European Journal of Radiology 83 (2014) 919–929
Contents lists available at ScienceDirect
European Journal of Radiology journal homepage: www.elsevier.com/locate/ejrad
Review
Benign breast lesions detected by positron emission tomography-computed tomography Ana P. Benveniste a,∗ , Wei Yang a,1 , Marcelo F. Benveniste a,2 , Osama R. Mawlawi b,3 , Edith M. Marom a,4 a b
Department of Diagnostic Radiology,The University of Texas MD Anderson Cancer Center, Houston, TX, USA Department of imaging physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
a r t i c l e
i n f o
Article history: Received 31 December 2013 Received in revised form 6 February 2014 Accepted 9 February 2014 Keywords: FDG PET-CT Breast Benign
a b s t r a c t 18 F-fluorodeoxyglucose positron emission computed tomography (FDG PET-CT) is widely used in the initial staging and response evaluation of patients with malignancy. This review describes a spectrum of benign breast findings incidentally detected by FDG PET-CT at staging that may be misinterpreted as malignancy. We describe the pattern of distribution and intensity of FDG uptake in a spectrum of benign breast diseases with their corresponding typical morphological imaging characteristics to help the nuclear medicine physician and/or general radiologist identify benign lesions, avoiding unnecessary breast imaging work-up and biopsies. © 2014 Elsevier Ireland Ltd. All rights reserved.
1. Introduction 18 F-fluorodeoxyglucose
positron emission tomography computed tomography (FDG PET-CT) is used for the staging of malignant disease, the detection of recurrence, monitoring response to therapy, and screening high-risk patients [1–4]. FDG is a radiopharmaceutical analog of glucose that is taken up by metabolically active tumor cells via glucose transporter proteins; the degree of uptake is related to the cellular metabolic rate
∗ Corresponding author at: Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Tel.: +1 713 7452096; fax: 1 713 563 9779. E-mail addresses: [email protected], [email protected] (A.P. Benveniste), [email protected] (W. Yang), [email protected] (M.F. Benveniste), [email protected] (O.R. Mawlawi), [email protected] (E.M. Marom). 1 Wei Yang, MD, Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Tel.: +1 713 7455149; fax: +1 713 5639779. 2 Marcelo F. Benveniste, MD, Department of Diagnostic Radiology, Unit 1478, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Tel.: +1 713 7452096; fax: +1 713 5630638. 3 Osama R. Mawlawi, PhD, Department of imaging physics, Unit 1352, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Tel.: +1 713 5632711; fax: +1 713 5638934. 4 Edith M. Marom, MD, MD, Department of Diagnostic Radiology, Unit 1478, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Tel.: +1 713 7455977; fax: +1 713 5630638. http://dx.doi.org/10.1016/j.ejrad.2014.02.010 0720-048X/© 2014 Elsevier Ireland Ltd. All rights reserved.
and the number of glucose transporters [5]. Because FDG uptake in normal breast tissue is minimal, identifying focal breast FDG uptake is readily appreciated. Such FDG uptake can be seen in both malignant and benign processes such as second primary breast malignancies, metastases, benign masses or even physiologic changes [6–8]. Several reports of breast incidental findings detected by FDG PET-CT have been published. Litmanovich et al. [9] reported that unexpected breast foci were identified in 33 of 4048 patients (0.82%), and malignancy was diagnosed in 17 of 30 of these patients (57%) for whom follow-up data were available [9,10]. Although an increase in breast FDG uptake should be evaluated with dedicated breast imaging to exclude malignancy, knowledge of the typical FDG PET-CT characteristics of benign breast conditions may help avoid unnecessary work-up. In this review, we describe the FDG PET-CT features of benign breast lesions that should be recognized by the interpreting FDG PET-CT reader. 2. FDG PET-CT technique Images in this review were collected from a single institution from September 2005 to September 2011. FDG PET-CT imaging was performed using 1 of 3 scanners (DST, DRX, or DSTE–GE Healthcare, Milwaukee, WI). The corresponding CT scanners consisted of 8 slices (with the DST model), 16 slices (with the DRX model), or 64 slices (with the DSTE model). Patients were positioned supine, with
920
A.P. Benveniste et al. / European Journal of Radiology 83 (2014) 919–929
Fig. 1. Lactation. PET-CT image of a 40-year-old woman with history of adenoid cystic carcinoma of left parotid gland shows incidental FDG uptake both breasts due to lactation (arrowheads), SUVmax 5.1. Bilateral metastatic pulmonary nodules, SUVmax 4.8 (curved arrows).
their arms raised, in the PET-CT device, and all patients had fasted for 6 h before the FDG injection. A normal fasting blood glucose level of
Contents lists available at ScienceDirect
European Journal of Radiology journal homepage: www.elsevier.com/locate/ejrad
Review
Benign breast lesions detected by positron emission tomography-computed tomography Ana P. Benveniste a,∗ , Wei Yang a,1 , Marcelo F. Benveniste a,2 , Osama R. Mawlawi b,3 , Edith M. Marom a,4 a b
Department of Diagnostic Radiology,The University of Texas MD Anderson Cancer Center, Houston, TX, USA Department of imaging physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
a r t i c l e
i n f o
Article history: Received 31 December 2013 Received in revised form 6 February 2014 Accepted 9 February 2014 Keywords: FDG PET-CT Breast Benign
a b s t r a c t 18 F-fluorodeoxyglucose positron emission computed tomography (FDG PET-CT) is widely used in the initial staging and response evaluation of patients with malignancy. This review describes a spectrum of benign breast findings incidentally detected by FDG PET-CT at staging that may be misinterpreted as malignancy. We describe the pattern of distribution and intensity of FDG uptake in a spectrum of benign breast diseases with their corresponding typical morphological imaging characteristics to help the nuclear medicine physician and/or general radiologist identify benign lesions, avoiding unnecessary breast imaging work-up and biopsies. © 2014 Elsevier Ireland Ltd. All rights reserved.
1. Introduction 18 F-fluorodeoxyglucose
positron emission tomography computed tomography (FDG PET-CT) is used for the staging of malignant disease, the detection of recurrence, monitoring response to therapy, and screening high-risk patients [1–4]. FDG is a radiopharmaceutical analog of glucose that is taken up by metabolically active tumor cells via glucose transporter proteins; the degree of uptake is related to the cellular metabolic rate
∗ Corresponding author at: Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Tel.: +1 713 7452096; fax: 1 713 563 9779. E-mail addresses: [email protected], [email protected] (A.P. Benveniste), [email protected] (W. Yang), [email protected] (M.F. Benveniste), [email protected] (O.R. Mawlawi), [email protected] (E.M. Marom). 1 Wei Yang, MD, Department of Diagnostic Radiology, Unit 1350, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Tel.: +1 713 7455149; fax: +1 713 5639779. 2 Marcelo F. Benveniste, MD, Department of Diagnostic Radiology, Unit 1478, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Tel.: +1 713 7452096; fax: +1 713 5630638. 3 Osama R. Mawlawi, PhD, Department of imaging physics, Unit 1352, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Tel.: +1 713 5632711; fax: +1 713 5638934. 4 Edith M. Marom, MD, MD, Department of Diagnostic Radiology, Unit 1478, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Tel.: +1 713 7455977; fax: +1 713 5630638. http://dx.doi.org/10.1016/j.ejrad.2014.02.010 0720-048X/© 2014 Elsevier Ireland Ltd. All rights reserved.
and the number of glucose transporters [5]. Because FDG uptake in normal breast tissue is minimal, identifying focal breast FDG uptake is readily appreciated. Such FDG uptake can be seen in both malignant and benign processes such as second primary breast malignancies, metastases, benign masses or even physiologic changes [6–8]. Several reports of breast incidental findings detected by FDG PET-CT have been published. Litmanovich et al. [9] reported that unexpected breast foci were identified in 33 of 4048 patients (0.82%), and malignancy was diagnosed in 17 of 30 of these patients (57%) for whom follow-up data were available [9,10]. Although an increase in breast FDG uptake should be evaluated with dedicated breast imaging to exclude malignancy, knowledge of the typical FDG PET-CT characteristics of benign breast conditions may help avoid unnecessary work-up. In this review, we describe the FDG PET-CT features of benign breast lesions that should be recognized by the interpreting FDG PET-CT reader. 2. FDG PET-CT technique Images in this review were collected from a single institution from September 2005 to September 2011. FDG PET-CT imaging was performed using 1 of 3 scanners (DST, DRX, or DSTE–GE Healthcare, Milwaukee, WI). The corresponding CT scanners consisted of 8 slices (with the DST model), 16 slices (with the DRX model), or 64 slices (with the DSTE model). Patients were positioned supine, with
920
A.P. Benveniste et al. / European Journal of Radiology 83 (2014) 919–929
Fig. 1. Lactation. PET-CT image of a 40-year-old woman with history of adenoid cystic carcinoma of left parotid gland shows incidental FDG uptake both breasts due to lactation (arrowheads), SUVmax 5.1. Bilateral metastatic pulmonary nodules, SUVmax 4.8 (curved arrows).
their arms raised, in the PET-CT device, and all patients had fasted for 6 h before the FDG injection. A normal fasting blood glucose level of
