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Detection of Primary Breast Carcinoma with a Dedicated, Large-Field-of-View FDG PET Mammography Device: Initial Experience¹

¹ From the Department of Radiology, Duke University Medical Center, Room 24244b, Hospital South, Durham, NC 27710. From the 2003 RSNA Annual Meeting. Received April 12, 2004; revision requested May 18; revision received August 3; accepted August 26. Supported by DOD Concept Award DAMD17–01-1–0517. Supported in part by the Office of Biological and Environmental Research of the Office of Science of the U.S. Department of Energy. Address correspondence to E.L.R. (e-mail: eric.rosen@duke.edu).

View larger version (151K): [in a new window]   Figure 1. PET mammography system and mammography gantry. Film holder has been rotated to the right side to make room for lower detector (arrow). Upper detector (arrowhead) is positioned above compression paddle, which compresses the breast against the lower detector. (Reprinted, with permission, from reference 17.)

View larger version (145K): [in a new window]   Figure 2. PET mammography detector interfacing with mammography gantry. Upper detector (arrowhead) can be moved vertically toward or away from lower detector (arrow). In addition, the entire detector assembly can be pivoted, allowing acquisition of oblique views. Finally, the entire gantry can be moved up and down by using a motorized control to adjust to the height of each patient (Reprinted, with permission, from reference 17.)

View larger version (121K): [in a new window]   Figure 4a. Images of a 38-year-old woman with T1cN1M0 breast carcinoma in the right breast. (a) Spot-compression magnification conventional mammogram demonstrates architectural distortion and segmentally distributed microcalcifications (arrows). (b) US scan demonstrates an irregular 1.4-cm mass (*). (c) Transverse PET mammography image demonstrates segmental increased FDG activity (arrows) that mirrors the mammographic abnormality. Histologic examination demonstrated a 1.6-cm invasive adenocarcinoma with extensive ductal carcinoma in situ.

View larger version (137K): [in a new window]   Figure 4b. Images of a 38-year-old woman with T1cN1M0 breast carcinoma in the right breast. (a) Spot-compression magnification conventional mammogram demonstrates architectural distortion and segmentally distributed microcalcifications (arrows). (b) US scan demonstrates an irregular 1.4-cm mass (*). (c) Transverse PET mammography image demonstrates segmental increased FDG activity (arrows) that mirrors the mammographic abnormality. Histologic examination demonstrated a 1.6-cm invasive adenocarcinoma with extensive ductal carcinoma in situ.

View larger version (41K): [in a new window]   Figure 4c. Images of a 38-year-old woman with T1cN1M0 breast carcinoma in the right breast. (a) Spot-compression magnification conventional mammogram demonstrates architectural distortion and segmentally distributed microcalcifications (arrows). (b) US scan demonstrates an irregular 1.4-cm mass (*). (c) Transverse PET mammography image demonstrates segmental increased FDG activity (arrows) that mirrors the mammographic abnormality. Histologic examination demonstrated a 1.6-cm invasive adenocarcinoma with extensive ductal carcinoma in situ.

View larger version (96K): [in a new window]   Figure 5a. Images of a 41-year-old woman with a 1.8-cm mass in the left breast. (a, b) Mediolateral oblique and craniocaudal conventional mammograms of the left breast demonstrate architectural distortion (arrows) in the superior portion. (c) US scan of left breast demonstrates a solid mass (*) at the site of mammographic abnormality. (d) Transverse PET mammography image of the left breast depicts a single focus of increased FDG activity (arrows) at the site of the mass. Histologic examination demonstrated a 2.0-cm invasive ductal adenocarcinoma with associated ductal carcinoma in situ.

View larger version (88K): [in a new window]   Figure 5b. Images of a 41-year-old woman with a 1.8-cm mass in the left breast. (a, b) Mediolateral oblique and craniocaudal conventional mammograms of the left breast demonstrate architectural distortion (arrows) in the superior portion. (c) US scan of left breast demonstrates a solid mass (*) at the site of mammographic abnormality. (d) Transverse PET mammography image of the left breast depicts a single focus of increased FDG activity (arrows) at the site of the mass. Histologic examination demonstrated a 2.0-cm invasive ductal adenocarcinoma with associated ductal carcinoma in situ.

View larger version (145K): [in a new window]   Figure 5c. Images of a 41-year-old woman with a 1.8-cm mass in the left breast. (a, b) Mediolateral oblique and craniocaudal conventional mammograms of the left breast demonstrate architectural distortion (arrows) in the superior portion. (c) US scan of left breast demonstrates a solid mass (*) at the site of mammographic abnormality. (d) Transverse PET mammography image of the left breast depicts a single focus of increased FDG activity (arrows) at the site of the mass. Histologic examination demonstrated a 2.0-cm invasive ductal adenocarcinoma with associated ductal carcinoma in situ.

View larger version (58K): [in a new window]   Figure 5d. Images of a 41-year-old woman with a 1.8-cm mass in the left breast. (a, b) Mediolateral oblique and craniocaudal conventional mammograms of the left breast demonstrate architectural distortion (arrows) in the superior portion. (c) US scan of left breast demonstrates a solid mass (*) at the site of mammographic abnormality. (d) Transverse PET mammography image of the left breast depicts a single focus of increased FDG activity (arrows) at the site of the mass. Histologic examination demonstrated a 2.0-cm invasive ductal adenocarcinoma with associated ductal carcinoma in situ.

View larger version (50K): [in a new window]   Figure 3. Transverse FDG PET mammography image demonstrates two focal abnormalities. Lesion 1 represents invasive carcinoma that was depicted at conventional mammography. Lesion 2 represents a 0.4-cm noninvasive papillary carcinoma, which was not visible at conventional mammography. Directed US was used to localize the mass, which was then evaluated with core-needle biopsy.