Positron Emission Tomography _PET_ Mammography A New Diagnostic Tool

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Positron Emission Tomography (PET)
Mammography: A New Diagnostic Tool
                                               high risk for multi-focal or aggressive               Cost
     Positron emission                         disease.1
                                                                                                     The cost of the PEM Flex Solo II unit was
     tomography (PET)                          Regulatory Status                                     unavailable. The cost for each PET
                                                                                                     mammography scan will likely be similar
     mammography                               The PEM Flex™ Solo II unit (Naviscan PET              to the cost of a whole-body PET scan
     incorporates PET                          Systems, Inc.) received US Food and Drug              since the infrastructure and radio-
     technology into a                         Administration clearance in 2003 for                  pharmaceutical costs will be similar.
                                               general-purpose imaging. Unlike whole-
     mammography unit that                     body PET units, dedicated PET                         In Canada, the total cost for each whole-
     can detect lesions as small               mammography units are not yet licensed                body FDG PET scan ranges from $1,231 to
                                               in Canada. Toronto-based IMAGIN                       $7,869, depending on patient volumes,
     as 2 mm; this is two to                                                                         the cost of the FDG radiopharmaceutical
                                               Diagnostic Centres, Inc. holds the
     three times smaller than                  Canadian distribution rights for PEM Flex.            dose, physician fees, capital infrastructure
                                                                                                     costs, operational costs, and the
     lesions that can be detected
                                               Evidence                                              regulatory costs of a clinical trial
     by whole-body PET.1                                                                             application for FDG products that have
                                               Currently, there is limited published
                                                                                                     not received a notice of compliance from
                                               evidence available. However, dedicated
How It Works                                                                                         Health Canada.3 For out-of-province
                                               PET mammography is more sensitive than
                                                                                                     residents, Alberta and Manitoba charge
PET is a nuclear medicine technology best      whole-body FDG PET imaging for
                                                                                                     approximately $1,250 and BC charges
known for its role in cancer imaging. A        detecting small lesions.1 One prospective,
                                                                                                     $1,500 per FDG PET scan. Private
small amount of a radioactive sugar            non-randomized clinical trial with 77
                                                                                                     Canadian PET facilities charge patients
molecule, 18 fluoro-2-deoxyglucose             patients reported that PET mammography
                                                                                                     approximately twice this amount.
(FDG), is injected into the bloodstream        had an overall accuracy of 88% to 92%
                                                                                                     Physician professional fees range from
and a scanner is used to detect and            compared with 71% for conventional
                                                                                                     $200 to $300 per case.
generate images that indicate areas of         imaging (p<0.001).2 This was largely due
high-FDG uptake. Many cancers require          to PET mammography performing better
more energy than normal cells and the          for very early-stage breast cancer that had
                                               not spread beyond the site of origin.                 1. Tafra L. Ann Surg Oncol 2007;14(1):3-13.
FDG tracer preferentially accumulates in
                                                                                                     2. Berg WA, et al. Breast J 2006;12(4):309-23.
these cells. This allows cancers to be seen
                                                                                                     3. Chuck A, et al. Int J Technol Assess Health Care
as “hot spots” on the PET scan. PET also                                                                2005;21(4):442-51.
guides therapy by assessing treatment

How It Fits Into Current Practice
PET mammography is also called positron
emission mammography or PEM. Like
whole-body PET imaging, it is an adjunct
to conventional breast cancer imaging for
disease staging or restaging, surgical
                                                                                                                                                      Photo courtesy of Naviscan.

planning, and for treatment evaluation. It
is not intended for breast cancer
screening or for assessing lymph node
status. PET mammography is proposed for
women who have breast lesions that are
difficult to characterize, especially women
with dense breast tissue and those at
                                                The Naviscan PEM Flex™ Solo II images the breast at the molecular level.

2    Issue 7 September 2007   Sign up for complimentary future issues at https://secure.cadth.ca/index.php/en/subscribe

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