ABSTRACT
PURPOSE: This retrospective study aimed (1) to compare the diagnostic accuracy of whole-body FDG PET/CT for initial breast cancer staging with the accuracy of a conventional, multimodal imaging algorithm, and (2) to assess potential alteration in patient management based on the FDG PET/CT findings. METHODS: Patients with primary breast cancer (106 women, mean age 57 ± 13 years) underwent whole-body FDG PET/CT and conventional imaging (X-ray mammography, MR mammography, chest plain radiography, bone scintigraphy and breast, axillary and liver ultrasonography). The diagnostic accuracies of FDG PET/CT and a conventional algorithm were compared. Diagnostic accuracy was assessed in terms of primary tumour detection rate, correct assessment of primary lesion focality, T stage and the detection rates for lymph node and distant metastases. Histopathology, imaging or clinical follow-up served as the standards of reference. RESULTS: FDG PET/CT was significantly more accurate for detecting axillary lymph node and distant metastases (p = 0.0125 and p < 0.005, respectively). No significant differences were detected for other parameters. Synchronous tumours or locoregional extraaxillary lymph node or distant metastases were detected in 14 patients (13%) solely by FDG PET/CT. Management of 15 patients (14%) was altered based on the FDG PET/CT findings, including 3 patients with axillary lymph node metastases, 5 patients with extraaxillary lymph node metastases, 4 patients with distant metastases and 3 patients with synchronous malignancies. CONCLUSION: Full-dose, intravenous contrast-enhanced FDG PET/CT was more accurate than conventional imaging for initial breast cancer staging due to the higher detection rate of metastases and synchronous tumours, although the study had several limitations including a retrospective design, a possible selection bias and a relevant false-positive rate for the detection of axillary lymph node metastases. FDG PET/CT resulted in a change of treatment in a substantial proportion of patients.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Fluorodeoxyglucose F18 , Multimodal Imaging , Positron-Emission Tomography , Tomography, X-Ray Computed , Whole Body Imaging , Adult , Aged , Aged, 80 and over , Algorithms , Breast Neoplasms/therapy , Female , Humans , Middle Aged , Neoplasm Metastasis , Neoplasm Staging , Retrospective Studies , Sensitivity and SpecificityABSTRACT
OBJECTIVE: Evaluation of the diagnostic quality of high-resolution B-mode sonography for the detection of microcalcifications and calcification-associated focal findings in patients with BI-RADS lesions of subtype 4a. PATIENTS AND METHODS: 40 patients underwent X-ray mammography and 13-MHz B-mode sonography. The following parameters were examined: with X-ray mammography: extent of microcalcification and visibility of associated focal areas; with ultrasound: sensitivity of microcalcification findings, quality of presentation, extent of microcalcification, visibility of associated focal areas and feasibility of ultrasound-assisted biopsy. RESULTS: X-ray mammography showed a mean extent of microcalcification of 28 8 21 mm. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and accuracy of microcalcification-associated focal findings were 61.5, 57.9, 50, 45.8 and 47.5%. B-mode sonography achieved a sensitivity of 100%. Sonographically, the mean extent of microcalcification was 7 +/- 3 mm and thus significantly smaller (p < 0.01). Sensitivity, specificity, PPV, NPV and accuracy were 14.3, 84.2, 50, 47.1 and 47.5%. Ultrasound-assisted biopsy appeared feasible in 22 patients (55%). CONCLUSION: High-frequency B-mode sonography allows a highly sensitive confirmation of microcalcifications in the case of BI-RADS 4a lesions and seems to allow ultrasound-assisted biopsy in about half the patients.
Subject(s)
Breast Neoplasms/diagnosis , Calcinosis/diagnostic imaging , Carcinoma, Ductal/diagnosis , Carcinoma, Intraductal, Noninfiltrating/diagnosis , Carcinoma, Lobular/diagnosis , Mammography , Neoplasms, Multiple Primary/diagnosis , Ultrasonography, Mammary/methods , Aged , Biopsy, Needle , Breast/pathology , Breast Diseases/diagnosis , Breast Diseases/pathology , Breast Neoplasms/pathology , Carcinoma, Ductal/pathology , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Lobular/pathology , Female , Humans , Mass Screening , Middle Aged , Neoplasm Staging , Neoplasms, Multiple Primary/pathology , Sensitivity and Specificity , Ultrasonography, InterventionalABSTRACT
BACKGROUND: In the last few years, the therapy of cervical carcinoma has progressed substantially due to the use of simultaneous platinum- containing radiochemotherapy. However, there are no data which evaluate an individualized treatment adapted to tumor biology, in spite of the fact that patients show remarkably different responses to chemotherapy. Therefore this preclinical phase I study aims at finding therapeutic alternatives to the current cytostatic drugs to treat cervical carcinoma. MATERIAL AND METHODS: In a tumor chemosensitivity assay, 8 drugs were tested on freshly isolated tumor cells of 16 patients [carbo- and cisplatin, topotecan, paclitaxel as well as the 2 tyrosine kinase inhibitors imatinib (Glivec) and gefitinib (Iressa (R) ) and the 2 monoclonal antibodies cetuximab (Erbitux) and trastuzumab (Herceptin (R) )]. RESULTS: Overall the test was evaluable for 16 specimens (100%). Ten of 15 tumor samples (66.6%) were sensitive to imatinib. A sensitive therapeutic response could be demonstrated in all tested FIGO stages. An interindividual comparison could establish sensitivity to cetuximab in 12.5% of cases, to gefitinib in 6.25%, to trastuzumab in 6.6%, to cisplatin in 13.3%, to carboplatin in 7.6%, to paclitaxel in 93.8% and to topotecan in 25%. CONCLUSION: Imatinib seems to be an efficacious therapeutic option for patients with cervical carcinoma, independently of tumor subtype.