Investigation of Added Value of Imaging Performed in a Prone Position to Standard 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging for Staging in Patients with Breast Cancer

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Abstract
Objectives: To investigate whether additional imaging in a prone position has any value to the supine whole-body''fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) images by comparing the visual and quantitative data about a local disease in the breast and axilla for the initial staging of breast cancer (BC). Methods: In this study, a total of 91 female patients with the BC were studied. Both the supine and prone images were examined based on the axial diameter, number and location of the primary tumor, local invasion signs of the tumor, the number of axillary lymph nodes with a suspected metastasis, metabolic parameters of the primary tumor and axillary lymph nodes, and registration artifacts of the PET and CT images were evaluated individually. These findings were compared with the histopathological data obtained after a surgery. Results: In the evaluation of a supine and prone imaging, tumor diameter and metabolic tumor volume (MTV) values of the breast lesions were greater in the supine position than in the prone position. However, there was no significant difference found between the other metabolic parameters of a primary tumor and axilla in both positions. In the supine and prone images, accuracy for skin involvement was 84% and 91.3%, respectively. Conclusion: In our study, we observed that, obtaining additional images in the prone position does not significantly benefit the evaluation of a local disease. The average values of the primary tumor diameter and MTV in the prone position appear to be smaller than the one in the supine position. However, the prone imaging in the patients with a newly diagnosed BC may be beneficial in selected patients and may contribute to preventing the false-positive results especially in patients with a suspected skin involvement.

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