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Can dedicated breast PET help to reduce overdiagnosis and overtreatment by differentiating between indolent and potentially aggressive ductal carcinoma in situ?

  • Molecular Imaging
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To analyze the utility of metabolic imaging, and specifically of dedicated breast positron emission tomography (dbPET) to differentiate between indolent and potentially aggressive ductal carcinoma in situ (DCIS).

Methods

After institutional review board approval, we retrospectively reviewed the cases of pure DCIS who underwent dbPET before biopsy and surgery in Lucus Augusti Universitary Hospital (Lugo, Spain) and in Fudan Cancer Institute (Shanghai, China) between January 2016 and May 2018. Grade 1 and “non-comedo” grade 2 DCIS were considered low-risk disease, while intermediate-grade with necrosis or grade 3 cases were included in the high-risk group. DbPET sensitivity and specificity to differentiate between indolent and potentially aggressive DCIS were determined along with their respective 95% confidence intervals.

Results

We enrolled 139 surgery-confirmed pure DCIS cases. Fifty were high-risk neoplasms and 89 low-risk DCIS. Only seven low-risk lesions were positive at dbPET and five of potentially aggressive neoplasms did not show FDG uptake, all included into the field of view (FOV). Sensitivity and specificity of dbPET to differentiate between indolent and potentially aggressive DCIS were 90% (95% CI, 77–96%) and 92% (95% CI, 84–97%), respectively.

Conclusion

Metabolic imaging could help to identify the subgroup of indolent lesions from those potentially aggressive ones that may be managed by active surveillance.

Key Points

• Low- and high-grade DCIS likely arise from two distinct evolutionary paths and when low-grade lesions progress to invasive cancer, the tumor is frequently low grade and well differentiated.

• Ongoing clinical trials evaluate whether patients with low-risk DCIS could be safely managed by an active surveillance approach, with avoidance of unnecessary treatments and without impact on ipsilateral invasive breast cancer free survival time.

• Dedicated breast PET may differentiate harmless from potentially hazardous DCIS, supporting active surveillance for the management of those women with low-grade DCIS, decreasing the rate of the upgrade to invasive carcinoma at surgical excision.

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Abbreviations

18F-FDG:

18F-fluorodeoxyglucose

3D:

Three-dimensional

BC:

Breast cancer

CI:

Confidence interval

dbPET:

Dedicated breast PET

DCE:

Dynamic contrast-enhanced

DCIS:

Ductal carcinoma in situ

ER:

Estrogen receptor

FN:

False negative

FOV:

Field of view

FP:

False positive

FSPGR:

Fast spoiled gradient

GLUT:

Glucose transporter

HER2:

Human epidermal growth factor receptor 2

IBC:

Invasive breast cancer

MAMMI:

Mammography with molecular imaging

MRI:

Magnetic resonance imaging

NCCN:

National Comprehensive Cancer Network

PEM:

Positron emission mammography

PR:

Progesterone receptor

SD:

Standard deviation

SGLT:

Sodium-coupled glucose transporter

STIR:

Short-tau inversion recovery

SUV:

Standardized uptake value

US:

Ultrasound

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Radiology Department, Hospital Universitario Lucus Augusti Lugo, Ulises Romero 1, 27003, Lugo, Spain

    Lucía Graña-López, Michel Herranz, Ángeles Villares & Manuel Vázquez-Caruncho

  2. Breast Pathology Group, Hospital Universitario Lucus Augusti-IDIS, Ulises Romero 1, 27003, Lugo, Spain

    Lucía Graña-López, Michel Herranz, Ángeles Villares & Manuel Vázquez-Caruncho

  3. Nuclear Medicine Department, Complexo Hospitalario Universitario de Santiago de Compostela Travesíca Choupana s/n, 15706, Santiago de Compostela, Spain

    Michel Herranz, Inés Domínguez-Prado & Sonia Argibay

Authors
  1. Lucía Graña-López
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  4. Sonia Argibay
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  5. Ángeles Villares
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  6. Manuel Vázquez-Caruncho
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Corresponding author

Correspondence to Lucía Graña-López.

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Guarantor

The scientific guarantor of this publication is Dr. Manuel Vázquez-Caruncho.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all Spanish subjects (patients) in this study.

For the Chinese women, informed consent was waived because this is a retrospective review of a patient database and no changes on their standard of care were made.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

None study subjects or cohorts have been previously reported.

Methodology

• Retrospective

• Observational

• Multicenter study

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Graña-López, L., Herranz, M., Domínguez-Prado, I. et al. Can dedicated breast PET help to reduce overdiagnosis and overtreatment by differentiating between indolent and potentially aggressive ductal carcinoma in situ?. Eur Radiol 30, 514–522 (2020). https://doi.org/10.1007/s00330-019-06356-9

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  • DOI: https://doi.org/10.1007/s00330-019-06356-9

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