Same-Day PET-Guided Biopsies Rush Preoperative Work-Up for Breast Cancer Patients and Reduce Radiation Exposure

Clinicians have demonstrated how positron emission mammography (PEM)-guided biopsy may expedite preoperative work-up and reduce radiation exposure for breast cancer patients.

Researchers from the University of Cincinnati (OH, USA) presented their findings from a prospective study at the American Roentgen Ray Society 2011 annual meeting on May 3, 2011, held in Chicago (IL, USA).

PEM scanners are high-resolution breast positron emission tomography (PET) systems that can show the location as well as the metabolic phase of a lesion. This information is crucial in determining whether a lesion is malignant and influences the course of treatment. Naviscan's (San Diego, CA, USA) Stereo Navigator accessory is the first commercialized PET-guided biopsy tool, and has been cleared by the US Food and Drug Administration (FDA) since 2008.

"PEM is useful for performing local staging in women with newly diagnosed breast cancer," stated Dr. Amy Argus, assistant professor of radiology and one of the lead investigators of the study. "When additional breast abnormalities are identified by PEM, accurate PEM-guided biopsy can be performed on the same day as the diagnostic imaging, which decreases the patient's radiation dose and may expedite their preoperative work-up."

In this study, 18 women with breast cancer classified as BIRADS [Breast Imaging-Reporting and Data System]-5 identified on mammography or ultrasound, underwent a PEM scan and same day PEM-guided biopsy on 24 index and satellite lesions. Lesion size was 4 mm - 60 mm with a mean size of 16 mm. Results were concordant for 83% of lesions and discordant for the remaining due to patient movement and operator experience.

PEM is the only technology where physicians are able to biopsy on the same injection of the radiotracer. This is because the radiotracer utilized, fluorodeoxyglucose (FDG), does not washout of the tumor as with other blood flow-dependant modalities like magnetic resonance imaging (MRI) or breast-specific gamma imaging (BSGI). By avoiding a double injection of radiotracer, the radiation exposure to the patient and medical personnel is reduced. Same-day procedures are also feasible with PEM given the ease of interpretation compared to other advanced imaging modalities.

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