Breast PETX: Mammography Machine PET Scanner with Biopsy Guidance

描述（由申请人提供）：PET在乳腺癌的管理中发挥着越来越重要的作用，特别是在表征乳腺癌和评估其对治疗的反应方面。然而，PET在乳腺癌中的临床应用在很大程度上限于局部晚期或转移性疾病，因为难以准确识别和量化较小乳腺肿瘤中的示踪剂摄取。为了克服这一局限性，其他研究者设计并测试了专用设备，以改善原发性乳腺癌检测;然而，这些设备不太适合，也不打算用于图像量化，并且通常不能使用PET信息来指导活检，这是确认PET识别的肿瘤特征所必需的。为了满足对定量成像和活检能力的需求，并出于对较小乳腺肿瘤进行表征并跟踪其对治疗反应的愿望，我们将构建并实现一种专用的高分辨率乳腺正电子发射断层扫描（PET）设备，该设备连接到传统的乳腺X射线摄影机上。PET图像和数字乳房X线摄影将在图像采集之间不移动中度压迫的乳房的情况下采集。我们提出的系统的一个关键方面是，它将是一个真正的断层成像PET设备，而不是一个正电子发射乳腺摄影（PEM）扫描仪。因此，与PEM不同，PET图像将是定量的。定量生理信息可用于研究肿瘤的生物异质性、分子标记物的摄取和对治疗的反应。所提出的系统还将容纳活检引导机构，其将允许活检针由PET图像或合并的PET-乳房X线照片图像引导。这种方法将提供更小的，早期乳腺肿瘤的定量成像，活检方向，这对于我们正在进行的乳腺癌表征和治疗反应的研究都是必要的。公共卫生相关性：该项目旨在开发一种针对分子乳腺成像进行优化的扫描仪，该扫描仪补充了乳腺X射线摄影，能够进行活检针引导，并连接到乳腺X射线摄影机上运行。该扫描仪将大大降低功能性PET乳腺癌成像的阈值，从约20 mm降至约5 mm，这将允许在疾病过程中更早地进行表征，从而为最佳治疗选择提供更多机会。该工具将有助于乳腺恶性肿瘤的复杂表征，随着乳腺癌分子途径的多样性被发现，这被证明是患者预后中越来越重要的任务。

DESCRIPTION (provided by applicant): PET plays an increasing role in the management of breast cancer, especially in characterizing breast cancer and evaluating its response to treatment. However, the clinical use of PET in breast cancer has been largely restricted to locally advanced or metastatic disease due to the difficulty of accurately identifying and quantifying tracer uptake in smaller breast tumors. To overcome this limitation, other investigators have designed and tested dedicated devices to improve primary breast cancer detection; however these devices were not well suited, nor intended, for image quantification and generally were not able to use the PET information to direct biopsy, necessary to confirm tumor features identified by PET. To address the need for quantitative imaging and biopsy capability, and motivated by the desire to characterize smaller breast tumors and follow their response to therapy, we will build and implement a dedicated high-resolution breast positron emission tomograph (PET) device that attaches to a conventional mammography machine. PET images and digital mammograms will be acquired without moving the moderately compressed breast between image acquisitions. A key aspect of our proposed system is that it will be a true tomographic imaging PET device, rather than a positron emission mammographic (PEM) scanner. Thus the PET images will be quantitative, unlike PEM. The quantitative physiological information can be used to investigate biological heterogeneity of the tumor, uptake of molecular markers, and response to treatments. The proposed system will also accommodate a biopsy guidance mechanism that will allow a biopsy needle to be guided by the PET image, or the merged PET- mammogram image. This approach will provide quantitative imaging of smaller, earlier stage breast tumors, with biopsy direction, both necessary for our ongoing studies of breast cancer characterization and response to treatment. PUBLIC HEALTH RELEVANCE: This project aims to develop a scanner optimized for molecular breast imaging that complements mammography, is capable of biopsy needle guidance, and operates attached to a mammography machine. This scanner will greatly reduce the threshold of functional PET breast cancer imaging, from around 20 mm to around 5 mm, which will allow characterization earlier in the course of the disease giving more opportunity for the best treatment selection. This tool will assist in the complex characterization of breast malignancies that is proving to be an increasingly important task in patient prognosis as the multiplicity of breast cancer molecular pathways is uncovered.