Rev Esp Med Nucl.

2010;29(5):230-235

Original

Added value of prone position technique for PET-TAC in breast cancer patients
S. Vidal-Sicart a,b,c,*, T.S. Aukema b, W.V. Vogel b, C.A. Hoefnagel b and R.A. Valdés-Olmosb
a
Nuclear Medicine Department, CDIC, Hospital Clínic Barcelona, Barcelona, Spain
b
Nuclear Medicine Department, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Holland
c
Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain

INFORMATION ON THE ARTICLE ABSTRACT

History of the article: Aim: This study has aimed to assess if the prone position shows significant differences in regards to the
Received 16 March 2010 supine position in PET/CT studies in breast cancer patients and to determine which modality offers better
Accepted 10 May 2010 evaluation of the images.
Method: A total of 30 patients were included from October 2009 to February 2010 prior to beginning
neoadjuvant chemotherapy. An intravenous 18F-FDG dose ranging from 180 to 240 MBq was administered.
Keywords:
Image acquisition was begun 60±10 min after injection. First of all, a thorax scan was performed with the
Breast cancer
patient in prone position, followed by a whole body study with the patient in supine position.
Positron emission tomography-computerized
tomography
Results: Uptake in tumor lesions was observed in all of the patients. Twenty-four patients (80%) had the
Prone position same number of lesions with both techniques. Five patients (17%) had a different amount of axillary lymph
nodes. One patient (3.3%) had a different number of lesions.
The prone position lesions had a mean SUVmax 8.89±4.18 compared to 7.67±4.34 in supine position. The
areas of the primary breast lesions were higher in the prone position (8.59±7.80 compared with 7.81±7.39).
Mean SUVmax of axillary nodes was 5.97±4.02 in prone and 4.41±3.10 in supine.
Conclusion: The hanging breast technique can achieve higher lesion visualization as well as higher
semiquantitative values in comparison with standard procedure. This supports its inclusion in acquisition
guidelines of PET/CT imaging in breast cancer patients.
© 2010 Elsevier España, S.L. and SEMNIM. All rights reserved.

Valor añadido de la técnica en decúbito prono para el estudio con tomografía

por emisión de positrones-tomografía computarizada en las pacientes
con cáncer de mama
RESUMEN

Palabras clave:
Cáncer de mama Objetivo: El propósito del estudio fue valorar en las pacientes con cáncer de mama si la posición en decúbi-
Tomografía por emisión de positrones- to prono en la tomografía por emisión de positrones-tomografía computarizada (PET-TAC) muestra diferen-
tomografía computarizada cias significativas con el estudio clásico en decúbito supino y determinar qué modalidad ofrece mejor eva-
Decúbito prono luabilidad en las imágenes.
Método: Se incluyeron 30 pacientes entre octubre de 2009 y febrero de 2010 antes de comenzar la quimio-
terapia neoadyuvante. Las pacientes recibieron una dosis endovenosa entre 180-240 MBq de 18F-fluoro-2-
desoxi-D-glucosa. El intervalo hasta la adquisición de imágenes fue de 60±10 min. En primer lugar, se reali-
zó un estudio con PET-TAC del tórax con la paciente en posición de decúbito prono. Posteriormente, se
realizó un estudio del cuerpo entero en decúbito supino.
Resultados: Se visualizaron lesiones tumorales hipercaptantes en todas las pacientes. Veinticuatro de ellas
(80%) presentaron el mismo número de lesiones con ambas técnicas de posicionamiento. En 5 pacientes
(17%) se observó un número diferente de ganglios linfáticos axilares. En 1 paciente (3,3%) se visualizó un
número distinto de lesiones con ambos posicionamientos.
Los valores de captación estandarizados máximos en las pacientes valoradas con decúbito prono fueron
de 8,89 ± 4,18 frente a 7,67 ± 4,34 en decúbito supino. Las áreas de las lesiones primarias fueron mayores en
decúbito prono (8,59 ± 7,80 frente a 7,81 ± 7,39), así como el valor de captación estandarizado máximo de
los ganglios (5,97 ± 4,02 en comparación con 4,41 ± 3,10).
Conclusión: Con la técnica de mama colgante se puede lograr una mayor capacidad de visualización de las
lesiones, así como de los valores semicuantitativos con relación al posicionamiento estándar, lo que avala
su inclusión en los protocolos técnicos de adquisición del estudio con PET-TAC en las pacientes con cáncer
de mama.
© 2010 Elsevier España, S.L. y SEMNIM. Todos los derechos reservados.

* Corresponding author.
E-mail: svidal@clinic.ub.es (S. Vidal-Sicart).

0212-6982/$ - see front matter © 2010 Elsevier España, S.L. and SEMNIM. All rights reserved.
 S. Vidal-Sicart et al / Rev Esp Med Nucl. 2010;29(5):230-235 231

Objective needle biopsy was performed to determine the hormone receptors

and Her2 status, and to obtain tumor tissue for the genetic expression
Application of the positron emission tomography (PET) with 18F2- analysis with microarrays. Tumor stage (T) was evaluated by
fluoro-2-deoxy-d-glucose (FDG) has improved the diagnosis and mammography, ultrasonography and MRI. All the patients signed an
follow-up of oncology patients over the last decade.1 In breast informed consent.
cancer, the PET with FDG is not useful as a screening method
because of two limiting factors: the lesion size and histological Method
type. The spatial resolution of the current PET equipment is
approximately 4-6 mm, and devices have recently been obtained Screening with FDG PET-CT was performed on the days following
that make it possible to detect lesions of up to 2 mm. However, the the conventional images (mammography, ultrasonography and MRI)
sensitivity of the PET significantly decreases in lesions smaller of the breast and axilla. In preparation for the study, the patients
than 7 mm.2 On the other hand, the PET will probably identify fasted for at least 6 hours and 10 mg of diazepam were administered
an infiltrating ductal carcinoma, but it possibly may not detect orally 10 min prior to the administration of the FDG to avoid brown
infiltrating lobular carcinomas and, especially, in situ ductal fat activation. Blood glucose levels had to be less than 10 mmol/l
carcinomas. Although the basic uptake mechanism is glucose (<180 mg/dl). The patients received a dose between 180-240 MBq
metabolism, the underlying mechanisms that provoke this variation (4.8-6.5 mCi) of FDG intravenously, using a Venflon® needle (BD,
in the uptake of FDG in breast tumors have still not been identified. Helsinborg, Sweden) of 22 G to avoid extravasation of the radiotracer
FDG makes it possible to obtain information on tumor lesions with in the arm contralateral to the lesion. In case of bilateral lesions, the
moderate/high grade of activity.3 The greater the differentiation or
the lower the rhythm of cellular proliferation found in a tumor, the
lower the glucose activity and, for this reason, the greater the
likelihood of obtaining false negative results. However, it has been
stated that this fact would correlate with the grade of tumor
aggressivity when there is intense uptake of FDG in a primary breast
tumor.3 Recently, greater FDG uptake has been described in patients
with triple negative tumors.4
At present, magnetic resonance imaging (MRI) may be used to
detect lesions that are not visible on the mammography,
ultrasonography or clinical examination.5,6 The MRI has elevated
sensitivity in the detection of tissue alterations, but their specificity
is variable.7 The MRI is performed with the patient in prone position
because the breast volume in supine position is flattened and its
visualization is not optimal.
On the other hand, the patients are positioned in the prone
position for the mammary scintigraphy procedure using 99mTc-MIBI,
which provides more favorable evaluation than in the supine one.
Among the advantages are better separation of the deep structures
of the left breast from the myocardium, relaxation of the pectoral
muscles, separation of the right breast tissue from the liver and
better visualization of the entire breast.8
Hybrid systems of PET-computed tomography (CT) are increasing
in the Nuclear Medicine Departments. In these systems, the PET and
CT images are fused and provide images that combine anatomical
with physiological information. Typically, the CT scan is a low dose
device that is mainly used to provide attenuation correction and
anatomical correlation for the PET component. It has been
demonstrated that this modality improves diagnostic accuracy in
comparison with the PET performed alone.9,10 A comparable system
that integrates PET and MRI is currently not available, although some
experimental units are being developed.11
Based on the wide experience with the prone position, both with
MRI and breast scintigraphy with MIBI, the objective of our study has
been to evaluate if the prone position in patients with breast cancer
when performing the PET-CT study can offer better evaluability in
breast and axilla images in comparison with the classical study in
supine position.

Method

Patients

This study has included 30 patients with breast cancer who were
referred to the Nuclear Medicine Department of the Netherlands
Cancer Institute between October 2009 and February 2010 after the
administration of a neoadjuvant chemotherapy. All the breast cancers Figure 1. A) Prone decubitus positioning device (hanging breast). B) Optimal placement
were initially diagnosed with fine needle puncture biopsy. The thick of the patient to perform the study.
232 S. Vidal-Sicart et al / Rev Esp Med Nucl. 2010;29(5):230-235

radiotracer was administered in the same way in one of the two
arms. The interval between the tracer administration and the onset
of acquisition of the images was 60±10 min. A whole body PET-CT
devise (Gemini TF®, Philips, Eindhoven, Holland) was used. Acquisition
of PET images was performed using the standard method. Images
were acquired with low dose CT scan (40 mAs, slices at 5 mm)
without oral or intravenous contrast for the anatomical reference
and attenuation correction. First, a study was made with high
resolution PET-CT (2 mm) of the chest (including the breast and
axilla) with the patient in the prone position, using a special device
to position the breast (fig. 1) and 3 min per bed position. Second, a
whole body study was made from the base of the skull to the inguinal
region with 1:30 min per bed position and standard image resolution
(5 mm). The studies were made consecutively after changing from
prone to supine position (<5 min of interval between the termination
of the first one and initiation of the second one). Study duration was
10 min in the prone position and 15-20 min in the supine one. The
time difference between both studies was because images were only
made in 2-3 bed positions in the prone protocol, while in the supine
one, they were obtained of the whole body (4-5 bed positions). The
injected activity, the time when the activity is injected and body
weight on the day of the test were recorded to calculate the maximum
standard uptake value (SUVmax) of the tumor according to the
formula SUVmax=maximal activity (region of interest [ROI]) (MBq/
ml)/injected dose (MBq)/weight (g).
Interpretation of the images
All the studies with FDG PET-CT were evaluated by 3 nuclear
medicine physicians. Visual evaluations of their locations, extension
and intensity of the uptake patterns of the FDG were performed first.
After, a ROA was created in each focus of abnormal uptake (in the
breast) and in the lymph node having the greatest activity in each
lymphatic region. The FDG uptake in the primary tumors and in the
metastases in the lymph nodes was analyzed semiquantitatively
using the SUVmax.
The ROI were adapted to the shape of the highest uptake of the
radiotracer in each plane (coronal, transaxial or saggital) to calculate
the SUVmax. A ROI was drawn in the transaxial images, adjusted to
the tumor uptake, to calculate their extension, both in the prone and
in the supine images.
Statistical analysis
The accuracy of the FDG PET-CT to visualize a tumor as well as the
pathological lymph nodes was evaluated by comparing the results of
the images in both prone and supine position. The number of tumor
lesions in both groups of images and the tumor area visualized in the
breast were compared. Each patient was evaluated with a score,
depending on the number of lesions visualized in each imaging
technique. In this way, the patient was assigned a value of 1 when
the same number of lesions were observed in the axilla and in the
breast in both images. A value of 2 was assigned when different
lesions were observed in the breast by both methods and a values of
3 was assigned when there was a different number of active lymph
nodes visualized.
On the other hand, the SUVmax were correlated with both
techniques in the mammary and axillary lesions. A non-parametric
test for two-related samples (Wilcoxon) was performed. A value of
p<0.05 was considered as significant.
Results
In this study, a total of 30 patients were included. The patients
and tumor characteristics are described in table 1. Mean age of the
patients was 49 years (range: 32-64). Fourteen patients had breast
cancer on the left side, 14 more had breast cancer on the right side
(fig. 2) and 2 had bilateral lesions. Therefore, a total of 35 lesions

Table 1
Characteristics of the study patients

Case Age Breast Size (cm) Site Histology Stage Estrogens Progesterone Her2neu
1 52 L 7 UOQ/UUQ ILC+DCIS T3N3M0 Negative Negative Positive
2 45 R 1.1 UOut.Q IDC T1N1M0 Positive Positive Negative
3 45 L 7 UOQ IDC+DCIS T3N1M0 Positive Positive Negative
4 49 Rx2 1.9/1.5 LIQ/UInQ IDC T2N0M0 Positive Positive Negative
5 61 L 2.4 UOQ IDC T1N0M0 Positive Positive Negative
6 57 R 5.5 Areolar ILC T3N3M0 Negative Negative Positive
7 33 R 3.5 Areolar IDC T3N0M0 Negative Negative Negative
8 50 R 4 UUQ MPC T2N1M0 Negative Negative Negative
9 43 L 4 UIQ ILC T2N1M0 Positive Negative Negative
10 47 R 5 UUQ IDC T2N1M1 Positive Negative Negative
11 49 L 3.5 LOQ IDC T3N1M0 Positive Negative Negative
12 53 L 4.5 UOQ IDC T2N1M0 Negative Negative Positive
13 50 L 9 UOQ MPC T4 N1M0 Negative Negative Negative
14 38 Bilateral 2.6/5.8 LOQ (R)/LOQ (L) IDC T2N0M0 D/T3N1M0 I Positive/Positive Positive/Positive Negative/Positive (L)
15 54 Bilateral 2/9 UInQ (R)/UOQ (L) IDC T2N0M0 D/T4N1M0 I Positive Negative Negative
16 43 R 1.4/1.2 UOQ x 2 IDC T1N1M0 Positive Positive Negative
17 42 R 1.6 LOQ IDC+DCIS T1N0M0 Positive Positive Negative
18 51 L 3 UOQ IDC T3N1M0 Positive Negative Negative
19 64 L 2.1 UIQ MPC T2N0M0 Negative Negative Negative
20 45 L 3.3 UOut.Q IDC T2N0Mx Positive Positive Negative
21 58 R 2.5 UOQ ILC T2N1M0 Positive Negative Positive
22 58 L 2.3 Areolar IDC T2N3M0 Negative Negative Negative
23 41 L 1.5 LIQ IDC T1N1M0 Positive Positive Positive
24 32 R 3.1 UOQ IDC T2N1M0 Negative Negative Negative
25 55 L 9 UOQ IDC T3N1M0 Positive Negative Negative
26 42 R 3.3 UOQ IDC T2N0M0 Negative Negative Negative
27 38 R 2.8 LOQ IDC T2N1M0 Positive Positive Positive
28 43 L 5 LOQ IDC T3N3M0 Negative Negative Negative
29 63 R 3.1 UOQ IDC T2N3M0 Positive Positive Negative
30 61 R 3 Areolar IDC T3N0M0 Negative Negative Negative
DCIS: ductal carcinoma in situ; IDC: infiltrating ductal carcinoma; ILC: infiltrating lobular carcinoma; L: left; LIQ: lower-inner quadrant; LOQ: lower-outer quadrant;
MPC: metaplastic carcinoma; R: right; TNM: tumor, node, metastasis; UInQ: union of inner quadrants; UIQ: upper-inner quadrant; UOut.Q: union of outer quadrants;
UOQ: upper-outer quadrant; UUQ: union of upper quadrants.
 S. Vidal-Sicart et al / Rev Esp Med Nucl. 2010;29(5):230-235
were evaluated (since 2 patients had multicenter tumors and one a
multifocal one). The primary tumors had positive receptors for
estrogen. They were triple negative (estrogen, progesterone and Her2
negatives) or Her2 positives in 19, 9 and 7 cases, respectively. Twenty-
one patients had suspicious lymph nodes on the ultrasonography,
confirmed by fine needle puncture cytology.
Evaluation of the lesions
In all the patients, high uptake breast tumor lesions were
visualized, observing the same number of lesions in 24 of them
(80%), both in the breast as well as in the axilla or the extraaxillary
regions (fig. 3) with both positioning techniques. In 5 patients (16.7%),
high uptake axillary lymph nodes were observed in the prone
decubitus position. Finally, in 1 patient (3.3%), a different number of
mammary lesions were visualized with both positions.
The mean ±standard deviation of the SUVmax in the patients
evaluated with prone position was 8.89±4.18 compared to 7.67±4.34
in the patients studied in supine position (p<0.05). The values for the
area of the lesions determined in the images in prone decubitus were
8.59±7.80 compared to 7.81±7.39 in the images of the patients
evaluated in supine position (p<0.05). Finally, the average of the
SUVmax of the lymph nodes evaluated in the images obtained in
prone position was 5.97±4.02 in comparison with 4.41±3.10 in those
conducted in the supine position (p<0.05).
The coefficient of correlation between both groups in relationship
to the evaluation of the tumor and lymph nodes was high (r=0.91 and
0.99, respectively).
Figure 2. Patient with tumor in right breast. A) Image obtained in supine decubitus. B)
Image obtained in prone position. The different distribution of the radiotracer is
observed, with a greater area of visualization of metabolic visualization attributable
to the tumor in the prone position.
233
Figure 3. Patient with axillary metastases. The uptake and disposition of
hypermetabolic images are clearer in the prone decubitus disposition. This makes it
possible to visualize all the lymph nodes affected and to make a more accurate
quantification. Upper line: prone; inferior line: supine.
In regards to the lesions according to the hormone receptor profile
or the expression of the Her2neu, the average SUVmax in the triple
negative patients was higher than in those who expressed the
Her2neu and in those having positive estrogen receptors (12.6; 8.6
and 6.9, respectively).
Two patients with positive axilla could not be evaluated due to
absence of metabolic uptake, both in the prone and in the supine
position. On the other hand, the patients with negative axilla could
not be evaluated due to absence of activity (4 cases) or because it
showed average reduced valued (SUVmax of 2.6 in the evaluation in
the prone position and 1.8 in the supine position compared to the
values of 6.8 and 5.0 in the patients with positive abnormal lymph
nodes, respectively) (table 2).
Discussion
Breast cancer is a health problem worldwide and causes problems
both for the screening methodology and for the follow-up.
The PET-CT is a relatively new tool in the diagnosis of primary
tumors and its main use in breast cancer is associated to staging,
control of the response to the systemic therapy and diagnosis of
relapses.12-15
However, most of the imaging protocols with PET-CT in breast
cancer are based on whole body scanning, especially in an attempt to
rule out distant metastases. This method of obtaining images
is performed with the patient in supine position and it does not use
a protocol dedicated to the breast because of the need to scan the
whole body.16 However, several authors have suggested that the
prone position is recommendable for the study of the breast.17-19
In our series, two protocols were used to obtain different images.
In the first place, a study was performed oriented to the breast and
axilla, placing the patient in prone position in a device adapted for
this purpose (similar to that used in the MRI for the breast) and
allowing the breast tissue to hang freely. This method makes it
possible to increase the visible surface of the breast and to obtain a
better definition of the lesion and of the lymph nodes (especially the
axillary ones). In addition, because the patient is in a position in
which there is pressure on the anterior thorax, has less lung
movement during the respiration in comparison with the usual
position in supine position.
In a study published by Kaida et al., the use of a device especially
adapted to the breast for better comfort of the patient (avoiding
compression), less artifact of movement and optimization of the
visualization of the radiotracer uptake was recommended.20 Our
results support these facts, since in most of the patients (n=28; 93%),
the areas of the adequate ROI for each lesion were greater in the studies
performed in prone position and the mean values of the SUVmax
obtained were also superior (statistically significant differences).
234 S. Vidal-Sicart et al / Rev Esp Med Nucl. 2010;29(5):230-235

Table 2
Evaluation of the lesions according to the positioning of the patient

Case No. of lesions SUV P SUV S Area P Area S SUV in P position SUV in S position lymph nodes
1 3 11.1/15.2 7.9/9.4 4.0 2.9 17.3 10.3
2 1 5.3 4.5 5.9 4.3 6.7 4.5
3 3 6.0 5.6 6.0 5.8 5.6/3.9 (R)/6.8/7.3 (L) 3.7/2.5 (R)/4.6/3.6 (L)
4 1 10.8/10.5 7.3/7.0 6.9/6.4 7.1/6.3 Not evaluable Not evaluable
5 1 4.7 4.4 5.0 4.3 2.7 2.2
6 3 5.6 5.5 6.6 5.6 16.2 (Ax)/6.3 (IMC) 14.3 (Ax)/4.4 (IMC)
7 1 7.1 6.6 9.4 7.2 1.8 1.6
8 1 18.05 18.3 14.0 14.0 5.1 3.8
9 1 3.2 2.3 3.3 3.5 1.8 1.0
10 3 11.07 11.04 10.1 8.8 6.9 (R)/7.2 (L) 5.5 (R)/4.5 (L)
11 1 6.0 5.8 6.0 5.8 Not evaluable Not evaluable
12 1 11.5 12.3 4.8 4.8 2.7 2.2
13 2 11.5 9.7 42.7 40.7 Not evaluable Not evaluable
14 1 4.2 (R)/9.8 (L) 3.9 (R)/8.3 (L) 4.7 (R)/6.6 (L) 3.6 (R)/4.6 (L) Not evaluable (R)/4.7 (L) Not evaluable (R)/2.6 (L)
15 1 6.7 (R)/6.1 (L) 6.3 (R)/4.7 (L) 6.7 (R)/6.1 (L) 6.3 (R)/4.7 (L) 2.8 (R)/4.1 (L) 1.8 (R)/3.4 (L)
16 1 11.6/5.6 8.6/2.6 7.8 9.4 12.3 8.4
17 1 3.5 3.0 2.8 2.6 Not evaluable Not evaluable
18 1 5.4 4.5 7.5 5.5 5.5 5.5
19 1 21.1 24.2 15.9 13.3 Not evaluable Not evaluable
20 3 7.81 8.24 9.3 9.9 1.5 0.6
21 1 5.3 6.01 6.5 5.5 3.17 2.49
22 1 12.9 10.3 4.4 4.4 8.6 7.9
23 1 9.2 7.9 3.1 2.5 13.0 10.2
24 1 9.1 8.9 16.1 15.4 6.7 6.3
25 1 5.3 5.0 3.1 3.5 3.6 3.3
26 1 15.2 12.9 27.6 24.3 2.8 1.5
27 1 9.9 9.5 5.2 4.7 4.7 4.1
28 1 4.7 4.7 17.1 16.2 2.8 2.4
29 1 9.5 5.9 5.5 4.6 4.5 3.2
30 1 10.8 5.34 5.0 4.0 Not evaluable Not evaluable
Ax: axilla; IMC: internal mammary chain; R: right; P: prone; S: supine; L: left; SUV: standardized uptake value.

In spite of everything, the use of the prone position has not been
extended, on the contrary to the supine decubitus position. In our
study, disagreements were observed in the visualization of the
number of high uptake images in 6 patients (20%), especially in the
axillary region, the prone position demonstrating a greater number
of active lesions. This result, in spite of the limited number of cases
included, would lead to the recommendation to obtain image
acquisition with the patient in prone position to avoid the “under”
evaluation of the lesions. On another part, the pre-chemotherapy
baseline study, that is more optimized with the prone position,
would theoretically make it possible to evaluate the possible response
to systemic therapy with greater reliability.4
It is known that, over time, the uptake of FDG is greater in the
tumors. Several studies have demonstrated that the SUVmax
continues increasing in the malignant lesions several hours after the
administration of the radiotracer.21,22
In this sense, Kaida et al. discovered that in their study of 118
patients, 10 of them could be evaluated with a prone position while
no evaluable results could be shown in the supine position.23 Caprio
et al. conducted a study with “dual-point-time” with the
examination in prone decubitus after acquisition in supine position.
These authors observed a diagnostic accuracy of 85% in the lesions
with a SUVmax>2.5 and an increase of the SUVmax in the late
images (performed in prone position).24 In addition, the malignant
lesions showed a significant increase of the FDG with time in
comparison with the benign lesions. In our study, the order of
acquisitions was inverse. However, the mean value of the SUVmax
was superior in the study using the prone position and performed
first in 27 of the 30 patients (90%). Bearing in mind the findings of
the investigators, consideration could be given to whether the
acquisition protocol in prone decubitus is sufficiently sensitive to
acquire it at 60 minutes after the administration of the tracer or if
its value would be increased even more by delaying it. In this sense,
prospective studies should be performed aimed at evaluating this
point.
Finally, acquisition in the prone decubitus position with a device
similar to that used in the MRI makes it possible to obtain images
having similar morphological characteristics to the former,
permitting image fusion by software, and in a near future, by an
integrated hybrid imaging device. This fact can increase the
specificity of the MRI in both the primary tumor as well as in the
recurrent ones.25
An important difference in our study was observed in the axilla.
More high uptake lymph nodes were visualized with the prone
position. This can lead to better locoregional staging considering the
high specificity of FDG PET-CT.4,26,27 In this sense, although no
statistical study has been performed on the number of lymph nodes,
a change in staging in two of the patients who went from N1 to N2
was observed.
Although the refined techniques (prone position or acquisition in
two different times) may resolve part of the problems related with
the primary lesion, the problem of the limitation of the spatial
resolution of the equipment and high cost of the technique still
persist. This makes its routine application in the diagnosis of primary
breast cancer difficult (especially in the small-sized lesions). In this
sense, dedicated units (Positron emission mammography [PEM])
may provide a solution in this subgroup of patients.28
Conclusion
The image obtained with the PET is a clear advance in the approach
to and control of breast cancer. The positron image offers greater
accuracy than the conventional images in the identification of
metastatic disease both in the initial stages during the follow-up. The
PET-CT or PET mammography has demonstrated promising results in
the detection of primary breast cancer. However, acquisition
techniques may vary mildly according to the results to be evaluated.
In this sense, our study, in agreement with others, shows greater
capacity of visualization of the lesions, as of the other semiquantitative
values in relationships with the standard acquisition protocol. This
 S. Vidal-Sicart et al / Rev Esp Med Nucl. 2010;29(5):230-235
suggests its possible inclusion in the acquisition technique protocols
of the study with PET-CT in patients with breast cancer.
Conflict of interests
The authors declare that they do not have any conflict of
interest.
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