Una manera de evitar biopsias innecesarias

por Lauren Dubinsky, Senior Reporter | June 30, 2014
Dr. Katja Pinker
A new imaging approach called multiparametric (MP) 18FDG PET/MR combines several imaging technologies, which can help avoid unnecessary breast biopsies, according to a recent study published in Clinical Cancer Research. It's 96 percent accurate in differentiating malignant breast tumors from benign tumors and has better results than imaging techniques using fewer approaches.

Researchers at the Medical University of Vienna in Austria set out to determine if MP 18FDG PET/MR which uses dynamic contrast-enhanced MR (DCE-MR), diffusion-weighted imaging (DWI), three-dimensional proton MR spectroscopic imaging (3D H-MRSI) and 18FDG-PET would lead to an improvement in the differentiation of malignant and benign breast tumors.

They performed MP 18 FDG PET/MR on 76 patients who had suspicious or inconclusive findings after a mammogram or breast ultrasonograph. The patients' breast tumor biopsies were evaluated by histopathology.
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In order to find out what combination of imaging parameters led to the most accurate results, they first combined the imaging data from two parameters, then three and finally four. All of the two and three parameter evaluations involved DCE-MR.

Those results were compared with histopathology diagnosis in order to determine what combination was the most effective at making an accurate diagnosis. Histopathology found that 53 of the tumors were malignant and 23 were benign.

They found that the two and three parameter combinations did not reach the same sensitivity and specificity levels as the four parameter method. The technique can reduce the amount of unnecessary biopsies that are recommended by DCE-MR alone by 50 percent.

"It was shown that the more information we can get about breast tumors, the deeper is the understanding of tumor biology, the more accurate is tumor characterization and the better is the diagnosis," Dr. Katja Pinker, co-author of the study, told DOTmed News in an email. "This will contribute to tailoring a patient's therapy to her individual needs because not every breast cancer is the same."

Pinker wrote that if a hospital already has a PET/CT and an MR or a combined PET/MR then the technique can immediately be implemented in clinics.

She acknowledged that it's more costly to do PET/MR than other imaging methods, but that the use of one machine — PET/MR — instead of two machines — a PET/CT and MR — will improve cost-effectiveness. Additionally, since the study proved that there was a significant reduction in unnecessary breast biopsies with PET/MR, that will also further improve its cost-effectiveness.

"With all these advances in hardware and the possibility to spare biopsies, I believe this technique will rather sooner than later be adopted," she wrote.

Pinker and her fellow researchers are now conducting a follow-up study with a larger amount of patients to confirm the results of the first study.

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