Keywords:
Breast, Hybrid Imaging, Oncology, PET-CT, Cost-effectiveness, Molecular imaging, Cancer
Authors:
B. Raghavan1, S. Viswanathan1, G. SIVARAMALINGAM2, S. Singh1, R. Baburaj1, B. Ramakrishnan1; 1Chennai/IN, 2CHENNAI, tamilnadu/IN
DOI:
10.26044/ecr2019/C-2805
Methods and materials
Patient population: In this prospective study,
177 consecutive women (ages 26-82,
mean age 54) with unilateral operable early breast cancer were included between December 2015 and December 2018.
Inclusion criteria :
- Women above 18 yrs of age.
- Stage I and II breast cancer diseases which include lesions =<5cm with or without mobile axillary lymph node.
- Patients who are biopsy and clinically proven to be unilateral operable breast cancer disease without any suspicion of distant metastases.
Exclusion criteria:
- History of breast surgery,
chemotherapy,
radiotherapy or any oncologic treatment.
- Clinically detected distant metastases.
- Recurrent or bilateral breast cancer patients.
Data acquisition: Prior fasting for at least 6 hours to attain blood glucose level less than 150 mg/dl was recommended.
Each patient underwent a whole-body PET-CT imaging using a combined 64 slice PET-CT scanner after intravenously injecting these patients with 5mCi (3-5MBq/Kg) of 18F-FDG.
Spiral CT was acquired first in a cranio-caudal direction with 200–360 mAs and 90–120 kVp.
Then,
PET scan was performed in a reverse direction.
The scanning time was about 10-12 minutes for both the CT and PET.
Delayed CT and PET images were taken after 3-4 hours if indicated.
Data Analysis: Initially the CT images were analyzed independently by experienced radiologists and then PET images were analyzed independently by nuclear medicine physicians; following that combined PET-CT report was prepared and images were reviewed by the principal investigator for the study.
TNM staging was determined and final staging was assigned.
After which the utility of PET-CT was analysed depending on presence or absence of upgradation.
HPE analysis: Histopathological analysis and immunohistochemistry studies of the upgraded cases were done and classified into the molecular subtypes by the Pathology Department of our hospital.
Statistical analysis: All the continous variables were represented by mean standard deviation. All the categorical variables were represented by %. Comparison of continous variables was done by independent sample t test.
Comparison of categorical variables was done by either Chisquare test or Fischer exact test.
In addition to this,
the SUVmax value was correlated with the clinical and pathological features using univariate regression analysis by the statistician at our hospital and multiple linear regression analysis was also done to determine which variables were independently associated with SUVmax.