-load center. Patients and methods: In this retrospective study, we analyzed a total of 13 763 PET/CT studies performed from January 2017 to January 2020. After excluding 3148 scans, the maximum standardized uptake value (SUVmax) and maximum diameter (cm) of each BIU were measured. Clinical management, ultrasound/mammography and pathology reports were analyzed. Results: We found BIU in 27 scans of 26 patients (0.3% of the studies). Mean age was 62.2 years and 88.5% were women; 84.6% underwent PET/CT for oncological indications. Ultrasound/mammography was consequently performed in 23 patients (88.5%), and histological correlations were available for Breast Imaging Reporting and Data System categories 4 and 5. Finally, lesions were benign in 14 patients (60.9%; two of them with low/intermediate risk of malignancy) and malignant in nine patients (39.1%). The remaining three patients had no ultrasound/mammography reports. Mean SUVmax of benign and malignant lesions were 2.6 ± 1.4 and 5.8 ± 3.5, respectively ( P = 0.002). Considering a SUVmax cut-off value of 4.0, the sensitivity and specificity for differentiating benign vs. malignant lesions were 67 and 93%, respectively. Benign lesions were smaller than malignant in CT (maximum diameter:1.3 ± 0.5 cm vs. 2.0 ± 1.0 cm, P = 0.02). Conclusion: Although BIU detected by 18 F-FDG PET/CT is infrequently found, the risk of malignancy remains very high (39.1%). Both SUVmax and maximum diameter were greater in malignant than in benign lesions. An exhaustive study with ultrasound/mammography and selective histopathological correlation is mandatory after BIU findings, even in small lesions.