Evaluating heterogeneity of primary tumor 18F-FDG uptake in breast cancer with a dedicated breast PET (MAMMI)

Abstract

The aim of the study was to evaluate the heterogeneity of primary tumor F-fluorodeoxyglucose ((18)F-FDG) uptake in breast cancer patients using a dedicated breast PET. A positron emission tomography/computed tomography (PET/CT) of the thorax was performed 60 min after administration of 180-240 MBq of (18)F-FDG in patients with breast cancer. Subsequently, 110 min after injection, a scan was taken with a dedicated high-resolution breast PET [MAMmography with Molecular Imaging (MAMMI)]. Both procedures were performed with the patients in the prone position. Four-point scores were used to compare the intensity (0: none; 1: mild; 2: moderate; 3: high) and heterogeneity (0: none; 1: mild; 2: moderate; 3: high) of (18)F-FDG uptake between PET/CT and MAMMI images. Thirty-five patients in whom the primary tumor was visualized on both scans were included in this analysis. The mean primary tumor size was 35.1 mm (range 10-108 mm). The mean intensity score was similar on both devices (2.4 for PET/CT and 2.3 for MAMMI; P=0.439), but the mean heterogeneity score on MAMMI images was significantly higher (PET/CT 1.9 vs. MAMMI 2.3; P=0.005). MAMMI showed a higher heterogeneity score in 11 (31%) of 35 patients, especially in tumors with moderate or high intensity. Significantly higher heterogeneity scores on both PET/CT and MAMMI were seen in large tumors (P=0.005 and 0.014, respectively) and in tumors with high intensity scores (P=0.012 and P<0.001, respectively). Heterogeneous tumor (18)F-FDG uptake in breast cancer is frequently observed, particularly in large tumors with intense (18)F-FDG uptake. It is more often seen on MAMMI PET than on conventional PET/CT. Although the observed heterogeneity should be proven histopathologically, this finding offers a rationale for (18)F-FDG-guided biopsies.