J Korean Soc Radiol.  2010 May;62(5):491-496. 10.3348/jksr.2010.62.5.491.

Radio-Clinico-Pathologic Factors of False Negative 18F-FDG PET/CT Results in the Diagnosis of Breast Cancer

• Kim DK
• Choo KS
• Kim SJ
• Bae YT
• Lee SH

• KMID: 2002959
• DOI: http://doi.org/10.3348/jksr.2010.62.5.491

Abstract

PURPOSE
To identify radio-clinico-pathologic factors that result in false negative FDG uptake on 18F-FDG -PET/CT in the diagnosis of breast cancer.
MATERIALS AND METHODS
We retrospectively reviewed a total of 140 breast lesions in 140 patients (mean age: 51.3 years) who underwent PET/CT for the staging of breast cancer from May 2007 to January 2008. All patients were divided as false negative (group 1, n=20) or true positive (group 2, n=120). A retrospective analysis was performed to analyze the statistical differences in clinico-pathologic factors between groups 1 and 2 using the Mann-Whitney U test, as well as the stepwise logistic regression analysis and the Chi-squared or Fisher's exact test.
RESULTS
Estrogen receptor positivity, mass on mammography, carcinoma in situ, and size were significantly different between groups 1 and 2 (p < 0.05). A stepwise logistic regression analysis showed that the estrogen receptor positivity (odds ratio, 5.623; 95% confidence interval: 1.100, 28.746; p = 0.021) and carcinoma in situ (odds ratio, 6.900; 95% confidence interval: 1.151, 41.361; p = 0.026) were significant clinico-pathology variables associated with false negative PET/CT findings.
CONCLUSION
Estrogen receptor positivity and carcinoma in situ may be helpful in the possible explanation of false negative PET/CT results in the diagnosis of breast cancer.

MeSH Terms

Breast
Breast Neoplasms
Carcinoma in Situ
Estrogens
Fluorodeoxyglucose F18
Humans
Logistic Models
Mammography
Retrospective Studies
Estrogens
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 Breast images of a 54-year-old woman with a 12 mm invasive ductal carcinoma in the right breast were not seen on 18F-FDG-PET/CT. The estrogen receptor was found to be positive. A. Bilateral craniocaudal (right) and mediolateral oblique (left) mammograms showed a round mass with a spiculated margin in the right upper outer quadrant (arrow). B. 18F-FDG PET/CT showed no abnormally elevated FDG uptake rate for both breasts.

• 

  Fig. 2 Breast images of a 34-year-old woman with 9 mm carcinoma in situ in the left breast was not seen on 18F-FDG PET/CT. The estrogen receptor was negative. A. Bilateral craniocaudal (right) and mediolateral oblique (left) mammograms show clustered pleomorphic microcalcifications in upper outer quadrant of the left breast (arrow). B. 18F-FDG PET/CT showed no abnormally elevated FDG uptake rate in both breasts.

• 

  Fig. 3 Breast images of a 45-year-old woman with 42 mm invasive ductal carcinoma in the right breast was seen on 18F-FDG PET/CT. The estrogen receptor was found to be negative. A. Bilateral craniocaudal (right) and mediolateral oblique (left) mammograms showed an irregular-shaped mass with a partially indistinct margin in the subareolar region of the right breast (arrow). B. 18F-FDG PET/CT showed an abnormal increase in FDG uptake in the upper region of the right breast. The maximum standardized uptake value was 5.2.

• 

  Fig. 4 Breast images of a 42-year-old woman with 35 mm invasive ductal carcinoma of the right breast was not seen on 18F-FDG PET/CT. The estrogen receptor was found to be positive. A. Bilateral craniocaudal (right) and mediolateral oblique (left) mammograms showed an oval-shaped mass with a partially indistinct margin in the subareolar region of the right breast (arrow). B. 18F-FDG PET/CT showed no abnormally elevated FDG uptake rate in both breasts.

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