Continuing Medical Education Article
The Role of Radiotracer Imaging in the Diagnosis and Management of Patients with Breast Cancer: Part 1—Overview, Detection, and Staging
JNM, April 2009, Volume 50, Number 4
Jean H. Lee1, Eric L. Rosen2, and David A. Mankoff1
1Department of Radiology, Seattle Cancer Care Alliance and University of Washington,
Seattle, Washington; and 2Seattle Radiologists, Seattle, Washington
In accordance with ACCME Revised Standards for Commercial Support and SNM Conflict-of-Interest Policy, David Mankoff has indicated he receives scientific study/trial support from Pfizer and GE Healthcare. No other potential conflict of interest relevant to this article was reported. Disclosure of a relationship is not intended to suggest or to condone bias but is made to provide participants with information that might be of potential importance to their evaluation of the activity.
This article contains information of value to imaging practitioners and professionals, including nuclear medicine physicians, technologists, and radiologists.
On successful completion of this activity, participants should be able to:
1. List diagnostic needs for breast cancer and current modalities used for each diagnostic need. 2. Describe where radionuclide imaging is most helpful in directing the care of breast cancer patients. 3. Discuss how current and future radiotracer imaging approaches may contribute to increasingly individualized breast cancer care.
1. Which of the following treatment modalities is not commonly used for breast cancer? A. Breast-conserving surgery. B. Thermal ablation. C. Breast radiotherapy.
D. Systemic chemotherapy or endocrine therapy. 2. Which of the following therapeutic agents specifically targets breast cancers that overexpress HER2? A. Trastuzumab. B. Bevacizumab. C. Letrozole. D. Tamoxifen. 3. Which of the following screening modalities has been shown to reduce the mortality of breast cancer and is widely recommended as part of routine breast cancer screening? A. Physical examination. B. Mammography. C. Breast MRI. D. Breast-specific γ-imaging. 4. Which of the following is the most sensitive for axillary nodal disease? A. Sentinel lymph node (SLN) biopsy. B. 18F-FDG PET/CT. C. Axillary ultrasound. D. MRI with ultra-small superparamagnetic iron oxide particles. 5. Which of the following recommendations for systemic staging in early (stage I and early stage II) breast cancer is consistent with current National Comprehensive Cancer Network guidelines? A. Chest or abdomen CT and bone scan for all patients. B. Chest, abdomen, or pelvis CT for all patients. C. 18F-FDG PET/CT for all patients. D. Systemic staging only if directed by symptoms. 6. Which statement best describes the relative effectiveness of a bone scan and 18F-FDG PET for detecting breast cancer bone metastases? A. 18F-FDG PET is more sensitive for all bone metastases. B. A bone scan is more sensitive for all bone metastases. C. 18F-FDG PET is more sensitive for lytic bone metastases. D. 18F-FDG PET is more sensitive for blastic metastases. 7. Compared with whole-body imaging devices, dedicated devices for SPECT and PET breast imaging. A. Can use a wider range of radiopharmaceuticals. B. Have higher spatial resolution and can therefore better detect uptake in smaller lesions. C. Have been shown to be more accurate in breast cancer diagnosis than breast MRI and ultrasound. D. Have a longer track record of use and clinical experience.
8. Which of the following breast cancers is most likely to be detected on 99m Tc-sestamibi or 18F-FDG PET: A. Tumors larger than 1 cm. B. Well-differentiated tumors. C. In situ carcinoma. D. All of the above. E. None of the above. 9. Which of the following statements is true regarding 18F-FDG PET in breast cancer? A. 18F-FDG PET is effective in primary tumor detection and has the potential to become a substitute for mammography in the near future. B. 18F-FDG PET is sensitive in axillary disease detection and has the potential to become a substitute for SLN biopsy. C. 18F-FDG PET, used in conjunction with directed ultrasonography and ultrasonography-guided biopsy, is helpful in high-risk patients for axillary disease who can benefit from direct axillary lymph node dissection without SLN biopsy. D. 18F-FDG PET is sensitive in distant disease detection including blastic bone metastasis. 10. Which of the following radiotracer imaging modalities is not suitable for the systemic staging of breast cancer? A. 18F-FDG PET and PET/CT. B. Positron emission mammography. C. 99mTc bone scintigraphy and SPECT.
NEWS RELEASE Ireland / Crisis: “Put people at the centre of policy measures,” says UN expert on extreme poverty GENEVA – The economic and financial crisis in Ireland poses a disproportionate threat to vulnerable segments in the country who benefitted little from its economic boom in the first place, the UN Independent Expert on human rights and extreme poverty, Magdalena Sepú
THE CALMING NATURE OF REPRODUCTORY DOMINANCE OF THE QUEEN IN THE HONEYBEE COLONY ( Apis mellifera L.) Z b i g n i e w L i p i ñ s k i 10-736 Olsztyn, Janina Wengris str 8. Poland. E-mail: [email protected] Received 05 April 2007; accepted 08 May 2007 The observation that withdrawal of the queen from the colony of western honeybees( A. mellifera L.) cause it unusual agit