Can dedicated breast PET help to reduce overdiagnosis and overtreatment by differentiating between indolent and potentially aggressive ductal carcinoma in situ?
Objectives To analyze the utility of metabolic imaging, and specifically of dedicated breast positron emission tomography (dbPET) to differentiate between indolent and potentially aggressive ductal carcinoma in situ (DCIS). Methods After institutional review board approval, we retrospectively review...
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| Veröffentlicht in: | European radiology 2020, Vol.30 (1), p.514-522 |
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| creator | Graña-López, Lucía Herranz, Michel Domínguez-Prado, Inés Argibay, Sonia Villares, Ángeles Vázquez-Caruncho, Manuel |
| description | Objectives
To analyze the utility of metabolic imaging, and specifically of dedicated breast positron emission tomography (dbPET) to differentiate between indolent and potentially aggressive ductal carcinoma in situ (DCIS).
Methods
After institutional review board approval, we retrospectively reviewed the cases of pure DCIS who underwent dbPET before biopsy and surgery in Lucus Augusti Universitary Hospital (Lugo, Spain) and in Fudan Cancer Institute (Shanghai, China) between January 2016 and May 2018. Grade 1 and “non-comedo” grade 2 DCIS were considered low-risk disease, while intermediate-grade with necrosis or grade 3 cases were included in the high-risk group. DbPET sensitivity and specificity to differentiate between indolent and potentially aggressive DCIS were determined along with their respective 95% confidence intervals.
Results
We enrolled 139 surgery-confirmed pure DCIS cases. Fifty were high-risk neoplasms and 89 low-risk DCIS. Only seven low-risk lesions were positive at dbPET and five of potentially aggressive neoplasms did not show FDG uptake, all included into the field of view (FOV). Sensitivity and specificity of dbPET to differentiate between indolent and potentially aggressive DCIS were 90% (95% CI, 77–96%) and 92% (95% CI, 84–97%), respectively.
Conclusion
Metabolic imaging could help to identify the subgroup of indolent lesions from those potentially aggressive ones that may be managed by active surveillance.
Key Points
• Low- and high-grade DCIS likely arise from two distinct evolutionary paths and when low-grade lesions progress to invasive cancer, the tumor is frequently low grade and well differentiated.
• Ongoing clinical trials evaluate whether patients with low-risk DCIS could be safely managed by an active surveillance approach, with avoidance of unnecessary treatments and without impact on ipsilateral invasive breast cancer free survival time.
• Dedicated breast PET may differentiate harmless from potentially hazardous DCIS, supporting active surveillance for the management of those women with low-grade DCIS, decreasing the rate of the upgrade to invasive carcinoma at surgical excision. |
| doi_str_mv | 10.1007/s00330-019-06356-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_webof</sourceid><recordid>TN_cdi_webofscience_primary_000501139000027CitationCount</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2267997699</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-b050dc93c20c10c3a113a1eab1039a21dc1bb714f6f2b01e711e643e19977a163</originalsourceid><addsrcrecordid>eNqNkU2L1TAUhosoznX0D7iQgBtBquc0vU2zErmMHzCgi3Fd0uS0ZmiTa5LOcP-NP9Xc23EEF-Ii5IPnPcnJUxTPEd4ggHgbATiHElCW0PBtU8oHxQZrXpUIbf2w2IDkbSmkrM-KJzFeA4DEWjwuzjhysW0bsSl-7pRjhozVKpFhfSAVE_t6ccW-07RnybNAZtHE_A0FY9XofLSRKWdOJynzaSaXWH9gxg4DhbyxKlk3sp7SLZFj1hk_HZljau_TiZimA1PjGChGe0Ms35HUxLQK2jo_qxxi0abl3dPi0aCmSM_u5vPi24eLq92n8vLLx8-795elzq2ksoctGC25rkAjaK4Q8yDVI3CpKjQa-15gPTRD1QOSQKSm5oRSCqGw4efFq7XuPvgfC8XUzTZqmiblyC-xq6qm5VgJCRl9-Rd67Zfg8uuOVP5v0UiZqWqldPAxBhq6fbCzCocOoTv661Z_XfbXnfx1x9CLu9JLP5O5j_wWloF2BW6p90PUlpymeywb3kLuXOYFVGJnUzbh3c4vLuXo6_-PZpqvdMyEGyn8afIf7_8Fl97JEQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2267997699</pqid></control><display><type>article</type><title>Can dedicated breast PET help to reduce overdiagnosis and overtreatment by differentiating between indolent and potentially aggressive ductal carcinoma in situ?</title><source>MEDLINE</source><source>Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><source>SpringerLink Journals - AutoHoldings</source><creator>Graña-López, Lucía ; Herranz, Michel ; Domínguez-Prado, Inés ; Argibay, Sonia ; Villares, Ángeles ; Vázquez-Caruncho, Manuel</creator><creatorcontrib>Graña-López, Lucía ; Herranz, Michel ; Domínguez-Prado, Inés ; Argibay, Sonia ; Villares, Ángeles ; Vázquez-Caruncho, Manuel</creatorcontrib><description>Objectives
To analyze the utility of metabolic imaging, and specifically of dedicated breast positron emission tomography (dbPET) to differentiate between indolent and potentially aggressive ductal carcinoma in situ (DCIS).
Methods
After institutional review board approval, we retrospectively reviewed the cases of pure DCIS who underwent dbPET before biopsy and surgery in Lucus Augusti Universitary Hospital (Lugo, Spain) and in Fudan Cancer Institute (Shanghai, China) between January 2016 and May 2018. Grade 1 and “non-comedo” grade 2 DCIS were considered low-risk disease, while intermediate-grade with necrosis or grade 3 cases were included in the high-risk group. DbPET sensitivity and specificity to differentiate between indolent and potentially aggressive DCIS were determined along with their respective 95% confidence intervals.
Results
We enrolled 139 surgery-confirmed pure DCIS cases. Fifty were high-risk neoplasms and 89 low-risk DCIS. Only seven low-risk lesions were positive at dbPET and five of potentially aggressive neoplasms did not show FDG uptake, all included into the field of view (FOV). Sensitivity and specificity of dbPET to differentiate between indolent and potentially aggressive DCIS were 90% (95% CI, 77–96%) and 92% (95% CI, 84–97%), respectively.
Conclusion
Metabolic imaging could help to identify the subgroup of indolent lesions from those potentially aggressive ones that may be managed by active surveillance.
Key Points
• Low- and high-grade DCIS likely arise from two distinct evolutionary paths and when low-grade lesions progress to invasive cancer, the tumor is frequently low grade and well differentiated.
• Ongoing clinical trials evaluate whether patients with low-risk DCIS could be safely managed by an active surveillance approach, with avoidance of unnecessary treatments and without impact on ipsilateral invasive breast cancer free survival time.
• Dedicated breast PET may differentiate harmless from potentially hazardous DCIS, supporting active surveillance for the management of those women with low-grade DCIS, decreasing the rate of the upgrade to invasive carcinoma at surgical excision.</description><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-019-06356-9</identifier><identifier>PMID: 31375867</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biopsy ; Breast - diagnostic imaging ; Breast - pathology ; Breast cancer ; Breast Neoplasms - diagnostic imaging ; Breast Neoplasms - pathology ; Cancer ; Carcinoma, Intraductal, Noninfiltrating - diagnostic imaging ; Carcinoma, Intraductal, Noninfiltrating - pathology ; China ; Clinical trials ; Comedones ; Confidence intervals ; Diagnosis, Differential ; Diagnostic Radiology ; Female ; Field of view ; Health risks ; Humans ; Imaging ; Internal Medicine ; Interventional Radiology ; Invasiveness ; Lesions ; Life Sciences & Biomedicine ; Medical imaging ; Medical Overuse - prevention & control ; Medical research ; Medicine ; Medicine & Public Health ; Metabolism ; Middle Aged ; Molecular Imaging ; Necrosis ; Neoplasms ; Neuroradiology ; Positron emission ; Positron emission tomography ; Positron-Emission Tomography - methods ; Radiology ; Radiology, Nuclear Medicine & Medical Imaging ; Retrospective Studies ; Risk ; Risk groups ; Risk management ; Science & Technology ; Sensitivity ; Sensitivity and Specificity ; Spain ; Subgroups ; Surgery ; Surveillance ; Tomography ; Tumors ; Ultrasound</subject><ispartof>European radiology, 2020, Vol.30 (1), p.514-522</ispartof><rights>European Society of Radiology 2019</rights><rights>European Radiology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>6</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000501139000027</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c375t-b050dc93c20c10c3a113a1eab1039a21dc1bb714f6f2b01e711e643e19977a163</citedby><cites>FETCH-LOGICAL-c375t-b050dc93c20c10c3a113a1eab1039a21dc1bb714f6f2b01e711e643e19977a163</cites><orcidid>0000-0002-4809-4208</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-019-06356-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-019-06356-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,28253,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31375867$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Graña-López, Lucía</creatorcontrib><creatorcontrib>Herranz, Michel</creatorcontrib><creatorcontrib>Domínguez-Prado, Inés</creatorcontrib><creatorcontrib>Argibay, Sonia</creatorcontrib><creatorcontrib>Villares, Ángeles</creatorcontrib><creatorcontrib>Vázquez-Caruncho, Manuel</creatorcontrib><title>Can dedicated breast PET help to reduce overdiagnosis and overtreatment by differentiating between indolent and potentially aggressive ductal carcinoma in situ?</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>EUR RADIOL</addtitle><addtitle>Eur Radiol</addtitle><description>Objectives
To analyze the utility of metabolic imaging, and specifically of dedicated breast positron emission tomography (dbPET) to differentiate between indolent and potentially aggressive ductal carcinoma in situ (DCIS).
Methods
After institutional review board approval, we retrospectively reviewed the cases of pure DCIS who underwent dbPET before biopsy and surgery in Lucus Augusti Universitary Hospital (Lugo, Spain) and in Fudan Cancer Institute (Shanghai, China) between January 2016 and May 2018. Grade 1 and “non-comedo” grade 2 DCIS were considered low-risk disease, while intermediate-grade with necrosis or grade 3 cases were included in the high-risk group. DbPET sensitivity and specificity to differentiate between indolent and potentially aggressive DCIS were determined along with their respective 95% confidence intervals.
Results
We enrolled 139 surgery-confirmed pure DCIS cases. Fifty were high-risk neoplasms and 89 low-risk DCIS. Only seven low-risk lesions were positive at dbPET and five of potentially aggressive neoplasms did not show FDG uptake, all included into the field of view (FOV). Sensitivity and specificity of dbPET to differentiate between indolent and potentially aggressive DCIS were 90% (95% CI, 77–96%) and 92% (95% CI, 84–97%), respectively.
Conclusion
Metabolic imaging could help to identify the subgroup of indolent lesions from those potentially aggressive ones that may be managed by active surveillance.
Key Points
• Low- and high-grade DCIS likely arise from two distinct evolutionary paths and when low-grade lesions progress to invasive cancer, the tumor is frequently low grade and well differentiated.
• Ongoing clinical trials evaluate whether patients with low-risk DCIS could be safely managed by an active surveillance approach, with avoidance of unnecessary treatments and without impact on ipsilateral invasive breast cancer free survival time.
• Dedicated breast PET may differentiate harmless from potentially hazardous DCIS, supporting active surveillance for the management of those women with low-grade DCIS, decreasing the rate of the upgrade to invasive carcinoma at surgical excision.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biopsy</subject><subject>Breast - diagnostic imaging</subject><subject>Breast - pathology</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - diagnostic imaging</subject><subject>Breast Neoplasms - pathology</subject><subject>Cancer</subject><subject>Carcinoma, Intraductal, Noninfiltrating - diagnostic imaging</subject><subject>Carcinoma, Intraductal, Noninfiltrating - pathology</subject><subject>China</subject><subject>Clinical trials</subject><subject>Comedones</subject><subject>Confidence intervals</subject><subject>Diagnosis, Differential</subject><subject>Diagnostic Radiology</subject><subject>Female</subject><subject>Field of view</subject><subject>Health risks</subject><subject>Humans</subject><subject>Imaging</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Invasiveness</subject><subject>Lesions</subject><subject>Life Sciences & Biomedicine</subject><subject>Medical imaging</subject><subject>Medical Overuse - prevention & control</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolism</subject><subject>Middle Aged</subject><subject>Molecular Imaging</subject><subject>Necrosis</subject><subject>Neoplasms</subject><subject>Neuroradiology</subject><subject>Positron emission</subject><subject>Positron emission tomography</subject><subject>Positron-Emission Tomography - methods</subject><subject>Radiology</subject><subject>Radiology, Nuclear Medicine & Medical Imaging</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Risk groups</subject><subject>Risk management</subject><subject>Science & Technology</subject><subject>Sensitivity</subject><subject>Sensitivity and Specificity</subject><subject>Spain</subject><subject>Subgroups</subject><subject>Surgery</subject><subject>Surveillance</subject><subject>Tomography</subject><subject>Tumors</subject><subject>Ultrasound</subject><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkU2L1TAUhosoznX0D7iQgBtBquc0vU2zErmMHzCgi3Fd0uS0ZmiTa5LOcP-NP9Xc23EEF-Ii5IPnPcnJUxTPEd4ggHgbATiHElCW0PBtU8oHxQZrXpUIbf2w2IDkbSmkrM-KJzFeA4DEWjwuzjhysW0bsSl-7pRjhozVKpFhfSAVE_t6ccW-07RnybNAZtHE_A0FY9XofLSRKWdOJynzaSaXWH9gxg4DhbyxKlk3sp7SLZFj1hk_HZljau_TiZimA1PjGChGe0Ms35HUxLQK2jo_qxxi0abl3dPi0aCmSM_u5vPi24eLq92n8vLLx8-795elzq2ksoctGC25rkAjaK4Q8yDVI3CpKjQa-15gPTRD1QOSQKSm5oRSCqGw4efFq7XuPvgfC8XUzTZqmiblyC-xq6qm5VgJCRl9-Rd67Zfg8uuOVP5v0UiZqWqldPAxBhq6fbCzCocOoTv661Z_XfbXnfx1x9CLu9JLP5O5j_wWloF2BW6p90PUlpymeywb3kLuXOYFVGJnUzbh3c4vLuXo6_-PZpqvdMyEGyn8afIf7_8Fl97JEQ</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>Graña-López, Lucía</creator><creator>Herranz, Michel</creator><creator>Domínguez-Prado, Inés</creator><creator>Argibay, Sonia</creator><creator>Villares, Ángeles</creator><creator>Vázquez-Caruncho, Manuel</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature</general><general>Springer Nature B.V</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4809-4208</orcidid></search><sort><creationdate>2020</creationdate><title>Can dedicated breast PET help to reduce overdiagnosis and overtreatment by differentiating between indolent and potentially aggressive ductal carcinoma in situ?</title><author>Graña-López, Lucía ; Herranz, Michel ; Domínguez-Prado, Inés ; Argibay, Sonia ; Villares, Ángeles ; Vázquez-Caruncho, Manuel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-b050dc93c20c10c3a113a1eab1039a21dc1bb714f6f2b01e711e643e19977a163</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biopsy</topic><topic>Breast - diagnostic imaging</topic><topic>Breast - pathology</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - diagnostic imaging</topic><topic>Breast Neoplasms - pathology</topic><topic>Cancer</topic><topic>Carcinoma, Intraductal, Noninfiltrating - diagnostic imaging</topic><topic>Carcinoma, Intraductal, Noninfiltrating - pathology</topic><topic>China</topic><topic>Clinical trials</topic><topic>Comedones</topic><topic>Confidence intervals</topic><topic>Diagnosis, Differential</topic><topic>Diagnostic Radiology</topic><topic>Female</topic><topic>Field of view</topic><topic>Health risks</topic><topic>Humans</topic><topic>Imaging</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Invasiveness</topic><topic>Lesions</topic><topic>Life Sciences & Biomedicine</topic><topic>Medical imaging</topic><topic>Medical Overuse - prevention & control</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolism</topic><topic>Middle Aged</topic><topic>Molecular Imaging</topic><topic>Necrosis</topic><topic>Neoplasms</topic><topic>Neuroradiology</topic><topic>Positron emission</topic><topic>Positron emission tomography</topic><topic>Positron-Emission Tomography - methods</topic><topic>Radiology</topic><topic>Radiology, Nuclear Medicine & Medical Imaging</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Risk groups</topic><topic>Risk management</topic><topic>Science & Technology</topic><topic>Sensitivity</topic><topic>Sensitivity and Specificity</topic><topic>Spain</topic><topic>Subgroups</topic><topic>Surgery</topic><topic>Surveillance</topic><topic>Tomography</topic><topic>Tumors</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Graña-López, Lucía</creatorcontrib><creatorcontrib>Herranz, Michel</creatorcontrib><creatorcontrib>Domínguez-Prado, Inés</creatorcontrib><creatorcontrib>Argibay, Sonia</creatorcontrib><creatorcontrib>Villares, Ángeles</creatorcontrib><creatorcontrib>Vázquez-Caruncho, Manuel</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Graña-López, Lucía</au><au>Herranz, Michel</au><au>Domínguez-Prado, Inés</au><au>Argibay, Sonia</au><au>Villares, Ángeles</au><au>Vázquez-Caruncho, Manuel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can dedicated breast PET help to reduce overdiagnosis and overtreatment by differentiating between indolent and potentially aggressive ductal carcinoma in situ?</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><stitle>EUR RADIOL</stitle><addtitle>Eur Radiol</addtitle><date>2020</date><risdate>2020</risdate><volume>30</volume><issue>1</issue><spage>514</spage><epage>522</epage><pages>514-522</pages><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Objectives
To analyze the utility of metabolic imaging, and specifically of dedicated breast positron emission tomography (dbPET) to differentiate between indolent and potentially aggressive ductal carcinoma in situ (DCIS).
Methods
After institutional review board approval, we retrospectively reviewed the cases of pure DCIS who underwent dbPET before biopsy and surgery in Lucus Augusti Universitary Hospital (Lugo, Spain) and in Fudan Cancer Institute (Shanghai, China) between January 2016 and May 2018. Grade 1 and “non-comedo” grade 2 DCIS were considered low-risk disease, while intermediate-grade with necrosis or grade 3 cases were included in the high-risk group. DbPET sensitivity and specificity to differentiate between indolent and potentially aggressive DCIS were determined along with their respective 95% confidence intervals.
Results
We enrolled 139 surgery-confirmed pure DCIS cases. Fifty were high-risk neoplasms and 89 low-risk DCIS. Only seven low-risk lesions were positive at dbPET and five of potentially aggressive neoplasms did not show FDG uptake, all included into the field of view (FOV). Sensitivity and specificity of dbPET to differentiate between indolent and potentially aggressive DCIS were 90% (95% CI, 77–96%) and 92% (95% CI, 84–97%), respectively.
Conclusion
Metabolic imaging could help to identify the subgroup of indolent lesions from those potentially aggressive ones that may be managed by active surveillance.
Key Points
• Low- and high-grade DCIS likely arise from two distinct evolutionary paths and when low-grade lesions progress to invasive cancer, the tumor is frequently low grade and well differentiated.
• Ongoing clinical trials evaluate whether patients with low-risk DCIS could be safely managed by an active surveillance approach, with avoidance of unnecessary treatments and without impact on ipsilateral invasive breast cancer free survival time.
• Dedicated breast PET may differentiate harmless from potentially hazardous DCIS, supporting active surveillance for the management of those women with low-grade DCIS, decreasing the rate of the upgrade to invasive carcinoma at surgical excision.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31375867</pmid><doi>10.1007/s00330-019-06356-9</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4809-4208</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0938-7994 |
| ispartof | European radiology, 2020, Vol.30 (1), p.514-522 |
| issn | 0938-7994 1432-1084 |
| language | eng |
| recordid | cdi_webofscience_primary_000501139000027CitationCount |
| source | MEDLINE; Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; SpringerLink Journals - AutoHoldings |
| subjects | Adult Aged Aged, 80 and over Biopsy Breast - diagnostic imaging Breast - pathology Breast cancer Breast Neoplasms - diagnostic imaging Breast Neoplasms - pathology Cancer Carcinoma, Intraductal, Noninfiltrating - diagnostic imaging Carcinoma, Intraductal, Noninfiltrating - pathology China Clinical trials Comedones Confidence intervals Diagnosis, Differential Diagnostic Radiology Female Field of view Health risks Humans Imaging Internal Medicine Interventional Radiology Invasiveness Lesions Life Sciences & Biomedicine Medical imaging Medical Overuse - prevention & control Medical research Medicine Medicine & Public Health Metabolism Middle Aged Molecular Imaging Necrosis Neoplasms Neuroradiology Positron emission Positron emission tomography Positron-Emission Tomography - methods Radiology Radiology, Nuclear Medicine & Medical Imaging Retrospective Studies Risk Risk groups Risk management Science & Technology Sensitivity Sensitivity and Specificity Spain Subgroups Surgery Surveillance Tomography Tumors Ultrasound |
| title | Can dedicated breast PET help to reduce overdiagnosis and overtreatment by differentiating between indolent and potentially aggressive ductal carcinoma in situ? |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-13T04%3A13%3A03IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_webof&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Can%20dedicated%20breast%20PET%20help%20to%20reduce%20overdiagnosis%20and%20overtreatment%20by%20differentiating%20between%20indolent%20and%20potentially%20aggressive%20ductal%20carcinoma%20in%20situ?&rft.jtitle=European%20radiology&rft.au=Gra%C3%B1a-L%C3%B3pez,%20Luc%C3%ADa&rft.date=2020&rft.volume=30&rft.issue=1&rft.spage=514&rft.epage=522&rft.pages=514-522&rft.issn=0938-7994&rft.eissn=1432-1084&rft_id=info:doi/10.1007/s00330-019-06356-9&rft_dat=%3Cproquest_webof%3E2267997699%3C/proquest_webof%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2267997699&rft_id=info:pmid/31375867&rfr_iscdi=true |