RESUMO
PURPOSE: To compare the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) and 18F-fluoroestradiol (18F-FES) positron emission tomography/computed tomography (PET/CT) for initial staging of estrogen receptor (ER) positive breast cancer. METHODS: Twenty-eight patients with ER-positive breast cancer underwent 18F-FDG and 18F-FES PET/CT for initial staging. Diagnostic performance and concordance rates were analyzed for both radiotracers. Semiquantitative parameters of maximum standardized uptake value (SUVmax) and tumor-to-normal ratio (T/N ratio) were compared using Wilcoxon signed-rank test. Factors potentially affecting the degree of radiotracer uptake were analyzed by multi-level linear regression analysis. RESULTS: The overall diagnostic performance of 18F-FES was comparable to 18F-FDG, except for higher specificity and NPV, with sensitivity, specificity, PPV, NPV, and accuracy of 87.56%, 100%, 100%, 35.14%, and 88.35%, respectively, for 18F-FES and 83.94%, 30.77%, 94.74%, 11.43%, and 95.37%, respectively, for 18F-FDG. Diagnostic performance of strong ER expression was better in 18F-FES but worse for 18F-FDG. There was a correlation of mucinous cell type and Allred score 7-8 with 18F-FES uptake, with correlation coefficients of 26.65 (19.28, 34.02), 5.90 (- 0.005, 11.81), and p-value of < 0.001, 0.05, respectively. Meanwhile, luminal B and Ki-67 were related to 18F-FDG uptake, with correlation coefficients of 2.76 (1.10, 0.20), 0.11 (0.01, 0.2), and p-value of 0.018, 0.025, respectively. CONCLUSION: Diagnostic performance of 18F-FES is comparable to 18F-FDG, but better for strongly ER-positive breast cancer. Combination of 18F-FES and 18F-FDG would potentially overcome the limitations of each tracer with more accurate staging.
RESUMO
Purpose: The aim of this study was to create and validate a normal brain template of F 18 -fluorodeoxyglucose ( F 18 - FDG ) uptake using the MIMneuro software to improve clinical practice. Approach: One hundred and nine volunteers underwent an F 18 - FDG positron emission tomography/computed tomography scan. Sixty-three participants with normal Alzheimer's disease (AD) biomarkers were used to create a template. A group of 23 participants with abnormal AD biomarkers and an additional group of 23 participants with normal AD biomarkers were used to validate the performance of the generated template. The MIMneuro software was used for the analysis and template creation. The performance of our newly created template was compared with that of the MIMneuro software template in the validation groups. Results were confirmed by visual analysis by nuclear medicine physicians. Results: Our created template provided higher sensitivity, specificity, positive predictive value, and negative predictive value (NPV; 90%, 97.83%, 100%, and 100%, respectively) than did the MIMneuro template when using the positive validation group. Similarly, slightly higher performance was observed for our template than for the MIMneuro template in the negative validation group (the highest specificity and NPV were 100% and 100%, respectively). Conclusions: Our normal brain template for F 18 - FDG was shown to be clinically useful because it enabled more accurate discrimination between aging brain and patients with AD. Thus, the template may improve the accuracy of AD diagnoses.