Is there a difference in FDG PET findings of invasive ductal carcinoma of the breast with and without coexisting DCIS?

Ismet Sarikaya 1, Ali Sarikaya 2, Ahmed N Albatineh 3, Ebru Tastekin 4, Yavuz Atakan Sezer 5

Affiliations

01 January 2020

-

doi: 10.22038/aojnmb.2019.41658.1284

Abstract

Objectives: Studies have reported that invasive ductal carcinoma (IDC) with coexisting ductal carcinoma in situ (DCIS) show lower metastatic potential and recurrence and better overall survival than pure IDC. In this study, we assessed F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) images of patients with newly diagnosed IDC to determine if there is any difference in PET findings in IDC-DCIS and pure IDC cases.

Methods: FDG PET/CT images of patients with newly diagnosed IDC of the breast who subsequently underwent breast surgery and had histopathology result in our records were further evaluated. Tumor grade, pathological staging, and presence of DCIS were noted from the histopathology results. Standardized uptake value (SUV) of the primary tumor (SUVmax and SULmax), other hypermetabolic foci in the breast, and ipsilateral normal breast were measured. Presence of axillary and distant metastases was noted.

Results: Fifty seven (57) patients with IDC were included. Coexisting DCIS was present in 44 (IDC-DCIS) and not present in 13 (pure IDC) cases. Per histopathology, the primary tumor was unifocal in 33 IDC-DCIS (75%) and 12 pure IDC (92.3%) cases, and multifocal in 11 IDC-DCIS cases (25%), and 1 pure IDC case (7.7%). FDG uptake was multifocal in 20 IDC-DCIS cases (45.5%) and 1 pure IDC case (7.7%), and unifocal in 24 IDC-DCIS (54.5%), and 12 pure IDC (92.3%) cases. There was no significant difference in patient age, size of the primary tumor, SUVmax and SULmax of the primary tumor and SUVmax of the normal breast in IDC-DCIS and pure IDC cases (p>0.05). Pathology showed axillary metastasis in all 13 pure IDC (100%), and 27 IDC-DCIS (61.4%) cases. PET showed axillary uptake in 25 IDC-DCIS (56.8%), and 8 pure IDC (61.5%) cases, and abnormal/questionable distant uptake in 12 IDC-DCIS cases and 1 pure IDC case.

Conclusion: In our preliminary findings, multifocal breast FDG uptake and multifocal tumor appear to be more common in IDC-DCIS than pure IDC. There is no significant difference in SUV and size of the primary tumor in IDC-DCIS and pure IDC cases. Axillary metastases appear to be more common in pure IDC than IDC-DCIS cases.

Keywords: Breast carcinoma; Coexisting DCIS; FDG PET; Invasive ductal carcinoma.

Figures

Figure 1 F-18 FDG whole body maximum intensity projection image and selected transaxial PET, CTand PET/CT fusion images of the breasts of a 60 year-old patient with left invasive ductal carcinoma who underwent lumpectomy, sentinel node biopsy and axillary dissection. Histopathology showed unifocal tumor, 4.4×4×2.2 cm in size, primary tumor grade 3, pathological stage T2N1A as well as ductal carcinoma insitu. PET showed the hypermetabolic primary tumor (SUVmax=5.4) (arrow) and mildly hypermetabolic 3 other foci adjacent/around the primary tumor with SUVmax 1.6 to 3.5 (arrow heads) (normal breast SUVmax=0.8) and mildly hypermetabolic left axillary lymph nodes (SUVmax=1.9). Mild focal uptake in the right breast could be physiological or not

Figure 1 F-18 FDG whole body maximum intensity projection image and selected transaxial PET, CTand PET/CT fusion images of the breasts of a 60 year-old patient with left invasive ductal carcinoma who underwent lumpectomy, sentinel node biopsy and axillary dissection. Histopathology showed unifocal tumor, 4.4×4×2.2 cm in size, primary tumor grade 3, pathological stage T2N1A as well as ductal carcinoma insitu. PET showed the hypermetabolic primary tumor (SUVmax=5.4) (arrow) and mildly hypermetabolic 3 other foci adjacent/around the primary tumor with SUVmax 1.6 to 3.5 (arrow heads) (normal breast SUVmax=0.8) and mildly hypermetabolic left axillary lymph nodes (SUVmax=1.9). Mild focal uptake in the right breast could be physiological or not

Figure 2 F-18 FDG whole body maximum intensity projection image and selected transaxial CT, PET and PET/CT fusion images of the breasts of a 51 year-old female with right invasive ductal carcinoma who underwent mastectomy, sentinel node biopsy and axillary dissection. Histopathology showed unifocal tumor, 11.3×5.5×3 cm in size, primary tumor grade 2, pathological stage T3N2A as well as ductal carcinoma insitu. PET showed a large hypermetabolic primary tumor (SUVmax=7.4) (arrow) and multiple small foci surrounding the primary tumor with SUVmax around 2.7 (short arrows) and mildly hypermetabolic right axillary lymph nodes (SUVmax=2.8)

Figure 2 F-18 FDG whole body maximum intensity projection image and selected transaxial CT, PET and PET/CT fusion images of the breasts of a 51 year-old female with right invasive ductal carcinoma who underwent mastectomy, sentinel node biopsy and axillary dissection. Histopathology showed unifocal tumor, 11.3×5.5×3 cm in size, primary tumor grade 2, pathological stage T3N2A as well as ductal carcinoma insitu. PET showed a large hypermetabolic primary tumor (SUVmax=7.4) (arrow) and multiple small foci surrounding the primary tumor with SUVmax around 2.7 (short arrows) and mildly hypermetabolic right axillary lymph nodes (SUVmax=2.8)

Figure 3 F-18 FDG whole body maximum intensity projection image and selected transaxial CT, PET and PET/CT fusion images of the breasts of a 58 year-old patient with right invasive ductal carcinoma who underwent right mastectomy and axillary dissection. Histopathology showed primary tumor in lower inner quadrant, 2.4×1.7×1.5 cm in size, with retroareolar extension and multiple microscopic foci (primary tumor grade 3, pathological stage T2N2A) as well as ductal carcinoma insitu surrounding the main tumor. PET showed the hypermetabolic primary tumor (SUVmax=12) (arrow) and multiple smaller hypermetabolic foci surrounding the primary tumor and also in retroareolar region (SUVmax=3.4, 3.7, 4.1 and 4.4) (short arrows) as well as right axillary lymph node metastases (SUVmax=8.9). Diffuse uptake is also seen in the skin of the right breast, indicating extension of the tumor

Figure 3 F-18 FDG whole body maximum intensity projection image and selected transaxial CT, PET and PET/CT fusion images of the breasts of a 58 year-old patient with right invasive ductal carcinoma who underwent right mastectomy and axillary dissection. Histopathology showed primary tumor in lower inner quadrant, 2.4×1.7×1.5 cm in size, with retroareolar extension and multiple microscopic foci (primary tumor grade 3, pathological stage T2N2A) as well as ductal carcinoma insitu surrounding the main tumor. PET showed the hypermetabolic primary tumor (SUVmax=12) (arrow) and multiple smaller hypermetabolic foci surrounding the primary tumor and also in retroareolar region (SUVmax=3.4, 3.7, 4.1 and 4.4) (short arrows) as well as right axillary lymph node metastases (SUVmax=8.9). Diffuse uptake is also seen in the skin of the right breast, indicating extension of the tumor

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