J Breast Cancer.  2015 Mar;18(1):63-72. 10.4048/jbc.2015.18.1.63.

Effectiveness of Breast MRI and 18F-FDG PET/CT for the Preoperative Staging of Invasive Lobular Carcinoma versus Ductal Carcinoma

• Jung NY
• Kim SH
• Kim SH
• Seo YY
• Oh JK
• Choi HS
• You WJ

• KMID: 2286339
• DOI: http://doi.org/10.4048/jbc.2015.18.1.63

Abstract

PURPOSE
We evaluated the utility of magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for the preoperative staging of invasive lobular carcinoma (ILC) of the breast and compared the results with those of invasive ductal carcinoma (IDC).
METHODS
The study included pathologically proven 32 ILCs and 73 IDCs. We compared clinical and histopathological characteristics and the diagnostic performances of MRI and 18F-FDG PET/CT for the primary mass, additional ipsilateral and/or contralateral lesion(s), and axillary lymph node metastasis between the ILC and IDC groups.
RESULTS
Primary ILCs were greater in size, but demonstrated lower maximum standardized uptake values than IDCs. All primary masses were detected on MRI. The detection rate for ILCs (75.0%) was lower than that for IDCs (83.6%) on 18F-FDG PET/CT, but the difference was not significant. For additional ipsilateral lesion(s), the sensitivities and specificities of MRI were 87.5% and 58.3% for ILC and 100.0% and 66.7% for IDC, respectively; whereas the sensitivities and specificities of 18F-FDG PET/CT were 0% and 91.7% for ILC and 37.5% and 94.7% for IDC, respectively. The sensitivity of 18F-FDG PET/CT for ipsilateral lesion(s) was significantly lower in the ILC group than the IDC group. The sensitivity for ipsilateral lesion(s) was significantly higher with MRI; however, specificity was higher with 18F-FDG PET/CT in both tumor groups. There was no significant difference in the diagnostic performance for additional contralateral lesion(s) or axillary lymph node metastasis on MRI or 18F-FDG PET/CT for ILC versus IDC.
CONCLUSION
The MRI and 18F-FDG PET/CT detection rates for the primary cancer do not differ between the ILC and IDC groups. Although 18F-FDG PET/CT demonstrates lower sensitivity for primary and additional ipsilateral lesions, it shows higher specificity for additional ipsilateral lesions, and could play a complementary role in the staging of ILC as well as IDC.

Keyword

18F-fluorodeoxyglucose positron emission tomography/computed tomography; Breast; Ductal carcinoma; Lobular carcinoma; Magnetic resonance imaging

MeSH Terms

Breast*
Carcinoma, Ductal*
Carcinoma, Lobular*
Electrons
Fluorodeoxyglucose F18*
Lymph Nodes
Magnetic Resonance Imaging*
Neoplasm Metastasis
Positron-Emission Tomography and Computed Tomography*
Sensitivity and Specificity
Fluorodeoxyglucose F18

Figure

• 

  Figure 1 A 40-year-old female with invasive lobular carcinoma with a low maximum standardized uptake value (SUVmax). (A) Axial contrast-enhanced magnetic resonance imaging shows a heterogeneously enhanced irregular mass with irregular margin (arrow) at right mid outer breast. Axial 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) fusion image (B) and PET-only image (C) show focal mild FDG uptake (arrows) in the right outer breast with a SUVmax measured at 1.0. The lesion was categorized as positive for a primary mass by visual assessment.

• 

  Figure 2 A 45-year-old female with invasive lobular carcinoma (ILC) with a false-positive ipsilateral lesion on magnetic resonance imaging (MRI). (A) Axial postcontrast MRI at the nipple level shows a heterogeneously enhancing mass (circle) in the right mid outer breast. (B) Axial postcontrast MRI at the level of 1.5 cm cranial to the nipple shows an additional smaller enhancing mass (circle) at the right upper outer breast. (C) Kinetic curve obtained at the mass in the right upper outer breast (in Figure 2B) shows early rapid enhancement and a delayed washout pattern. (D-G) Axial 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) fusion image and PETonly image at the nipple level (D, E) show ill-defined mild focal FDG uptake (arrows) in the right mid outer breast with maximum standardized uptake value measured at 2.1, with no additional FDG uptake cranially (F, G). After a wide excision with ultrasonographically guided wire localization, the primary mass was confirmed as ILC, but the additional lesion was confirmed as lobular carcinoma in situ.

• 

  Figure 3 A 44-year-old female with invasive ductal carcinoma (IDC) with an additional ipsilateral lesion with true-positive on magnetic resonance imaging (MRI) and false-negative on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). (A) Axial contrast enhanced MRI shows a heterogeneously enhancing irregular mass with irregular margin (arrow) at right mid outer breast. Additionally, a smaller heterogeneously enhancing lesion was visible at right outer periareolar region (arrowhead). (B) Axial 18F-FDG PET/CT fusion image demonstrates strong FDG uptake (arrow) on primary tumor with a maximum standardized uptake value measured at 6.9. But no additional ipsilateral lesion on right outer periareolar region on 18F-FDG PET/CT fusion images at the level of primary mass (B) and nipple level (C). After breast-conserving surgery, the primary lesion was confirmed as IDC, and the additional lesion was confirmed as ductal carcinoma in situ.

• 

  Figure 4 A 48-year-old female with invasive lobular carcinoma in the left breast with a contralateral invasive ductal carcinoma in the right breast. (A) Axial postcontrast magnetic resonance imaging (MRI) at the left nipple level shows an indistinct irregular heterogeneously enhancing mass (arrow) in the left mid outer breast. (B) Axial postcontrast MRI of the right upper breast shows another indistinct irregular heterogeneously enhancing mass (arrow) in the right upper outer breast. (C) 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the left mid outer breast shows little FDG uptake (arrow) in the corresponding area of the left breast mass. (D) 18F-FDG PET/CT shows ill-defined focal FDG uptake (arrow) in the right upper outer breast with a maximum standardized uptake value measured at 2.5.

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