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Investigations of Breast Tumors Withfluorine 10. Pacini F, Gasperi M, Fugazzola L, et al. Testicular thyroid cancer: potential risks and recommendations. dent: temporal correlation or casual relation? Br MedJ function in patients with differentiated thyroid carci Ear J Nuc! Med I993:20:192—194. 1994:309:158—162. noma treated with radioiodine. J Nucl Med 1994:35: 23. Dottorini ME, Lomuscio G, Mazzucchelli L, Vignati 34. Harjuletho T, Aro T, Rita H. Rytomaa T, SaxénL. The 1418 —1422. A, Colombo L. Assessment of female fertility and accident at Chernobyl and outcome of pregnancy in 11. Brincker H, Hansen HS, Andersen AP. Induction of carcinogenesis after iodine-I 3 1 therapy for differenti Finland. Br Med J I989:288:995—997. leukaemia by ‘@‘Itreatment ofthyroid carcinoma. BrJ ated thyroid carcinoma. J Nod Med 1995:36:21—27. 35. Bertollini R, Di Lallo D. Mastroiacovo P. Perucci CA. Cancer 1973:28:232—237. 24. Schlumberger M, Dc Vathaire F. Ceccarelli C, et al. 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Lancet 1990; high therapeutic doses of iodine- I3 1 in differentiated Berlin nine months after the Chemobyl reactor acci 335:887—888. withFluorine-Investigations of Breast Tumors SPECTLutz-H.18-Fluorodeoxygluco se and SchmidtandHolle, Ludwin Trampert, Sabine Lung-Kurt, Carlos E. Vittena-Heinsen, Werner Püschel,Sylvia OberhausenDepartmentsErich ofNuclear Medicine, Gynecology and Pathology, University Clinics ofSaarland, HomburglSaar, Germany Methods: We designed a prospective study to investigate the feasibility of combined FDG-SPECTand whole-body acquisition in Breastcancerisoneoftheleadingmalignantdiseasesof the diagnostic work-up of breast tumors applying visual analysis. women in the western hemisphere and is the most frequent We studied 50 patients with breast tumors of unknown histology. cause of death from malignant disease in women (1 ). Prognosis Results: ,AJlmalignantdiseaseswere accuratelydetected in tumors depends on early detection of the primary tumor site and >2.3 cm, while the smallest FDG-positivelesion was 1.4 cm. In a worsens after the development of metastases and disease subgroup of these patients,quantitativeevaluation(tumor-to-back progression (2). Standard imaging methods give accurate infor ground ratios) was added, which improved the sensitivity. Lymph mation in many patients, but there is concern that mammogra node metastaseswere accuratelyindicatedin 9 of 13 patients,while phy results in many unnecessary surgeries to obtain needed the detection of distant metastasesdepended on the location and size.False-positiveFDGscanswereobservedininflamedtissue,in histological information (3 ). Small lesions and recurrences after a rapidlygrowing phylloidestumor and in supposedlyhealthy surgery often lead to diagnostic problems. Therefore, an imag breasts.Conclusion: Theseresultsarecomparablewith prior inves ing method to detect primary and metastatic malignancies and tigations of other groups using PET. Therefore, FDG-SPECTand to distinguish between malignant and nonmalignant disease whole-body acquisition may be an adequate and less expensive would be useful. technique to meet the increasingdemand of FDG examinations. Recently, some efforts were made to use the glucose analog Key Words: fluorodeoxyglucose; breast tumors; SPECT; whole ‘8F-fluoro-2-deoxy-D-glucose (FDG) for this purpose (4,5). body acquisition; radionuclide imaging For several decades, tumor cells have been known to exhibit J Nuci Med 1996;37@15-622 increased glycolytic activity due to a higher energy demand and changes in the intracellular enzymatic profile (6, 7). FDG is phosphorylated like glucose by intracellular hexokinase and Received Feb. 23, 1995; revision accepted Jul. 30, 1995. undergoes no further metabolism, a phenomenon which results For correspondence or reprints contact Lutz-H. HOIIe, MD, Department of Nudear Medicine, University Clinics of Saarland, 66421 Homburg/Saar, Germany. in vigorous intracellular accumulation (8, 9). Several expen GAMMA CAMERA FDG IMAGING OF BREAST TUMORS •Hotle et at. 615 mental tumors were investigated with FDG and all showed high no myocardial physiological FDG uptake, resulting in improved FDG uptake suitable for PET or gamma camera imaging with imaging conditions for the detection of tumorous tissue, i.e., breast specially fitted collimators (9—13). Human studies demon lesions. FDG was produced by the Kernforschungszentrum strated the feasibility ofFDG for imaging lymphomas (14—16), Karlsruhe and transported to our department by courier service lung tumors (1 7—19),head and neck tumors (20,21 ), colon over a distance of 100 km. Fluorine-l8 was produced by the 180 cancer (22,23), liver tumors (24,25), brain tumors (26,27), (p, n)'8F nuclear reaction using highly enriched 180 water. The thyroid cancer (28) and breast cancer (29,30). FDG was used reaction in an IBA processing module is based on the transfer for primary and metastatic tumor detection and follow-up mediated substitution oftriflate by [‘8F]fluoride.The nonpyrogenic studies to assess the effectiveness of the tumor therapy FDG solution had a radiochemical purity higher than 95%. (5,25,31,32). Thus, FDG is suitable for imaging tumors with Anterior and posterior whote-body acquisition started 50 mm enhanced glycolytic activity. after the FDG application using a scan speed of 15 cm/mm.
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