Combining Multiple Imaging Approaches Can Better Distinguish Malignant and Benign Breast Tumors and Reduce Unnecessary Biopsies
A new study found that an imaging technique called multiparametric 18fluorodeoxyglucose positron-emission tomography magnetic resonance imaging (18FDG PET-MRI), which combines four imaging approaches, can better distinguish malignant breast tumors from those that are benign, compared with imaging techniques using fewer approaches. The findings may help reduce unnecessary breast biopsies. The study by Pinker et al is published in Clinical Cancer Research.
The four parameters that the new imaging approach uses are dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging, three-dimensional proton MR spectroscopic imaging, and 18FDG-PET.
Study Methodology
The study included 76 female patients in the study (mean age = 55.7) who had an imaging abnormality from a mammogram or a breast ultrasonography. The researchers performed an multiparametric 18FDG PET-MRI on all the patients, and patients’ breast tumor biopsies were evaluated by histopathology. To determine the combination of imaging parameters that would yield the most accurate results, the researchers combined the imaging data from two parameters, three parameters, and all four parameters. All two- and three-parameter evaluations included DCE-MRI.
The results were compared with histopathology diagnosis to evaluate which combination was the most efficient in making an accurate diagnosis. Of the 76 tumors tested, 53 were malignant and 23 were benign, based on histopathology.
Findings
The researchers found that none of the two- or three-parameter combinations had the same level of sensitivity and specificity as the four-parameter method, which was 96% accurate in distinguishing malignant breast tumors from those that were benign, and provided better results than combinations of two or three imaging approaches.
The researchers estimate that multiparametric 18FDG PET-MRI can reduce unnecessary breast biopsies recommended by the commonly used imaging method, the DCE-MRI, by 50%.
“This feasibility study shows that [multiparametric 18FDG PET-MRI] enables an improved differentiation of benign and malignant breast tumors when several MRI and PET parameters are combined. [Multiparametric 18FDG PET-MRI] may lead to a reduction in unnecessary breast biopsies,” concluded the study authors. “The data suggest that [multiparametric 18FDG PET-MRI], especially with regard to the future use of targeted radiotracers, may have widespread applications in the diagnosis, staging, and assessment of the treatment response in breast cancer.”
Thomas Helbich, MD, MSc, MBA, of the Medical University of Vienna, is the corresponding author for the Clinical Cancer Research article.
Funding for this study was provided by the Austrian Society of Senology Scientific Funding Award, the Austrian National Bank “Jubiläumsfond” Project, and the Medical Scientific Fund of the Mayor of Vienna Project. The researchers reported no conflicts of interest.
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