J Breast Cancer.  2015 Mar;18(1):73-79. 10.4048/jbc.2015.18.1.73.

Incidental Breast Lesions Identified by 18F-FDG PET/CT: Which Clinical Variables Differentiate between Benign and Malignant Breast Lesions?

Affiliations
  • 1Department of Radiology, Kyungpook National University Medical Center, Daegu, Korea. mamrad@knu.ac.kr
  • 2Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
  • 3Department of Nuclear Medicine, Kyungpook National University Medical Center, Daegu, Korea.
  • 4Department of Radiology, Kyungpook National University Hospital, Daegu, Korea.
  • 5Departments of Surgery, Kyungpook National University Medical Center, Daegu, Korea.
  • 6Departments of Pathology, Kyungpook National University Medical Center, Daegu, Korea.

Abstract

PURPOSE
The aim of our study was to evaluate the risk of malignancy and to determine which clinical variables differentiate between benign and malignant focal breast lesions found incidentally on 18F-flourodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT).
METHODS
From March 2005 to October 2011, 21,224 women with no history of breast cancer underwent FDG PET/CT at three university-affiliated hospitals. We retrospectively identified 214 patients with incidental focal hypermetabolic breast lesions and grouped them into benign and malignant lesion groups. Of the 214 patients, 82 patients with 91 lesions were included in this study. All lesions were confirmed histologically or were assessed by follow-up imaging for greater than 2 years. The patient age, maximum standardized uptake value (SUVmax), lesion size on ultrasonography (US), and Breast Imaging-Reporting and Data System (BI-RADS) category on US in conjunction with mammography were compared between the groups. Multivariate logistic regression analysis was used to identify independent factors associated with malignancy.
RESULTS
The risk of malignancy was 29.7% (27/91) in breast incidentalomas detected by FDG PET/CT. The univariate analysis showed that the patient age, SUVmax, tumor size, and BI-RADS category differed significantly between the malignant and benign groups. The multivariate analysis showed that the BI-RADS category was the only significant factor differentiating benign from malignant lesions (p=0.002).
CONCLUSION
BIRADS category based on US in conjunction with mammography was the only useful tool to differentiate between malignant and benign lesions in breast incidentalomas on FDG PET/CT.

Keyword

Breast neoplasms; Mammography; Positron-emission tomography; Ultrasonography

MeSH Terms

Breast Neoplasms
Breast*
Female
Fluorodeoxyglucose F18*
Follow-Up Studies
Humans
Information Systems
Logistic Models
Mammography
Multivariate Analysis
Positron-Emission Tomography
Positron-Emission Tomography and Computed Tomography*
Retrospective Studies
Ultrasonography
Fluorodeoxyglucose F18

Figure

  • Figure 1 Consort diagram. There were 55,762 patients who underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT) between March 2005 and October 2011. Data of 82 patients met the inclusion criteria and were used in this study.

  • Figure 2 Breast incidentaloma in a 61-year-old woman with thyroid cancer. (A) Axial 18F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT) image shows focally increased uptake (maximum standardized uptake value, 2.6) (arrow) in the right upper outer breast. (B, C) Mammography shows a focal asymmetry (arrows) with suspicious microcalcifications (arrowheads). (D) Ultrasonography (US) image shows a 1.8-cm hypoechoic mass (arrows) with microlobulated margin and an oval shape in the right upper outer breast, correlating with the focal uptake on the PET/CT scan. Final assessment of the mass on US showed that it was of category 4c. The lesion was confirmed to be an invasive ductal carcinoma by USguided core biopsy.

  • Figure 3 Breast incidentaloma in a 48-year-old woman with lymphoma. (A) Axial 18F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT) image shows focally increased uptake (maximum standardized uptake value, 5.7) (arrow) in the right upper outer breast. (B) Ultrasonography (US) image shows a 1.0-cm hypoechoic mass with circumscribed margin and an oval shape (asterisk) in the right upper outer breast, correlating with the focal uptake on the PET scan. Final assessment of the mass on US showed that it was of category 3. The lesion was confirmed to be an intraductal papilloma by excision.


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