Abstract P2-09-08: Correlating Breast Density with FDG-avidity on PET Imaging

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Abstract Purpose: It is well documented that breast density is an independent risk factor for the development of breast cancer[1]. Unlike traditional mammograms, PET-CT is uniquely positioned to analyze both the anatomy and metabolism of the breast parenchyma. FDG-avidity seen on PET-CT has been shown to correspond to the proliferation and number of tumor cells, though uptake in different types of breast cancer is variable, [2,3]. High FDG activity is not specific to malignancy, however, and can reflect increased metabolic activity in physiologic tissue like brown adipose tissue [4]. Increased metabolic activity in breast fibroglandular tissue could help explain the increased risk of malignancy in dense breasts. This study evaluates the correlation between FDG-avidity and tissue density of the breast in patients without breast malignancy. Patients and Methods: Radiology reports for PET-CTs from Jan. 1 - Sept. 1, 2023 were extracted from a single hospital site. Ten reports were selected in each age category (groups 30-39, 40-49, 50-59) in reverse chronological order. Inclusion criteria included female gender and complete visibility of bilateral breast tissue on PET-CT. Exclusion criteria included patients with primary breast cancer or with known metastases to the breast tissue (n=7), and prior breast procedures including implants (n=1). Each breast was scored on a scale of 1-4 on CT based on BI-RADS guidelines for breast density [5]. On attenuation-corrected PET imaging, each breast was scored on a scale of 1-4 based on the percentage of tissue with FDG-avidity. Results and Conclusion: There was a positive correlation between breast density and FDG-avid breast tissue with correlation coefficient (cc) of 0.53 (p<0.01, n=30). The positive correlation was maintained within each age category, cc= 0.45 in ages 30-39 (p=0.04, n=10), cc= 0.75 in ages 40-49(p<0.01, n=10), and cc = 0.67 in ages 50-59 (p<0.01, n=10). For most patients, the FDG-avidity of the breast correlated directly with the amount of fibroglandular tissue, though exceptions included a patient with extremely dense breast tissue (4) and minimal FDG-avidity (1) and one with scattered fibroglandular tissue (2) but high FDG-avidity (4). Given this positive correlation, increased metabolic activity in breast fibroglandular tissue may explain the association between breast density and development of breast cancer. References: Acciavatti et al. (2023). Beyond Breast Density: Risk Measures for Breast Cancer in Multiple Imaging Modalities. Radiology, 306(3), e222575. https://doi.org/10.1148/radiol.222575.Bos et al. Biologic correlates of (18)fluorodeoxyglucose uptake in human breast cancer measured by positron emission tomography. J Clin Oncol. 2002 Jan 15;20(2):379-87. Avril et al. (1996). Metabolic characterization of breast tumors with positron emission tomography using F-18 fluorodeoxyglucose. Journal of Clinical Oncology, 14(6), 1848–1857. Aukema et al. (2010). Prevention of brown adipose tissue activation in 18F-FDG PET/CT of breast cancer patients receiving neoadjuvant systemic therapy. Journal of nuclear medicine technology, 38(1), 24–27.D’Orsi et al. (2013). ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology. Citation Format: YiLi Zhao, Mary Salvatore. Correlating Breast Density with FDG-avidity on PET Imaging [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-09-08.

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