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Metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging according to primary tumor uptake and background parenchymal enhancement

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Abstract

Objective

This study was aimed at investigating metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging (DTPI) according to primary tumor uptake and determining whether this technique is affected by background parenchymal enhancement (BPE).

Methods

A total of 189 patients with newly diagnosed breast cancer who underwent DTPI examination were retrospectively evaluated. DTPI was performed using a standard FDG/PET protocol followed by delayed image acquisition at 120 min after injection. Patients were divided into two groups according to primary tumor uptake as breast cancer with low maximum standard uptake value (SUVmax) (< 2.5) and high SUVmax (≥ 2.5). The maximal SUV of the primary breast tumor (T-SUVmax), contralateral breast parenchyma uptake (B-SUVmax) according to different BPE grades, tumor to background ratio (T/B-SUVmax), and their percentage changes between early and delayed images (retention index, RI) were calculated.

Results

For primary tumor uptake, tumors with high SUV had a significant increase in mean T-SUVmax between early and delayed images (8.17 vs. 9.16, P < 0.001), and %RI T-SUVmax was 10.52%. Conversely, mean T-SUVmax did not change between early and delayed images for tumors with low SUV (1.96 vs. 1.94, P = 0.610), and %RI T-SUVmax was − 1.41%. The mean %RI B-SUVmax was − 12.43% for minimal BPE, − 14.19% for mild BPE, − 19.49% for moderate BPE, and − 21.25% for marked BPE grade, indicating that higher BPE grades undergo better washouts on delayed imaging (β = − 3.220, P < 0.001 for trend). The %RI T/B-SUVmax of both breast cancer groups with low SUV and high SUV was 18.86% and 32.47%, respectively.

Conclusions

Breast cancer with low SUV undergoes no significant change in SUV on DTPI; however, washing of background parenchymal activity was evident over time, resulting in significantly increased tumor contrast in delayed images, which leads to increased sensitivity. Breast parenchymal washout was more significant with increased BPE level. Therefore, DTPI is expected to be more useful for evaluating breast lesions in regions with marked BPE on MRI.

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Acknowledgements

No potential conflicts of interest were disclosed. We would like to thank Hye Ah Lee, professor of statistics at the Clinical Trial Center, Ewha Womans University, for advising the statistical analysis.

Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (2018R1D1A1B07049400, Hai-Jeon Yoon; 2018R1D1A1B07045321, Bom Sahn Kim).

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Author notes

  1. Bom Sahn Kim and Hai-Jeon Yoon contributed equally to the study.

Authors and Affiliations

  1. Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Anyangcheon-ro, Yangcheon-gu, (07985) 1071, Seoul, Republic of Korea

    Hye Ok Kim, Bom Sahn Kim, Seo Young Kang & Hai-Jeon Yoon

  2. Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea

    Ji-In Bang

  3. Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Republic of Korea

    Jeongshin An

  4. Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea

    Jeoung Hyun Kim

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Kim, H.O., Kim, B.S., Kang, S.Y. et al. Metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging according to primary tumor uptake and background parenchymal enhancement. Ann Nucl Med 34, 942–951 (2020). https://doi.org/10.1007/s12149-020-01525-z

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