Abstract

Breast positron emission tomography (PET) has had insurance coverage when performed with conventional whole-body PET in Japan since 2013. Together with whole-body PET, accurate examination of breast cancer and diagnosis of metastatic disease are possible, and are expected to contribute significantly to its treatment planning. To facilitate a safer, smoother, and more appropriate examination, the Japanese Society of Nuclear Medicine published the first edition of practice guidelines for high-resolution breast PET in 2013. Subsequently, new types of breast PET have been developed and their clinical usefulness clarified. Therefore, the guidelines for breast PET were revised in 2019. This article updates readers as to what is new in the second edition. This edition supports two different types of breast PET depending on the placement of the detector: the opposite-type (positron emission mammography; PEM) and the ring-shaped type (dedicated breast PET; dbPET), providing an overview of these scanners and appropriate imaging methods, their clinical applications, and future prospects. The name “dedicated breast PET” from the first edition is widely used to refer to ring-shaped type breast PET. In this edition, “breast PET” has been defined as a term that refers to both opposite- and ring-shaped devices. Up-to-date breast PET practice guidelines would help provide useful information for evidence-based breast imaging.

Highlights

  • This article updates readers as to what is new in the second edition. This edition supports two different types of breast positron emission tomography (PET) depending on the placement of the detector: the opposite-type and the ring-shaped type, providing an overview of these scanners and appropriate imaging methods, their clinical applications, and future prospects

  • The name “dedicated breast PET” from the first edition is widely used to refer to ring-shaped type breast PET

  • High-resolution breast positron emission tomography imaging is a diagnostic imaging method with a PET scanner that has been specially designed for breast imaging

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Summary

Introduction

High-resolution breast positron emission tomography (breast PET) imaging is a diagnostic imaging method with a PET scanner that has been specially designed for breast imaging. The FDG-PET examination has been covered by public health insurance since 2002 as a diagnostic imaging modality for 12 types of cancer, including breast cancer. Conventional whole-body PET demonstrates low sensitivity for small breast cancers of diameters of up to 1 cm This may be due to the limited spatial resolution of wholebody PET devices, the decreased detectability of supine imaging due to respiratory movement, and the physiological FDG uptake in mammary glands. PET/CT is not recommended as a preoperative diagnostic exam for stage I and II breast cancers In these cases, since the possibility of metastasis is low, the disadvantages of PET/CT (exposure, cost) may outweigh the benefits (detection of metastasis). Radiation waste disposal Follow the standards of whole-body PET examination

Education and training of radiation workers
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Structural and installation criteria
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