• The Korean Journal of Nuclear Medicine
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• v.36 no.1
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• pp.34-38
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• 2002

Positron emission tomography(PET) is an imaging method that employs radionuclide and tomography techniques. Since 1995, we applied PET not only to the diagnosis of breast cancer but also to the detection of abnormalities in the augmented breast and to the detection of metastasis. Until 2001, we evaluated 242 breast cases by PET at PET center of Seoul National University Hospital. Our group has reported serially at the international journals. In the first report, PET showed high sensitivity for detecting breast cancer, both the primary and axillary node metastasis. A total of 27 patients underwent breast operations based on PET results at Seoul National University Hospital from 1995 to 1996. The diagnostic accuracy of PET were 97% for the primary tumor mass and 96% for axillary lymph node metastasis. In case of the breast augmented, PET also showed excellent diagnostic results for primary breast cancer and axillary lymph node metastasis where mammography and ultrasound could not diagnose properly. PET also had outstanding results in the detection of recurrent or metastatic breast cancer(sensitivity 94%, specificity 80%, accuracy 89%). In addition, our study gave some evidence that PET could be applied further to evaluate the growth rate of tumors by measuring SUV, and finally to prognosticated the disease. PET could also be applied to evaluate the response after chemotherapy to measure its metabolic rate and size. In conclsion, PET is a highly sensitive, accurate diagnostic tool for breast cancer of primary lesion in various conditions including metastasis.

• The Korean Journal of Nuclear Medicine
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• v.33 no.6
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• pp.502-511
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• 1999

Purpose: F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been proven to be useful in the differential diagnosis of breast mass and staging of breast cancer. This study assessed the diagnostic accuracy of F-18-FDG PET in the differentiation of breast mass and staging of breast cancer. Materials and Methods: Total 42 patients who had breast mass underwent F-18-FDG PET (all female, 40: 10 year old). We compared F-18 FDG PET results with pathologic findings in 24 patients Results: In the differentiation of breast mass, sensitivity and specificity were 95% (19/20) and 77% (7/9) respectively. Three false positive cases were due to inflammation and one false negative patient had small tumor less than 1 cm. In the assessment of axillary lymph node status, sensitivity and specificity were 73% (8/11) and 100% (7/7) respectively. We found distant metastasis that were not suspected before F-18-FDG PET in 2 patients. Conclusion: F-18-FDG PET shows good diagnostic performance in differentiation of breast mass and staging of breast cancer.

• Korean Journal of Radiology
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• v.22 no.12
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• pp.1938-1945
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• 2021

Breast radiologists are increasingly seeing patients with axillary adenopathy related to COVID-19 vaccination. Vaccination can cause levels I-III axillary as well as cervical lymphadenopathy. Appropriate management of vaccine-related adenopathy may vary depending on clinical context. In patients with current or past history of malignancy, vaccine-related adenopathy can be indistinguishable from nodal metastasis. This article presents imaging findings of oncology patients with adenopathy seen in the axilla or neck on cross-sectional imaging (breast MRI, CT, or PET-CT) after COVID-19 vaccination. Management approach and rationale is discussed, along with consideration on strategies to minimize false positives in vaccinated cancer patients. Time interval between vaccination and adenopathy seen on breast MRI, CT, or PET-CT is also reported.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.sup1
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• pp.76-90
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• 2008

$^{18}F-FDG$ PET in combination with conventional imaging modalities could help avoid unnecessary biopsy for the primary mass, and it also has a high diagnostic accuracy in patients with dense breasts. In the assessment of metastasis, $^{18}F-FDG$ PET was useful to select patients who required sentinel lymph node biopsy and to detect extra-axillary lymph node metastasis and distant metastasis. To increase the sensitivity for osteoblastic bone metastasis, bone scintigraphy should be added. In the detection of recurrence, $^{18}F-FDG$ PET showed a higher diagnostic accuracy than tumor marker or computed tomography, and therefore it can be used in routine breast cancer follow-up. $^{18}F-FDG$ PET has been reported that it correctly predicted the response of neoadjuvant chemotherapy on as early as 8th day of treatment. Therefore, it is useful for the early detect of therapeutic response in advanced breast cancer.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.6
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• pp.456-463
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• 2008

Purpose: We evaluated the incidence and malignant risk of focal breast lesions incidentally detected by $^{18}F-FDG$ PET/CT. Various PET/CT findings of the breast lesions were also analyzed to improve the differentiation between benign from malignant focal breast lesions. Materials & Methods: The subjects were 3,768 consecutive $^{18}F-FDG$ PET/CT exams performed in adult females without a history of breast cancer. A focal breast lesion was defined as a focal $^{18}F-FDG$ uptake or a focal nodular lesion on CT image irrespective of $^{18}F-FDG$ uptake in the breasts. The maximum SUV and CT pattern of focal breast lesions were evaluated, and were compared with final diagnosis. Results: The incidence of focal breast lesions on PET/CT in adult female subjects was 1.4% (58 lesions in 53 subjects). In finally confirmed 53 lesions of 48 subjects, 11 lesions of 8 subjects (20.8%) were proven to be malignant. When the PET/CT patterns suggesting benignancy (maximum attenuation value>75 HU or <30HU; standard deviation of mean attenuation > 20) were added as diagnostic criteria of PET/CT to differentiate benign from malignant breast lesions along with maximum SUV, the area under ROC curve of PET/CT was significantly increased compared with maximum SUV alone ($0.680{\pm}0.093$ vs. $0.786{\pm}0.076$, p<0.05). Conclusion: The malignant risk of focal breast lesions incidentally found on $^{18}F-FDG$ PET/CT is not low, deserving further diagnostic confirmation. Image interpretation considering both $^{18}F-FDG$ uptake and PET/CT pattern may be helpful to improve the differentiation from malignant and benign focal breast lesion.

• Journal of radiological science and technology
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• v.40 no.1
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• pp.79-85
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• 2017

The purpose of this study was to measure contrast to noise ratio (CNR) and signal to noise ratio (SNR) according to change of reconstruction from region of interest (ROI) in breast positron emission tomography-computed tomography (PET-CT), and to analyze the CNR and SNR statically. We examined images of breast PET-CT of 100 patients in a University-affiliated hospital, Seoul, Korea. Each patient's image of breast PET-CT were calculated by using ImageJ. Differences of CNR and SNR among four reconstruction algorithms were tested by SPSS Statistics21 ANOVA test for there was statistical significance (p<0.05). We have analysis socio-demographical variables, CNR and SNR according to reconstruction images, 95% confidence according to CNR and SNR of reconstruction and difference in a mean of CNR and SNR. SNR results, with the quality of distributions in the order of PSF_TOF, Iterative and Iterative-TOF, FBP-TOF. CNR, with the quality of distributions in the order of PSF_TOF, Iterative and Iterative-TOF, FBP-TOF. CNR and SNR of PET-CT reconstruction methods of the breast would be useful to evaluate breast diseases.

• Korean Journal of Clinical Oncology
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• v.14 no.2
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• pp.135-141
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• 2018

Purpose: Axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) are important for staging of patients with node-positive breast cancer. However, these can be avoided in select micrometastatic diseases, preventing postoperative complications. The present study evaluated the ability of axillary lymph node maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET-CT) to predict axillary metastasis of breast cancer. Methods: The records of invasive breast cancer patients who underwent pretreatment (surgery and/or chemotherapy) PET-CT between January 2006 and December 2014 were reviewed. ALNs were preoperatively evaluated by PET-CT. Lymph nodes were dissected by SLNB or ALND. SUVmax was measured in both the axillary lymph node and primary tumor. Student t-test and chi-square test were used to analyze sensitivity and specificity. Receiver operating characteristic (ROC) and area under the ROC curve (AUC) analyses were performed. Results: SUV-tumor (SUV-T) and SUV-lymph node (SUV-LN) were significantly higher in the triple-negative breast cancer (TNBC) group than in other groups (SUV-T: 5.99, P<0.01; SUV-LN: 1.29, P=0.014). The sensitivity (0.881) and accuracy (0.804) for initial ALN staging were higher in fine needle aspiration+PET-CT than in other methods. For PET-CT alone, the subtype with the highest sensitivity (0.870) and negative predictive value (0.917) was TNBC. The AUC for SUV-LN was greatest in TNBC (0.797). Conclusion: The characteristics of SUV-T and SUV-LN differed according to immunohistochemistry subtype. Compared to other subtypes, the true positivity of axillary metastasis on PET-CT was highest in TNBC. These findings could help tailor management for therapeutic and diagnostic purposes.

• The Korean Journal of Nuclear Medicine Technology
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• v.12 no.1
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• pp.44-48
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• 2008

Purpose: In FDG-PET/CT of breast cancer, a sensitivity was 80~96% and a specificity was 75~95% commonly. It was valuable to identify a cancer in early stage been difficult in Mammography. Most of the PET/CT scans have been examined on supine position, so, the image of breast has been acquired by reconstructed whole body scan image. However, using prone position with a compensator, a shape of breast was reassembly shown to be real by gravity. Therefore, the purpose of this study was to evaluate diagnostic value of prone position in FDG PET-CT of breast cancer. Materials and Methods: 30 female patients with doubtful or positive breast cancer were examined. The PET-CT whole body scan was acquired at 60 minutes after $^{18}F$-FDG injection on Supine position. Then, regional breast spot scan was progressed on prone position using a compensator. Each image was evaluated by physicians blinded to patient's data, and statistical analysis did through SUVs measured in PET-CT images. Results: In 27 of 30 patients, prone position was shown accurate discrimination and diagnostic value, but in another 3 patients had a lesion 1cm below, PET-CT couldn't detect it, unlike MRI. Consequently, prone position distinguished a lesion better than Supine position, because of low degree of metamorphosis by gravity. The SUVs analysis of each position was significant (p value=0.004). Conclusion: In PET-CT of breast cancer, prone position could detect micrometastasis as well as primary lesion, better than supine position. Therefore, this study proposes that any technical change considered morphological feature like prone position can offer adequate and useful diagnostic information, together with complementary quantitative analysis.

• Journal of Radiation Industry
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• v.17 no.4
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• pp.391-396
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• 2023

Currently, state-of-the-art devices such as SPECT, PET/CT, and PET/MRI are rapidly spreading nationwide, and the penetration rate of nuclear medical devices is also ranked fifth in the world. However, PET/MRI's system is slower and less common because it is more complex than PET/CT. The purpose of this study is to provide optimal information on PET/MRI according to the patient's disease. The subjects obtained information on head and neck cancer, pediatric patients, breast cancer patients, heart disease patients, lung cancer patients, and rectal cancer patients. We tried to accumulate protocols by obtaining a lot of information about each disease. In diagnosing head and neck cancer, it is believed that it is highly likely to be used in evaluating preoperative stage determination, recurrence and remote metastasis after treatment, and unclear primary cervical lymph node metastasis. Diagnosis and continuous follow-up of pediatric patients can increase patient benefits by minimizing radiation exposure. Breast cancer provides a comprehensive evaluation of the clinical need to determine the extent of disease in breast and local lymph nodes and the systematic stages of early diagnosis or recurrence. In diagnosing heart disease patients, MR-based PET motion correction helps to realize the full potential of PET images. For lung cancer patients, the clinical value and usefulness of the resolution and detection ability of integrated PET/MRI for soft tissues such as lung cancer will be sufficient. In diagnosing rectal cancer patients, the detection of missing residual diseases can change the clinical response evaluation for rectal cancer patients treated with TNT, and both the initial stage and treatment response evaluation are possible. Therefore, this literature study provided basic clinical data for PET/MRI tests.

• Investigative Magnetic Resonance Imaging
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• v.22 no.4
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• pp.245-248
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• 2018

Foreign body injections into breasts may produce foreign body reactions, fibrosis, and local swelling of involved lymph nodes, which can be misdiagnosed as metastasis or malignancy. Here, the authors report MR imaging, PET-CT imaging, and pathologic findings of contralateral internal mammary lymphadenopathy suspicious of breast cancer metastasis in a 58-year-old woman with history of left breast cancer, and previous interstitial mammoplasty by paraffin injection in both breasts.