A Clinical Study Of Dedicated Breast Positron Emission Tomography And Its Texture Classification In The Diagnosis Of Breast Cancer

Objectives:Breast cancer is the most common malignant tumor in women and is a serious threat to women's health.There are many imaging methods for diagnosing breast cancer,but they all have certain limitations.MAMMI PET(MAMmography with Molecular Imaging Positron Emission Tomography)is high-resolution imaging device,which has important application value in early diagnosis of breast cancer.There are few studies on MAMMI PET in China.The purpose of this study was to comprehensively evaluate diagnosis of MAMMI PET in breast cancer patients and to explore the correlation between SUVmax(Standardized Uptake Value)and clinical and pathological features of breast cancer.To compare the performance characteristics of MAMMI PET with traditional imaging mammography and ultrasound.Preliminary exploration of the application value of tumor texture classification in breast cancer diagnosis in MAMMI PET,and correlation analysis with clinical and pathological features of breast cancer.It provides a basis for the clinical application of MAMMI PET in the diagnosis of breast cancer.Methods:Patients with breast tumors diagnosed for the first time due to clinical breast examination,mammography or ultrasound examination were examined by MAMMI PET,and clinical,imaging and pathological data were collected.Taking pathological diagnosis as the gold standard,the breast cancer tumor size,pathological type,histological grade,clinical stage,ER,PR,HER-2,Ki-67,P53 and blood tumor markers CA125,CA153,CEA and other data were obtained.Correlate the SUVmax with the above factors.To compare the diagnostic efficacy of MAMMI PET with traditional imaging methods for mammography and ultrasound.Finally,the correlation between tumor texture classification and clinical and pathological features of breast cancer in MAMMI PET was analyzed to explore the application value of texture classification.Results: A total of 289 patients with 289 lesions were included in the study.MAMMI PET had a sensitivity of 96.2%,specificity of 88.8%,accuracy of 93.3%,positive predictive value of 93.2% and negative predictive value of 95.5% for all breast lesions.Mammography had a sensitivity of 95.5%,specificity of 69.4%,accuracy of86.2%,positive predictive value of 83.4% and negative predictive value of 90.7% for all breast lesions.Ultrasound had a sensitivity of 96.2%,specificity of 74.5%,accuracy of87.8%,positive predictive value of 85.7% and negative predictive value of 92.4% for all breast lesions.The diagnostic efficacy of MAMMI PET was higher than that ofmammography and ultrasound,and the difference was statistically significant.MAMMI PET had a sensitivity of 98.0%,specificity of 93.4%,accuracy of 96.7%,positive predictive value of 97.4% and negative predictive value of 95.0% for tumors?1cm.Mammography had a sensitivity of 96.7%,specificity of 68.9%,accuracy of 88.7%,positive predictive value of 88.6% and negative predictive value of 89.4% for tumors?1cm.Ultrasound had a sensitivity of 96.7%,specificity of 72.1%,accuracy of 89.7%,positive predictive value of89.6% and negative predictive value of 89.8% for tumors?1cm.The diagnostic efficacy of MAMMI PET was higher than that of mammography and ultrasound,and the difference was statistically significant.MAMMI PET had a sensitivity of 91.4%,specificity of79.1%,accuracy of 84.6%,positive predictive value of 78.0% and negative predictive value of 91.9% for tumors < 1cm.Mammography had a sensitivity of 88.6%,specificity of74.4%,accuracy of 80.8%,positive predictive value of 73.8% and negative predictive value of 88.9% for tumors < 1cm.Ultrasound had a sensitivity of 85.7%,specificity of76.7%,accuracy of 80.8%,positive predictive value of 75.0% and negative predictive value of 86.8% for tumors<1cm.The diagnostic efficacy of MAMMI PET was higher than that of mammography and ultrasound,and the difference was not statistically significant.MAMMI PET had a sensitivity of 71.4%,specificity of 77.3%,accuracy of75.9%,positive predictive value of 50.0% and negative predictive value of 89.5% for tumors?5mm.Mammography had a sensitivity of 57.1%,specificity of 68.2%,accuracy of65.5%,positive predictive value of 36.4% and negative predictive value of 83.3% for tumors?5mm.Ultrasound had a sensitivity of 57.1%,specificity of 72.7%,accuracy of69.0%,positive predictive value of 40.0% and negative predictive value of 84.2% for tumors?5mm.The diagnostic efficacy of MAMMI PET was slightly higher than that of mammography and ultrasound,but the difference was not statistically significant.ROC(Receiver Operating Characteristic)curve analysis the area under the curve of MAMMI PET for the diagnosis of breast cancer was 0.903.When the SUVmax was 8.88,the diagnostic efficiency was the best.Among the patients mis-diagnosed by mammography,the diagnostic accuracy of MAMMI PET was 89.2%.Among the patients mis-diagnosed by ultrasound,the diagnostic accuracy of MAMMI PET was 80.6%.MAMMI PET combined with mammography and ultrasound can improve the accuracy of breast cancer diagnosis to 99.3%.The SUVmax and tumor diameter of malignant breast lesions are higher than those of benign breast lesions.The SUVmax of breast cancer lesions ?1 cm is higher than the breast cancer lesions <1 cm and <1cm breast cancer lesions have higherSUVmax values than benign breast lesions.The SUVmax of breast cancer lesions with lymph node metastasis is higher than that of breast cancer lesions without lymph node metastasis.The SUVmax of breast cancer lesions with late tumor stage is higher than that of breast cancer with early tumor stage.The SUVmax of a breast cancer lesion with a high histological grade is higher than that of a breast cancer lesion with a low histological grade.The SUVmax of Luminal B,HER-2 overexpressing,and triple negative breast cancer lesions were higher than those of Luminal A lesions.The SUVmax of ER-negative breast cancer was higher than that of ER-positive breast cancer,and the SUVmax was negatively correlated with ER status.The SUVmax of PR-negative breast cancer is higher than that of PR-positive breast cancer.There was no significant correlation between SUVmax and PR status.The SUVmax of HER-2 positive breast cancer is higher than that of HER-2negative breast cancer.The SUVmax of breast cancer with high levels of Ki-67 is higher than that of breast cancer with low levels of Ki-67.The SUVmax is positively correlated with the Ki-67 level.The SUVmax of P53-positive breast cancer is higher than that of P53-negative breast cancer.The SUVmax is positively correlated with the P53 status.There was no statistical difference between the SUVmax of the CEA high group and the SUVmax of the CEA low group.There was no significant correlation between SUVmax and CEA levels.There was no statistical difference between the SUVmax of the CA125 high group and the SUVmax of the CA125 low group.There was no significant correlation between SUVmax and CA125 levels.The SUVmax of the CA153 high group is higher than the CA153 low group.SUVmax is positively correlated with CA153 level.A total of 211 lesions were measured for TeHe classification.Malignant lesions mainly showed TeHe=4,TeHe=5 and benign lesions mainly showed TeHe=1.The SUVmax of breast cancer lesions with TeHe=3,TeHe=4and TeHe=5 were higher than those with TeHe=1.The histological grade I breast cancer was TeHe=3,and the histological grade II and III breast cancers were mainly TeHe=4.With the higher tumor stage,the proportion of TeHe=1 decreased gradually,and the proportion of TeHe=5increased gradually.The CEA levels bTeHe=4,TeHe=5 was higher than the TeHe=1 group.There was no significant correlation between TeHe group and breast cancer molecular typing,Ki-67 levels,P53 status,CA125 levels and CA153 levels.Conclusions:(1)MAMMI PET imaging has high sensitivity and high specificity in the diagnosis of breast cancer,and can detect malignant lesions that cannot be found by traditional imaging examination.It has very high application value in the examination ofsmall lesions and multi-focal breast cancer.Partial breast lesions out of the field of view on MAMMI PET resulted in false negative diagnosis,which is related to the structural design of MAMMI PET itself and needs further improvement.(2)The diagnostic efficacy of MAMMI PET in breast cancer is slightly higher than that of mammography and ultrasound.The combination of MAMMI PET with mammography and ultrasound for the diagnosis of breast cancer can significantly improve the diagnostic accuracy.MAMMI PET has a high diagnostic accuracy in patients mis-diagnosed by mammography and ultrasound.MAMMI PET is an effective supplement to conventional imaging examination.(3)SUVmax was negatively correlated with ER and PR expression in breast cancer,and positively correlated with histological grade,tumor stage,lymph node metastasis status,tumor size,HER-2status,Ki-67 levels,P53 status,CA153 levels.There was no significant correlation between CEA levels and CA125 levels.SUVmax was important for judging the invasiveness and prognosis of breast cancer.(4)Through ROC curve analysis,SUVmax is8.88 is the best diagnosis point for breast cancer.At this time,the sensitivity,sensitivity and accuracy are high,and there is good consistency with pathological diagnosis.(5)The TeHe classification of MAMMI PET can further reveal the invasiveness of tumor from the aspect of structure and texture,which is the development direction of future imaging research.