Positron emission mammography (PEM): a potentially promising one-stop shop for local staging of ILC

Background Invasive lobular cancer (ILC) has a high propensity for multiplicity, along with a high probability of incomplete surgical excision. Due to its insidious proliferative pattern, it tends to be clinically silent and radiologically elusive. We assess the performance characteristics of PEM in the detection and local staging of ILC. Methods A retrospective study evaluated a total of 193 patients who underwent PEM examination, including 44 patients with ILC. Image analysis of PEM examinations included morphological criteria, uptake pattern, lesion to background ratio (LTB) and maximum PEM uptake value (PUV max) assessment. The findings were correlated with the histopathological results. Results PEM showed high performance in surgical planning and detection of additional ILC lesions with sensitivity of 90.6% and specificity 82%. The mean PUV max and LTB of ILC lesions were significantly different from those of benign lesions and IDC lesions. The cutoff average LTB and PUVmax values to differentiate ILC from benign lesions were ≥ 3.3 & ≥ 2.2, respectively. Conclusions The inclusion of PEM provides a functional image that can improve the diagnostic accuracy of the conventional studies, decreasing the rates of false results and improving the detection of multicentric ILC lesions identification and their differentiation from other benign breast lesions. Advance in knowledge PEM is a promising new imaging technique that further improves the pretherapeutic assessment of ILC and facilitates the assessment of patients with renal impairment.