Positron emission mammography (PEM) in newly diagnosed breast cancer patients: Can it detect other occult breast lesions and tumor size accurately

Positron emission mammography (PEM) in newly diagnosed breast cancer patients: Can it detect other occult breast lesions and tumor size accurately | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Positron emission mammography (PEM) in newly diagnosed breast cancer patients: Can it detect other occult breast lesions and tumor size accurately Eman Kamal, Mahmoud Mekhaimar, Rasha Abdel Hamid, Ghada Abdel-Salam, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6492983/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To evaluate the added value of preoperative positron emission mammography (PEM) in detecting tumor multiplicity and size. Methods: Seventy-seven patients (80 pathologically proven malignant breast lesions) were included in this cross-sectional, single-site study. All cases underwent PEM in addition to standard diagnostic sono-mammography, core biopsy, and surgery. PUV max and lesion-to-background ratio (LTB) values were calculated for each lesion. Results: All patients had at least one breast mass detected during clinical examination or screening mammography. Three out of 77 patients had bilateral breast masses. One out of 77 patients presented with a mass post-conservative breast surgery (CBS). Five out of 77 patients had renal impairment. Histopathological assessment of the lesions revealed that 4/80 (5%) were DCIS, 64/80 (80%) were IDC, and 11/80 (13.8%) were ILC. One case out of the 80 (1.3%) presented with metastatic axillary adenocarcinoma with no detectable pre- or post-operative breast cancer. Regarding tumor multiplicity, there was almost perfect agreement (Kappa value = 0.827, P value < 0.001) between the results of PEM and the post-operative pathology results, while there was fair agreement (Kappa value = 0.401, P value < 0.001) between sono-mammography (SM) and the post-operative pathology results. Ten cases were diagnosed by SM as single or multifocal malignant lesions. PEM was performed and revealed multicentric malignant lesions. The surgical management was modified accordingly, and they underwent modified radical mastectomy (MRM). The post-operative pathology results confirmed multicentric disease. Six cases were diagnosed by SM as multifocal or multicentric disease. PEM was performed and revealed a single malignant mass only. MRM could be avoided, and CBS was performed. The post-operative pathology results confirmed a single mass. One case was diagnosed by SM as a single malignant mass. PEM was performed and revealed multifocal malignant masses. The surgical management was modified accordingly, and CBS was performed. The post-operative pathology results confirmed multifocal malignant masses. One case was diagnosed by SM as multicentric malignant masses. PEM was performed and revealed multifocal malignant masses. The surgical management was modified accordingly, and CBS was performed instead of MRM. The post-operative pathology results confirmed multifocal malignant masses. Regarding lesion size, PEM also showed substantial agreement with the post-operative pathology results (single-measure intra-class correlation = 0.724, P value < 0.001). SM revealed fair agreement (intra-class correlation = 0.275, P value < 0.006). Conclusion: PEM is a sensitive and specific imaging modality for diagnosing breast cancer. It also demonstrates great accuracy in detecting tumor multiplicity and estimating precise tumor size; therefore, its use prior to surgery should be considered. Clinical Relevance/Application: PEM is a problem-solving tool in the pre-operative local staging of breast cancer in patients with contraindications to undergo MRI. Breast cancer post-operative SM (sono-mammography) positron emission mammography (PEM) conventional imaging PUV max LTB. Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6492983","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":473165651,"identity":"977649df-2616-4a1a-a27c-390aa7a2b072","order_by":0,"name":"Eman Kamal","email":"","orcid":"","institution":"Kasr Al-Ainy, Cairo University, Diagnostic and interventional Radiology,Department, Cairo, Egypt.","correspondingAuthor":false,"prefix":"","firstName":"Eman","middleName":"","lastName":"Kamal","suffix":""},{"id":473165652,"identity":"23a4ce45-cea1-464d-bd0d-3f2b56fe1a23","order_by":1,"name":"Mahmoud 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Moustafa","email":"","orcid":"","institution":"National Cancer Institute, Cairo University, Diagnostic and interventional Radiology Department, Cairo, Egypt.","correspondingAuthor":false,"prefix":"","firstName":"Amr","middleName":"","lastName":"Moustafa","suffix":""},{"id":473165665,"identity":"130dbba6-4907-4f3c-973b-4799f723e5b0","order_by":6,"name":"Mohammed Gomaa","email":"","orcid":"","institution":"National Cancer Institute, Cairo University, Diagnostic and interventional Radiology Department, Cairo, Egypt.","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"","lastName":"Gomaa","suffix":""},{"id":473165670,"identity":"c56488b1-6c52-4d7c-9e03-3e83a33cde24","order_by":7,"name":"Rasha Kamal","email":"","orcid":"","institution":"Kasr Al-Ainy, Cairo University, Diagnostic and interventional Radiology,Department, Cairo, Egypt.","correspondingAuthor":false,"prefix":"","firstName":"Rasha","middleName":"","lastName":"Kamal","suffix":""}],"badges":[],"createdAt":"2025-04-21 06:23:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6492983/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6492983/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85077954,"identity":"47fa7a62-441b-47da-a7ae-1fc3a54766ca","added_by":"auto","created_at":"2025-06-20 17:01:45","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1054782,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6492983/v1_covered_d1569461-90fa-448c-809e-59bd157f4b2c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Positron emission mammography (PEM) in newly diagnosed breast cancer patients: Can it detect other occult breast lesions and tumor size accurately","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, post-operative, SM (sono-mammography), positron emission mammography (PEM), conventional imaging, PUV max, LTB.","lastPublishedDoi":"10.21203/rs.3.rs-6492983/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6492983/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo evaluate the added value of preoperative positron emission mammography (PEM) in detecting tumor multiplicity and size.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeventy-seven patients (80 pathologically proven malignant breast lesions) were included in this cross-sectional, single-site study. All cases underwent PEM in addition to standard diagnostic sono-mammography, core biopsy, and surgery.\u003cbr\u003e\nPUV max and lesion-to-background ratio (LTB) values were calculated for each lesion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients had at least one breast mass detected during clinical examination or screening mammography. Three out of 77 patients had bilateral breast masses. One out of 77 patients presented with a mass post-conservative breast surgery (CBS). Five out of 77 patients had renal impairment.\u003cbr\u003e\nHistopathological assessment of the lesions revealed that 4/80 (5%) were DCIS, 64/80 (80%) were IDC, and 11/80 (13.8%) were ILC. One case out of the 80 (1.3%) presented with metastatic axillary adenocarcinoma with no detectable pre- or post-operative breast cancer.\u003cbr\u003e\nRegarding tumor multiplicity, there was almost perfect agreement (Kappa value = 0.827, P value \u0026lt; 0.001) between the results of PEM and the post-operative pathology results, while there was fair agreement (Kappa value = 0.401, P value \u0026lt; 0.001) between sono-mammography (SM) and the post-operative pathology results.\u003cbr\u003e\nTen cases were diagnosed by SM as single or multifocal malignant lesions. PEM was performed and revealed multicentric malignant lesions. The surgical management was modified accordingly, and they underwent modified radical mastectomy (MRM). The post-operative pathology results confirmed multicentric disease.\u003cbr\u003e\nSix cases were diagnosed by SM as multifocal or multicentric disease. PEM was performed and revealed a single malignant mass only. MRM could be avoided, and CBS was performed. The post-operative pathology results confirmed a single mass.\u003cbr\u003e\nOne case was diagnosed by SM as a single malignant mass. PEM was performed and revealed multifocal malignant masses. The surgical management was modified accordingly, and CBS was performed. The post-operative pathology results confirmed multifocal malignant masses.\u003cbr\u003e\nOne case was diagnosed by SM as multicentric malignant masses. PEM was performed and revealed multifocal malignant masses. The surgical management was modified accordingly, and CBS was performed instead of MRM. The post-operative pathology results confirmed multifocal malignant masses.\u003cbr\u003e\nRegarding lesion size, PEM also showed substantial agreement with the post-operative pathology results (single-measure intra-class correlation = 0.724, P value \u0026lt; 0.001). SM revealed fair agreement (intra-class correlation = 0.275, P value \u0026lt; 0.006).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePEM is a sensitive and specific imaging modality for diagnosing breast cancer. It also demonstrates great accuracy in detecting tumor multiplicity and estimating precise tumor size; therefore, its use prior to surgery should be considered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Relevance/Application:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePEM is a problem-solving tool in the pre-operative local staging of breast cancer in patients with contraindications to undergo MRI.\u003c/p\u003e","manuscriptTitle":"Positron emission mammography (PEM) in newly diagnosed breast cancer patients: Can it detect other occult breast lesions and tumor size accurately","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-20 16:37:40","doi":"10.21203/rs.3.rs-6492983/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33c5b727-53f9-4215-9cdb-5c2c2ed08aa4","owner":[],"postedDate":"June 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T19:38:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-20 16:37:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6492983","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6492983","identity":"rs-6492983","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}