Breast Cancer: Comparative Effectiveness of Positron Emission Mammography and MR Imaging in Presurgical Planning for the Ipsilateral Breast
Breast Cancer: Comparative Effectiveness of Positron Emission Mammography and MR Imaging in Presurgical Planning for the Ipsilateral Breast
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DOI：
10.1148/radiol.10100454
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发表时间：
2011-01-01
期刊：
影响因子：
19.7
通讯作者：
Kalinyak, Judith E.
中科院分区：
文献类型：
--
作者：
Berg, Wendie A.;Madsen, Kathleen S.;Kalinyak, Judith E.
目的：确定正电子发射乳腺X线摄影（PEM）与磁共振（MR）成像相比在患癌同侧乳腺中的性能，包括对手术治疗的影响。材料和方法：2006年9月至2008年11月，472名接受保乳手术的新诊断乳腺癌妇女同意参加一个多中心机构审查委员会-批准的符合HIPAA的协议。受试者随机接受对比剂增强MR成像和氟18氟脱氧葡萄糖PEM检查，结果图像独立解读。增加活检和改变同侧乳房手术与组织病理学结果。通过使用McNemar检验和广义估计方程比较性能特征。结果：388名女性（中位年龄，58岁;年龄范围，26-93岁;中位估计肿瘤大小，1.5厘米）完成了研究。在82例（21%）女性中发现了其他癌症（82例同侧乳房;肿瘤大小中位数为0.7 cm）。82个乳房中有28个（34%）通过PEM和MR成像进行了识别; 21个（26%）乳房仅通过MR成像进行了识别; 14个（17%）乳房仅通过PEM进行了识别; 7个（8.5%）乳房通过乳房X线摄影和超声检查进行了识别。12例（15%）额外癌症病例在所有影像学检查中均被遗漏。PEM和MR成像的结合增加了82个乳房中61个（74%）的癌症检测，而单独使用MR成像的82个乳房中有49个（60%）（P <0.001）。在306例无其他癌症的乳腺中，279例（91.2%）通过PEM正确评估，而264例（86.3%）通过MR成像正确评估（P = 0.03）。PEM结果提示活检的阳性预测值（71例中的47例[66%]）高于MR结果提示活检的阳性预测值（116例中的61例[53%]）（P = 0.016）。在另外116例癌症中，61例（53%）通过MR成像描述，47例（41%）通过PEM描述（P = 0.043）。388例女性中有五十六例（14%）需要乳房切除术：其中40例（71%）通过MR成像确定，20例（36%）通过PEM确定（P，0.001）。11名（2.8%）妇女进行了不必要的乳房切除术，这是提示只有MR结果在5名妇女，只有PEM结果在一个，PEM和MR结果在五个。33（8.5%）妇女需要更广泛的切除：24（73%），这些妇女被确定与MR成像，22（67%）被确定与PEM。结论：PEM和MR成像具有可比的乳房水平的敏感性，虽然MR成像有更大的病变水平的敏感性，更准确地描述了乳房切除术的需要。PEM在乳腺和病变水平具有更高的特异性。89例（23%）参与者需要更广泛的手术：其中61例（69%）通过MR成像确定，41例（46%）通过PEM确定（P = 0.003）。14名（3.6%）女性仅在PEM处观察到肿瘤。(C)RSNA，2010年
Purpose: To determine the performance of positron emission mammography (PEM), as compared with magnetic resonance (MR) imaging, including the effect on surgical management, in ipsilateral breasts with cancer.Materials and Methods: Four hundred seventy-two women with newly diagnosed breast cancer who were offered breast-conserving surgery consented from September 2006 to November 2008 to participate in a multicenter institutional review board-approved, HIPAA-compliant protocol. Participants underwent contrast material-enhanced MR imaging and fluorine 18 fluorodeoxyglucose PEM in randomized order; resultant images were interpreted independently. Added biopsies and changes in surgical procedure for the ipsilateral breast were correlated with histopathologic findings. Performance characteristics were compared by using the McNemar test and generalized estimating equations.Results: Three hundred eighty-eight women (median age, 58 years; age range, 26-93 years; median estimated tumor size, 1.5 cm) completed the study. Additional cancers were found in 82 (21%) women (82 ipsilateral breasts; median tumor size, 0.7 cm). Twenty-eight (34%) of the 82 breasts were identified with both PEM and MR imaging; 21 (26%) breasts, with MR imaging only; 14 (17%) breasts, with PEM only; and seven (8.5%) breasts, with mammography and ultrasonography. Twelve (15%) cases of additional cancer were missed at all imaging examinations. Integration of PEM and MR imaging increased cancer detection-to 61 (74%) of 82 breasts versus 49 (60%) of 82 breasts identified with MR imaging alone (P < .001). Of 306 breasts without additional cancer, 279 (91.2%) were correctly assessed with PEM compared with 264 (86.3%) that were correctly assessed with MR imaging (P = .03). The positive predictive value of biopsy prompted by PEM findings (47 [66%] of 71 cases) was higher than that of biopsy prompted by MR findings (61 [53%] of 116 cases) (P = .016). Of 116 additional cancers, 61 (53%) were depicted by MR imaging and 47 (41%) were depicted by PEM (P = .043). Fifty-six (14%) of the 388 women required mastectomy: 40 (71%) of these women were identified with MR imaging, and 20 (36%) were identified with PEM (P,.001). Eleven (2.8%) women underwent unnecessary mastectomy, which was prompted by only MR findings in five women, by only PEM findings in one, and by PEM and MR findings in five. Thirty-three (8.5%) women required wider excision: 24 (73%) of these women were identified with MR imaging, and 22 (67%) were identified with PEM.Conclusion: PEM and MR imaging had comparable breast-level sensitivity, although MR imaging had greater lesion-level sensitivity and more accurately depicted the need for mastectomy. PEM had greater specificity at the breast and lesion levels. Eighty-nine (23%) participants required more extensive surgery: 61 (69%) of these women were identified with MR imaging, and 41 (46%) were identified with PEM (P = .003). Fourteen (3.6%) women had tumors seen only at PEM. (C) RSNA, 2010