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Vaz SC, Woll JPP, Cardoso F, Groheux D, Cook GJR, Ulaner GA, Jacene H, Rubio IT, Schoones JW, Peeters MJV, Poortmans P, Mann RM, Graff SL, Dibble EH, de Geus-Oei LF. Joint EANM-SNMMI guideline on the role of 2-[ 18F]FDG PET/CT in no special type breast cancer : (endorsed by the ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA). Eur J Nucl Med Mol Imaging 2024; 51:2706-2732. [PMID: 38740576 PMCID: PMC11224102 DOI: 10.1007/s00259-024-06696-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/20/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION There is much literature about the role of 2-[18F]FDG PET/CT in patients with breast cancer (BC). However, there exists no international guideline with involvement of the nuclear medicine societies about this subject. PURPOSE To provide an organized, international, state-of-the-art, and multidisciplinary guideline, led by experts of two nuclear medicine societies (EANM and SNMMI) and representation of important societies in the field of BC (ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA). METHODS Literature review and expert discussion were performed with the aim of collecting updated information regarding the role of 2-[18F]FDG PET/CT in patients with no special type (NST) BC and summarizing its indications according to scientific evidence. Recommendations were scored according to the National Institute for Health and Care Excellence (NICE) criteria. RESULTS Quantitative PET features (SUV, MTV, TLG) are valuable prognostic parameters. In baseline staging, 2-[18F]FDG PET/CT plays a role from stage IIB through stage IV. When assessing response to therapy, 2-[18F]FDG PET/CT should be performed on certified scanners, and reported either according to PERCIST, EORTC PET, or EANM immunotherapy response criteria, as appropriate. 2-[18F]FDG PET/CT may be useful to assess early metabolic response, particularly in non-metastatic triple-negative and HER2+ tumours. 2-[18F]FDG PET/CT is useful to detect the site and extent of recurrence when conventional imaging methods are equivocal and when there is clinical and/or laboratorial suspicion of relapse. Recent developments are promising. CONCLUSION 2-[18F]FDG PET/CT is extremely useful in BC management, as supported by extensive evidence of its utility compared to other imaging modalities in several clinical scenarios.
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Affiliation(s)
- Sofia C Vaz
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal.
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - David Groheux
- Nuclear Medicine Department, Saint-Louis Hospital, Paris, France
- University Paris-Diderot, INSERM U976, Paris, France
- Centre d'Imagerie Radio-Isotopique (CIRI), La Rochelle, France
| | - Gary J R Cook
- Department of Cancer Imaging, King's College London, London, UK
- King's College London and Guy's & St Thomas' PET Centre, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gary A Ulaner
- Molecular Imaging and Therapy, Hoag Family Cancer Institute, Newport Beach, CA, USA
- University of Southern California, Los Angeles, CA, USA
| | - Heather Jacene
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Cancer Center Clinica Universidad de Navarra, Navarra, Spain
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium
- University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Ritse M Mann
- Radiology Department, RadboudUMC, Nijmegen, The Netherlands
| | - Stephanie L Graff
- Lifespan Cancer Institute, Providence, Rhode Island, USA
- Legorreta Cancer Center at Brown University, Providence, Rhode Island, USA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands.
- Department of Radiation Science & Technology, Technical University of Delft, Delft, The Netherlands.
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Hottat NA, Badr DA, Ben Ghanem M, Besse-Hammer T, Lecomte SM, Vansteelandt C, Lecomte SL, Khaled C, De Grove V, Salem Wehbe G, Cannie MM, Jani JC. Assessment of whole-body MRI including diffusion-weighted sequences in the initial staging of breast cancer patients at high risk of metastases in comparison with PET-CT: a prospective cohort study. Eur Radiol 2024; 34:165-178. [PMID: 37555959 DOI: 10.1007/s00330-023-10060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/19/2023] [Accepted: 06/13/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE The aim of this study was to assess the diffusion-weighted whole-body-MRI (WBMRI) in the initial staging of breast cancer at high risk of metastases in comparison with positron emission tomography (PET)-CT. METHODS Forty-five women were prospectively enrolled. The inclusion criteria were female gender, age >18, invasive breast cancer, an initial PET-CT, and a performance status of 0-2. The exclusion criteria were contraindication to WB-MRI and breast cancer recurrence. The primary outcome was the concordance of WB-MRI and PET-CT in the diagnosis of distant metastases, whereas secondary outcomes included their concordance for the primary tumor and regional lymph nodes (LN), as well as the agreement of WB-MRI interpretation between two radiologists. RESULTS The mean age was 51.2 years with a median size of the primary tumor of 30 mm. Concordance between the two modalities was almost perfect for metastases staging, all sites included (k = 0.862), with excellent interobserver agreement. The accuracy of WB-MRI for detecting regional LN, distant LN, lung, liver, or bone metastases ranged from 91 to 96%. In 2 patients, WB-MRI detected bone metastases that were overlooked by PET-CT. WB-MRI showed a substantial agreement with PET-CT for staging the primary tumor, regional LN status, and stage (k = 0.766, k = 0.756, and k = 0.785, respectively) with a high interobserver agreement. CONCLUSION WB-MRI including DWI could be a reliable and reproducible examination in the initial staging of breast cancer patients at high risk of metastases, especially for bone metastases and therefore could be used as a surrogate to PET-CT. CLINICAL RELEVANCE STATEMENT Whole-body-MRI including DWI is a promising technique for detecting metastases in the initial staging of breast cancer at high risk of metastases. KEY POINTS Whole-body-MRI (WB-MRI) was effective for detecting metastases in the initial staging of 45 breast cancer patients at high risk of metastases in comparison with PET-CT. Concordance between WB-MRI and PET-CT was almost perfect for metastases staging, all sites included, with excellent interobserver agreement. The accuracy of WB-MRI for detecting bone metastases was 92%.
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Affiliation(s)
- Nathalie A Hottat
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020, Brussels, Belgium.
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium.
| | - Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Meriem Ben Ghanem
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020, Brussels, Belgium
| | - Tatiana Besse-Hammer
- Clinical Research Unit, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvie M Lecomte
- Department of Oncology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Catherine Vansteelandt
- Department of Oncology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Sophie L Lecomte
- Department of Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Chirine Khaled
- Department of Pathology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Veerle De Grove
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020, Brussels, Belgium
| | - Georges Salem Wehbe
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Mirshahvalad SA, Kohan A, Metser U, Hinzpeter R, Ortega C, Farag A, Veit-Haibach P. Diagnostic performance of whole-body [ 18F]FDG PET/MR in cancer M staging: A systematic review and meta-analysis. Eur Radiol 2024; 34:673-685. [PMID: 37535156 DOI: 10.1007/s00330-023-10009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/14/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES To calculate the pooled diagnostic performances of whole-body [18F]FDG PET/MR in M staging of [18F]FDG-avid cancer entities. METHODS A diagnostic meta-analysis was conducted on the [18F]FDG PET/MR in M staging, including studies: (1) evaluated [18F]FDG PET/MR in detecting distant metastasis; (2) compared[ 18F]FDG PET/MR with histopathology, follow-up, or asynchronous multimodality imaging as the reference standard; (3) provided data for the whole-body evaluation; (4) provided adequate data to calculate the meta-analytic performances. Pooled performances were calculated with their confidence interval. In addition, forest plots, SROC curves, and likelihood ratio scatterplots were drawn. All analyses were performed using STATA 16. RESULTS From 52 eligible studies, 2289 patients and 2072 metastases were entered in the meta-analysis. The whole-body pooled sensitivities were 0.95 (95%CI: 0.91-0.97) and 0.97 (95%CI: 0.91-0.99) at the patient and lesion levels, respectively. The pooled specificities were 0.99 (95%CI: 0.97-1.00) and 0.97 (95%CI: 0.90-0.99), respectively. Additionally, subgroup analyses were performed. The calculated pooled sensitivities for lung, gastrointestinal, breast, and gynecological cancers were 0.90, 0.93, 1.00, and 0.97, respectively. The pooled specificities were 1.00, 0.98, 0.97, and 1.00, respectively. Furthermore, the pooled sensitivities for non-small cell lung, colorectal, and cervical cancers were 0.92, 0.96, and 0.86, respectively. The pooled specificities were 1.00, 0.95, and 1.00, respectively. CONCLUSION [18F]FDG PET/MR was a highly accurate modality in M staging in the reported [18F]FDG-avid malignancies. The results showed high sensitivity and specificity in each reviewed malignancy type. Thus, our findings may help clinicians and patients to be confident about the performance of [18F]FDG PET/MR in the clinic. CLINICAL RELEVANCE STATEMENT Although [18F]FDG PET/MR is not a routine imaging technique in current guidelines, mostly due to its availability and logistic issues, our findings might add to the limited evidence regarding its performance, showing a sensitivity of 0.95 and specificity of 0.97. KEY POINTS • The whole-body [18F]FDG PET/MR showed high accuracy in detecting distant metastases at both patient and lesion levels. • The pooled sensitivities were 95% and 97% and pooled specificities were 99% and 97% at patient and lesion levels, respectively. • The results suggested that 18F-FDG PET/MR was a strong modality in the exclusion and confirmation of distant metastases.
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Affiliation(s)
- Seyed Ali Mirshahvalad
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada.
| | - Andres Kohan
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada
| | - Ricarda Hinzpeter
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada
| | - Claudia Ortega
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada
| | - Adam Farag
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada
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Mainta IC, Sfakianaki I, Shiri I, Botsikas D, Garibotto V. The Clinical Added Value of Breast Cancer Imaging Using Hybrid PET/MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:565-577. [PMID: 37741641 DOI: 10.1016/j.mric.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Dedicated MR imaging is highly performant for the evaluation of the primary lesion and should regularly be added to whole-body PET/MR imaging for the initial staging. PET/MR imaging is highly sensitive for the detection of nodal involvement and could be combined with the high specificity of axillary second look ultrasound for the confirmation of the N staging. For M staging, with the exception of lung lesions, PET/MR imaging is superior to PET/computed tomography, at half the radiation dose. The predictive value of multiparametric imaging with PET/MR imaging holds promise to improve through radiomics and artificial intelligence.
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Affiliation(s)
- Ismini C Mainta
- Department of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland.
| | - Ilektra Sfakianaki
- Department of Radiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
| | - Isaac Shiri
- Department of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
| | - Diomidis Botsikas
- Department of Radiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
| | - Valentina Garibotto
- Department of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland; Faculty of Medicine, University of Geneva, Rue Michel Servet 1, Geneva 1211, Switzerland
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Sabeghi P, Katal S, Chen M, Taravat F, Werner TJ, Saboury B, Gholamrezanezhad A, Alavi A. Update on Positron Emission Tomography/Magnetic Resonance Imaging: Cancer and Inflammation Imaging in the Clinic. Magn Reson Imaging Clin N Am 2023; 31:517-538. [PMID: 37741639 DOI: 10.1016/j.mric.2023.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Hybrid PET/MRI is highly valuable, having made significant strides in overcoming technical challenges and offering unique advantages such as reduced radiation, precise data coregistration, and motion correction. Growing evidence highlights the value of PET/MRI in broad clinical aspects, including inflammatory and oncological imaging in adults, pregnant women, and pediatrics, potentially surpassing PET/CT. This newly integrated solution may be preferred over PET/CT in many clinical conditions. However, further technological advancements are required to facilitate its broader adoption as a routine diagnostic modality.
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Affiliation(s)
- Paniz Sabeghi
- Department of Radiology, Keck School of Medicine of University of Southern California, Health Science Campus, 1500 San Pablo Street, Los Angeles, CA 90033, USA
| | - Sanaz Katal
- Medical Imaging Department of St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michelle Chen
- Department of Radiology, Keck School of Medicine of University of Southern California, Health Science Campus, 1500 San Pablo Street, Los Angeles, CA 90033, USA
| | - Farzaneh Taravat
- Department of Radiology, Keck School of Medicine of University of Southern California, Health Science Campus, 1500 San Pablo Street, Los Angeles, CA 90033, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Babak Saboury
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine of University of Southern California, Health Science Campus, 1500 San Pablo Street, Los Angeles, CA 90033, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Vaz SC, Oliveira C, Teixeira R, Arias-Bouda LMP, Cardoso MJ, de Geus-Oei LF. The current role of nuclear medicine in breast cancer. Br J Radiol 2023; 96:20221153. [PMID: 37097285 PMCID: PMC10461286 DOI: 10.1259/bjr.20221153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 04/26/2023] Open
Abstract
Breast cancer is the most common cancer in females worldwide. Nuclear medicine plays an important role in patient management, not only in initial staging, but also during follow-up. Radiopharmaceuticals to study breast cancer have been used for over 50 years, and several of these are still used in clinical practice, according to the most recent guideline recommendations.In this critical review, an overview of nuclear medicine procedures used during the last decades is presented. Current clinical indications of each of the conventional nuclear medicine and PET/CT examinations are the focus of this review, and are objectively provided. Radionuclide therapies are also referred, mainly summarising the methods to palliate metastatic bone pain. Finally, recent developments and future perspectives in the field of nuclear medicine are discussed. In this context, the promising potential of new radiopharmaceuticals not only for diagnosis, but also for therapy, and the use of quantitative imaging features as potential biomarkers, are addressed.Despite the long way nuclear medicine has gone through, it looks like it will continue to benefit clinical practice, paving the way to improve healthcare provided to patients with breast cancer.
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Affiliation(s)
| | - Carla Oliveira
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Ricardo Teixeira
- Nuclear Medicine-Radiopharmacology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
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Ruan D, Sun L. Diagnostic Performance of PET/MRI in Breast Cancer: A Systematic Review and Bayesian Bivariate Meta-analysis. Clin Breast Cancer 2023; 23:108-124. [PMID: 36549970 DOI: 10.1016/j.clbc.2022.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/07/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION By performing a systematic review and meta-analysis, the diagnostic value of 18F-FDG PET/MRI in breast lesions, lymph nodes, and distant metastases was assessed, and the merits and demerits of PET/MRI in the application of breast cancer were comprehensively reviewed. METHODS Breast cancer-related studies using 18F-FDG PET/MRI as a diagnostic tool published before September 12, 2022 were included. The pooled sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under the curve (AUC) were calculated using Bayesian bivariate meta-analysis in a lesion-based and patient-based manner. RESULTS We ultimately included 24 studies (including 1723 patients). Whether on a lesion-based or patient-based analysis, PET/MRI showed superior overall pooled sensitivity (0.95 [95% CI: 0.92-0.98] & 0.93 [95% CI: 0.88-0.98]), specificity (0.94 [95% CI: 0.90-0.97] & 0.94 [95% CI: 0.92-0.97]), LDOR (5.79 [95% CI: 4.95-6.86] & 5.64 [95% CI: 4.58-7.03]) and AUC (0.98 [95% CI: 0.94-0.99] & 0.98[95% CI: 0.92-0.99]) for diagnostic applications in breast cancer. In the specific subgroup analysis, PET/MRI had high pooled sensitivity and specificity for the diagnosis of breast lesions and distant metastatic lesions and was especially excellent for bone lesions. PET/MRI performed poorly for diagnosing axillary lymph nodes but was better than for lymph nodes at other sites (pooled sensitivity, specificity, LDOR, AUC: 0.86 vs. 0.58, 0.90 vs. 0.82, 4.09 vs. 1.98, 0.89 vs. 0.84). CONCLUSION 18F-FDG PET/MRI performed excellently in diagnosing breast lesions and distant metastases. It can be applied to the initial diagnosis of suspicious breast lesions, accurate staging of breast cancer patients, and accurate restaging of patients with suspected recurrence.
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Affiliation(s)
- Dan Ruan
- Department of Nuclear Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Long Sun
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen, China.
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Mirshahvalad SA, Metser U, Basso Dias A, Ortega C, Yeung J, Veit-Haibach P. 18F-FDG PET/MRI in Detection of Pulmonary Malignancies: A Systematic Review and Meta-Analysis. Radiology 2023; 307:e221598. [PMID: 36692397 DOI: 10.1148/radiol.221598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background There have been conflicting results regarding fluorine 18-labeled fluorodeoxyglucose (18F-FDG) PET/MRI diagnostic performance in lung malignant neoplasms. Purpose To evaluate the diagnostic performance of 18F-FDG PET/MRI for the detection of pulmonary malignant neoplasms. Materials and Methods A systematic search was conducted within the Scopus, Web of Science, and PubMed databases until December 31, 2021. Published original articles that met the following criteria were considered eligible for meta-analysis: (a) detecting malignant lesions in the lung, (b) comparing 18F-FDG PET/MRI with a valid reference standard, and (c) providing data for the meta-analytic calculations. A hierarchical method was used to pool the performances. The bivariate model was used to find the summary points and 95% CIs. The hierarchical summary receiver operating characteristic model was used to draw the summary receiver operating characteristic curve and calculate the area under the curve. The Higgins I2 statistic and Cochran Q test were used for heterogeneity assessment. Results A total of 43 studies involving 1278 patients met the inclusion criteria and were included in the meta-analysis. 18F-FDG PET/MRI had a pooled sensitivity and specificity of 96% (95% CI: 84, 99) and 100% (95% CI: 98, 100), respectively. 18F-FDG PET/CT had a pooled sensitivity and specificity of 99% (95% CI: 61, 100) and 99% (95% CI: 94, 100), respectively, which were comparable with those of 18F-FDG PET/MRI. At meta-regression, studies in which contrast media (P = .03) and diffusion-weighted imaging (P = .04) were used as a part of a pulmonary 18F-FDG PET/MRI protocol showed significantly higher sensitivities. Conclusion Fluorine 18-labeled fluorodeoxyglucose (18F-FDG) PET/MRI was found to be accurate and comparable with 18F-FDG PET/CT in the detection of malignant pulmonary lesions, with significantly improved sensitivity when advanced acquisition protocols were used. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Seyed Ali Mirshahvalad
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Ur Metser
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Adriano Basso Dias
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Claudia Ortega
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Jonathan Yeung
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Patrick Veit-Haibach
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
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HYBRID – 68Ga-FAPI-PET/MRT deckt bei Mammakarzinomen zusätzliche Tumoren auf. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/a-1754-1912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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10
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The potential of predictive and prognostic breast MRI (P2-bMRI). Eur Radiol Exp 2022; 6:42. [PMID: 35989400 PMCID: PMC9393116 DOI: 10.1186/s41747-022-00291-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
Magnetic resonance imaging (MRI) is an important part of breast cancer diagnosis and multimodal workup. It provides unsurpassed soft tissue contrast to analyse the underlying pathophysiology, and it is adopted for a variety of clinical indications. Predictive and prognostic breast MRI (P2-bMRI) is an emerging application next to these indications. The general objective of P2-bMRI is to provide predictive and/or prognostic biomarkers in order to support personalisation of breast cancer treatment. We believe P2-bMRI has a great clinical potential, thanks to the in vivo examination of the whole tumour and of the surrounding tissue, establishing a link between pathophysiology and response to therapy (prediction) as well as patient outcome (prognostication). The tools used for P2-bMRI cover a wide spectrum: standard and advanced multiparametric pulse sequences; structured reporting criteria (for instance BI-RADS descriptors); artificial intelligence methods, including machine learning (with emphasis on radiomics data analysis); and deep learning that have shown compelling potential for this purpose. P2-bMRI reuses the imaging data of examinations performed in the current practice. Accordingly, P2-bMRI could optimise clinical workflow, enabling cost savings and ultimately improving personalisation of treatment. This review introduces the concept of P2-bMRI, focusing on the clinical application of P2-bMRI by using semantic criteria.
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11
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de Mooij CM, Samiei S, Mitea C, Lobbes MBI, Kooreman LFS, Heuts EM, Beets-Tan RGH, van Nijnatten TJA, Smidt ML. Axillary lymph node response to neoadjuvant systemic therapy with dedicated axillary hybrid 18F-FDG PET/MRI in clinically node-positive breast cancer patients: a pilot study. Clin Radiol 2022; 77:e732-e740. [PMID: 35850866 DOI: 10.1016/j.crad.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
AIM To investigate the diagnostic performance of dedicated axillary hybrid 18F-2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) in detecting axillary pathological complete response (pCR) following neoadjuvant systemic therapy (NST) in clinically node-positive breast cancer patients. MATERIALS AND METHODS Ten prospectively included clinically node-positive breast cancer patients underwent dedicated axillary hybrid 18F-FDG PET/MRI after completing NST followed by axillary surgery. PET images were reviewed by a nuclear medicine physician and coronal T1-weighted and T2-weighted MRI images by a radiologist. All axillary lymph nodes visible on PET/MRI were matched with those removed during axillary surgery. Diagnostic performance parameters were calculated based on patient-by-patient and node-by-node validation with histopathology of the axillary surgical specimen as the reference standard. RESULTS Six patients achieved axillary pCR at final histopathology. A total of 84 surgically harvested axillary lymph nodes were matched with axillary lymph nodes depicted on PET/MRI. Histopathological examination of the matched axillary lymph nodes resulted in 10 lymph nodes with residual axillary disease of which eight contained macrometastases and two micrometastases. The patient-by-patient analysis yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 25%, 100%, 100%, and 67%, respectively. The diagnostic performance parameters of the node-by-node analysis were 0%, 96%, 0%, and 88%, respectively. Excluding micrometastases from the node-by-node analysis increased the negative predictive value to 90%. CONCLUSION This pilot study suggests that the negative predictive value and sensitivity of dedicated axillary 18F-FDG PET/MRI are insufficiently accurate to detect axillary pCR or exclude residual axillary disease following NST in clinically node-positive breast cancer patients.
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Affiliation(s)
- C M de Mooij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - S Samiei
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - C Mitea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - L F S Kooreman
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Pathology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - E M Heuts
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - R G H Beets-Tan
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Radiology, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - M L Smidt
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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12
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Bhaludin BN, Tunariu N, Koh DM, Messiou C, Okines AF, McGrath SE, Ring AE, Parton MM, Sharma B, Gagliardi T, Allen SD, Pope R, Johnston SRD, Downey K. A review on the added value of whole-body MRI in metastatic lobular breast cancer. Eur Radiol 2022; 32:6514-6525. [PMID: 35384456 DOI: 10.1007/s00330-022-08714-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/01/2022]
Abstract
Invasive lobular breast carcinomas (ILC) account for approximately 15% of breast cancer diagnoses. They can be difficult to diagnose both clinically and radiologically, due to their infiltrative growth pattern. The pattern of metastasis of ILC is unusual, with spread to the serosal surfaces (pleura and peritoneum), retroperitoneum and gastrointestinal (GI)/genitourinary (GU) tracts and a higher rate of leptomeningeal spread than IDC. Routine staging and response assessment with computed tomography (CT) can be undertaken quickly and measurements can be reproduced easily, but this is challenging with metastatic ILC as bone-only/bone-predominant patterns are frequently seen and assessment of the disease status is limited in these scenarios. Functional imaging such as whole-body MRI (WBMRI) allows the assessment of bone and soft tissue disease by providing functional information related to differences in cellular density between malignant and benign tissues. A number of recent studies have shown that WBMRI can detect additional sites of disease in metastatic breast cancer (MBC), resulting in a change in systemic anti-cancer therapy. Although WBMRI and fluorodeoxyglucose-positron-emission tomography-computed tomography (FDG-PET/CT) have a comparable performance in the assessment of MBC, WBMRI can be particularly valuable as a proportion of ILC are non-FDG-avid, resulting in the underestimation of the disease extent. In this review, we explore the added value of WBMRI in the evaluation of metastatic ILC and compare it with other imaging modalities such as CT and FDG-PET/CT. We also discuss the spectrum of WBMRI findings of the different metastatic sites of ILC with CT and FDG-PET/CT correlation. KEY POINTS: • ILC has an unusual pattern of spread compared to IDC, with metastases to the peritoneum, retroperitoneum and GI and GU tracts, but the bones and liver are the commonest sites. • WBMRI allows functional assessment of metastatic disease, particularly in bone-only and bone-predominant metastatic cancers such as ILC where evaluation with CT can be challenging and limited. • WBMRI can detect more sites of disease compared with CT, can reveal disease progression earlier and provides the opportunity to change ineffective systemic treatment sooner.
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Affiliation(s)
- Basrull N Bhaludin
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK.
| | - Nina Tunariu
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK.,Institute of Cancer Research, London, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK.,Institute of Cancer Research, London, UK
| | - Christina Messiou
- Department of Radiology, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK.,Institute of Cancer Research, London, UK
| | - Alicia F Okines
- Breast Unit, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Sophie E McGrath
- Breast Unit, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK
| | - Alistair E Ring
- Breast Unit, The Royal Marsden Hospital, Downs Rd, Sutton, England, SM2 5PT, UK
| | - Marina M Parton
- Breast Unit, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Bhupinder Sharma
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Tanja Gagliardi
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Steven D Allen
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Romney Pope
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Stephen R D Johnston
- Breast Unit, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
| | - Kate Downey
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Rd, London, England, SW3 6JJ, UK
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13
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Bruckmann NM, Morawitz J, Fendler WP, Ruckhäberle E, Bittner AK, Giesel FL, Herrmann K, Antoch G, Umutlu L, Kirchner J. A Role of PET/MR in Breast Cancer? Semin Nucl Med 2022; 52:611-618. [DOI: 10.1053/j.semnuclmed.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 01/18/2023]
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14
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The NILS Study Protocol: A Retrospective Validation Study of an Artificial Neural Network Based Preoperative Decision-Making Tool for Noninvasive Lymph Node Staging in Women with Primary Breast Cancer (ISRCTN14341750). Diagnostics (Basel) 2022; 12:diagnostics12030582. [PMID: 35328135 PMCID: PMC8947586 DOI: 10.3390/diagnostics12030582] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
Newly diagnosed breast cancer (BC) patients with clinical T1–T2 N0 disease undergo sentinel-lymph-node (SLN) biopsy, although most of them have a benign SLN. The pilot noninvasive lymph node staging (NILS) artificial neural network (ANN) model to predict nodal status was published in 2019, showing the potential to identify patients with a low risk of SLN metastasis. The aim of this study is to assess the performance measures of the model after a web-based implementation for the prediction of a healthy SLN in clinically N0 BC patients. This retrospective study was designed to validate the NILS prediction model for SLN status using preoperatively available clinicopathological and radiological data. The model results in an estimated probability of a healthy SLN for each study participant. Our primary endpoint is to report on the performance of the NILS prediction model to distinguish between healthy and metastatic SLNs (N0 vs. N+) and compare the observed and predicted event rates of benign SLNs. After validation, the prediction model may assist medical professionals and BC patients in shared decision making on omitting SLN biopsies in patients predicted to be node-negative by the NILS model. This study was prospectively registered in the ISRCTN registry (identification number: 14341750).
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Fowler AM, Strigel RM. Clinical advances in PET-MRI for breast cancer. Lancet Oncol 2022; 23:e32-e43. [PMID: 34973230 PMCID: PMC9673821 DOI: 10.1016/s1470-2045(21)00577-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 01/03/2023]
Abstract
Imaging is paramount for the early detection and clinical staging of breast cancer, as well as to inform management decisions and direct therapy. PET-MRI is a quantitative hybrid imaging technology that combines metabolic and functional PET data with anatomical detail and functional perfusion information from MRI. The clinical applicability of PET-MRI for breast cancer is an active area of research. In this Review, we discuss the rationale and summarise the clinical evidence for the use of PET-MRI in the diagnosis, staging, prognosis, tumour phenotyping, and assessment of treatment response in breast cancer. The continued development and approval of targeted radiopharmaceuticals, together with radiomics and automated analysis tools, will further expand the opportunity for PET-MRI to provide added value for breast cancer imaging and patient care.
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Affiliation(s)
- Amy M Fowler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
| | - Roberta M Strigel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Carbone Cancer Center, Madison, WI, USA
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16
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Seifert R, Kersting D, Rischpler C, Opitz M, Kirchner J, Pabst KM, Mavroeidi IA, Laschinsky C, Grueneisen J, Schaarschmidt B, Catalano OA, Herrmann K, Umutlu L. Clinical Use of PET/MR in Oncology: An Update. Semin Nucl Med 2021; 52:356-364. [PMID: 34980479 DOI: 10.1053/j.semnuclmed.2021.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022]
Abstract
The combination of PET and MRI is one of the recent advances of hybrid imaging. Yet to date, the adoption rate of PET/MRI systems has been rather slow. This seems to be partially caused by the high costs of PET/MRI systems and the need to verify an incremental benefit over PET/CT or sequential PET/CT and MRI. In analogy to PET/CT, the MRI part of PET/MRI was primarily used for anatomical imaging. Though this can be advantageous, for example in diseases where the superior soft tissue contrast of MRI is highly appreciated, the sole use of MRI for anatomical orientation lessens the potential of PET/MRI. Consequently, more recent studies focused on its multiparametric potential and employed diffusion weighted sequences and other functional imaging sequences in PET/MRI. This integration puts the focus on a more wholesome approach to PET/MR imaging, in terms of releasing its full potential for local primary staging based on multiparametric imaging and an included one-stop shop approach for whole-body staging. This approach as well as the implementation of computational analysis, in terms of radiomics analysis, has been shown valuable in several oncological diseases, as will be discussed in this review article.
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Affiliation(s)
- Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; Department of Nuclear Medicine, University Hospital Münster, Münster, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany.
| | - David Kersting
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Kim M Pabst
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Ilektra-Antonia Mavroeidi
- West German Cancer Center, University Hospital Essen, Essen, Germany.; Clinic for Internal Medicine (Tumor Research), University Hospital Essen, Essen, Germany
| | - Christina Laschinsky
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Johannes Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Onofrio Antonio Catalano
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA; Abdominal Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany; West German Cancer Center, University Hospital Essen, Essen, Germany.; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Liu J, Sun R, Yin Y, Li J, Liu X, Liu S, Zhang Z, Hu J, Wan X, Zhang H. Is 18F-FDG PET/CT Beneficial for Newly Diagnosed Breast Cancer Patients With Low Proportion of ER Expression? Front Oncol 2021; 11:755899. [PMID: 34804947 PMCID: PMC8599817 DOI: 10.3389/fonc.2021.755899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE It is unclear whether the receptor status of breast malignancy or the proportion of receptors expression is useful in the interpretation of 18F-FDG PET/CT. This study's purpose was to analyze whether 18F-FDG PET/CT was valuable for helping newly diagnosed breast cancer patients find suspected or unsuspected metastasis lesions based on the proportion of receptors expression. MATERIALS AND METHODS Eighty newly diagnosed breast cancer patients were divided into six groups, containing N0 (no extraaxillary lymph node metastasis), N1 (extraaxillary lymph node metastasis), M0 (no distant metastasis), and M1 (distant metastasis) groups, C0 (no unsuspected metastasis), and C1 (unsuspected metastasis and treatment plan changed) detected by PET/CT. The main data, including the proportion of receptors ER (estrogen receptor), PR (progesterone receptor), and Her-2 (human epidermal growth factor receptor 2) status, were extracted. Simple correlation and logistic regression were preformed to analyze the association between them. RESULTS Patients in N1 group had lower proportion of ER (%) and PR (%) than that in N0 group (ER: 2 [0-80] vs. 80 [15-95]; PR: 1 [0-10] vs. 20 [0-45], p<0.001). Moreover, the proportions of ER and PR were negatively correlated with N1 (ER: [r= -0.339, p= 0.002], PR: [r= -0.247, p= 0.011]) by simple correlation. Also, patients in C1 group had lower proportion of ER (%) and PR (%) than those in C0 group (ER: 10 [0-85] vs. 80 [15-90], p=0.026; PR: 1 [0-10] vs. 20 [0-70], p=0.041), while the distribution of ER and PR between M1 and M0 group had no significant difference. After the adjustment of traditional factors, the negative correlation between the proportion of ER (OR=0.986, 95% CI of OR [0.972-0.999], p=0.016) and C1 was found by logistic regression, cutoff value was 25% (ER) calculated by ROC (Receiver Operating Characteristic) curve (AUC [Area Under Curve]= 0.647, p=0.024). CONCLUSION The proportion of ER in newly diagnosed breast cancer was negatively correlated with unsuspected metastasis detected by 18F-FDG PET/CT. 18F-FDG PET/CT might be recommended for newly diagnosed breast cancer patients with single lesions when the ER expression proportion is less than 25% to find unsuspected metastasis lesions and to modify treatment plan contrasted with conventional imaging and clinical examination.
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Affiliation(s)
- Jiachen Liu
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Runlu Sun
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuping Yin
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingyan Li
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xuming Liu
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sheng Liu
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhanlei Zhang
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jieting Hu
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoting Wan
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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18
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Backhaus P, Burg MC, Roll W, Büther F, Breyholz HJ, Weigel S, Heindel W, Pixberg M, Barth P, Tio J, Schäfers M. Simultaneous FAPI PET/MRI Targeting the Fibroblast-Activation Protein for Breast Cancer. Radiology 2021; 302:39-47. [PMID: 34636633 DOI: 10.1148/radiol.2021204677] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Integrated PET/MRI is a promising modality for breast assessment. The most frequently used tracer, fluorine 18 (18F) fluorodeoxyglucose (FDG), is applied for whole-body staging in advanced breast cancer but has limited accuracy in evaluating primary breast lesions. The fibroblast-activation protein (FAP) is abundantly expressed in invasive breast cancer. FAP-directed PET tracers have recently become available, but results in primary breast tumors remain lacking. Purpose To evaluate the use of FAP inhibitor (FAPI) breast PET/MRI in assessing breast lesions and of FAPI whole-body scanning for lymph node (LN) and distant staging using the ligand gallium 68 (68Ga)-FAPI-46. Materials and Methods In women with histologically confirmed invasive breast cancer, all primary 68Ga-FAPI-46 breast and whole-body PET/MRI and PET/CT examinations conducted at the authors' center between October 2019 and December 2020 were retrospectively analyzed. MRI lesion characteristics and standardized uptake values (SUVs) were quantified with dedicated software. Mann-Whitney U tests were used to compare tumor SUVs across different tumor types. The Pearson correlation coefficient was calculated between SUV and measures of MRI morphologic characteristics. Results Nineteen women (mean age, 49 years ± 9 [standard deviation]) were evaluated-18 to complement initial staging and one for restaging after therapy for distant metastases. Strong tracer accumulation was observed in all 18 untreated primary breast malignancies (mean maximum SUV [SUVmax] = 13.9 [range, 7.9-29.9]; median lesion diameter = 26 mm [range, 9-155 mm]), resulting in clear tumor delineation across different gradings, receptors, and histologic types. All preoperatively verified LN metastases in 13 women showed strong tracer accumulation (mean SUVmax= 12.2 [range, 3.3-22.4]; mean diameter = 21 mm [range, 14-35 mm]). Tracer uptake established or supported extra-axillary LN involvement in seven women and affected therapy decisions in three women. Conclusion This retrospective analysis indicates use of 68Ga fibroblast-activation protein inhibitor tracers for breast cancer diagnosis and staging. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Mankoff and Sellmyer in this issue.
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Affiliation(s)
- Philipp Backhaus
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
| | - Matthias C Burg
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
| | - Wolfgang Roll
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
| | - Florian Büther
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
| | - Hans-Jörg Breyholz
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
| | - Stefanie Weigel
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
| | - Walter Heindel
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
| | - Michaela Pixberg
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
| | - Peter Barth
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
| | - Joke Tio
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
| | - Michael Schäfers
- From the Department of Nuclear Medicine (P. Backhaus, W.R., F.B., H.J.B., M.P., M.S.), Clinic for Radiology (M.C.B., S.W., W.H.), and Department of Gynecology and Obstetrics (J.T.), University Hospital Münster, Albert-Schweitzer-Campus 1 A1, 48149 Münster, Germany; European Institute for Molecular Imaging, University of Münster, Münster, Germany (P. Backhaus, F.B., M.S.); and Gerhard-Domagk Institute for Pathology, University of Münster, Münster, Germany (P. Barth)
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Morawitz J, Bruckmann NM, Dietzel F, Ullrich T, Bittner AK, Hoffmann O, Ruckhäberle E, Mohrmann S, Häberle L, Ingenwerth M, Abrar DB, Sawicki LM, Breuckmann K, Fendler WP, Herrmann K, Buchbender C, Antoch G, Umutlu L, Kirchner J. Comparison of nodal staging between CT, MRI, and [ 18F]-FDG PET/MRI in patients with newly diagnosed breast cancer. Eur J Nucl Med Mol Imaging 2021; 49:992-1001. [PMID: 34476552 PMCID: PMC8803812 DOI: 10.1007/s00259-021-05502-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/20/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE To compare CT, MRI, and [18F]-fluorodeoxyglucose positron emission tomography ([18F]-FDG PET/MRI) for nodal status, regarding quantity and location of metastatic locoregional lymph nodes in patients with newly diagnosed breast cancer. MATERIALS AND METHODS One hundred eighty-two patients (mean age 52.7 ± 11.9 years) were included in this prospective double-center study. Patients underwent dedicated contrast-enhanced chest/abdomen/pelvis computed tomography (CT) and whole-body ([18F]-FDG PET/) magnet resonance imaging (MRI). Thoracal datasets were evaluated separately regarding quantity, lymph node station (axillary levels I-III, supraclavicular, internal mammary chain), and lesion character (benign vs. malign). Histopathology served as reference standard for patient-based analysis. Patient-based and lesion-based analyses were compared by a McNemar test. Sensitivity, specificity, positive and negative predictive values, and accuracy were assessed for all three imaging modalities. RESULTS On a patient-based analysis, PET/MRI correctly detected significantly more nodal positive patients than MRI (p < 0.0001) and CT (p < 0.0001). No statistically significant difference was seen between CT and MRI. PET/MRI detected 193 lesions in 75 patients (41.2%), while MRI detected 123 lesions in 56 patients (30.8%) and CT detected 104 lesions in 50 patients, respectively. Differences were statistically significant on a lesion-based analysis (PET/MRI vs. MRI, p < 0.0001; PET/MRI vs. CT, p < 0.0001; MRI vs. CT, p = 0.015). Subgroup analysis for different lymph node stations showed that PET/MRI detected significantly more lymph node metastases than MRI and CT in each location (axillary levels I-III, supraclavicular, mammary internal chain). MRI was superior to CT only in axillary level I (p = 0.0291). CONCLUSION [18F]-FDG PET/MRI outperforms CT or MRI in detecting nodal involvement on a patient-based analysis and on a lesion-based analysis. Furthermore, PET/MRI was superior to CT or MRI in detecting lymph node metastases in all lymph node stations. Of all the tested imaging modalities, PET/MRI showed the highest sensitivity, whereas CT showed the lowest sensitivity, but was most specific.
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Affiliation(s)
- Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
| | - Nils-Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Tim Ullrich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Ann-Kathrin Bittner
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Oliver Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology, Medical Faculty, University Dusseldorf, 40225, Dusseldorf, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, Medical Faculty, University Dusseldorf, 40225, Dusseldorf, Germany
| | - Lena Häberle
- Institute of Pathology, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Marc Ingenwerth
- Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Lino Morris Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Katharina Breuckmann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Christian Buchbender
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
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PET/MRI for Staging the Axilla in Breast Cancer: Current Evidence and the Rationale for SNB vs. PET/MRI Trials. Cancers (Basel) 2021; 13:cancers13143571. [PMID: 34298781 PMCID: PMC8303241 DOI: 10.3390/cancers13143571] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 01/03/2023] Open
Abstract
Simple Summary PET/MRI is a relatively new, hybrid imaging tool that allows practitioners to obtain both a local and systemic staging in breast cancer patients in a single exam. To date, the available evidence is not sufficient to determine the role of PET/MRI in breast cancer management. The aims of this paper are to provide an overview of the current literature on PET/MRI in breast cancer, and to illustrate two ongoing trials aimed at defining the eventual role of PET/MRI in axillary staging in two different settings: patients with early breast cancer and patients with positive axillary nodes that are candidates for primary systemic therapy. In both cases, findings from PET/MRI will be compared with the final pathology and could be helpful to better tailor axillary surgery in the future. Abstract Axillary surgery in breast cancer (BC) is no longer a therapeutic procedure but has become a purely staging procedure. The progressive improvement in imaging techniques has paved the way to the hypothesis that prognostic information on nodal status deriving from surgery could be obtained with an accurate diagnostic exam. Positron emission tomography/magnetic resonance imaging (PET/MRI) is a relatively new imaging tool and its role in breast cancer patients is still under investigation. We reviewed the available literature on PET/MRI in BC patients. This overview showed that PET/MRI yields a high diagnostic performance for the primary tumor and distant lesions of liver, brain and bone. In particular, the results of PET/MRI in staging the axilla are promising. This provided the rationale for two prospective comparative trials between axillary surgery and PET/MRI that could lead to a further de-escalation of surgical treatment of BC. • SNB vs. PET/MRI 1 trial compares PET/MRI and axillary surgery in staging the axilla of BC patients undergoing primary systemic therapy (PST). • SNB vs. PET/MRI 2 trial compares PET/MRI and sentinel node biopsy (SNB) in staging the axilla of early BC patients who are candidates for upfront surgery. Finally, these ongoing studies will help clarify the role of PET/MRI in BC and establish whether it represents a useful diagnostic tool that could guide, or ideally replace, axillary surgery in the future.
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Morawitz J, Bruckmann NM, Dietzel F, Ullrich T, Bittner AK, Hoffmann O, Mohrmann S, Haeberle L, Ingenwerth M, Umutlu L, Fendler WP, Fehm T, Herrmann K, Antoch G, Sawicki LM, Kirchner J. Determining the axillary nodal status with four current imaging modalities including 18F-FDG PET/MRI in newly diagnosed breast cancer: A comparative study using histopathology as reference standard. J Nucl Med 2021; 62:jnumed.121.262009. [PMID: 34016726 PMCID: PMC8612201 DOI: 10.2967/jnumed.121.262009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: To compare breast magnetic resonance imaging (MRI), thoracal MRI, thoracal 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/MRI and axillary sonography for the detection of axillary lymph node metastases in women with newly diagnosed breast cancer. Materials and Methods: This prospective double-center study included patients with newly diagnosed breast cancer between March 2018 and December 2019. Patients underwent thoracal (18F-FDG PET/)MRI, axillary sonography, and dedicated prone breast MRI. Datasets were evaluated separately regarding nodal status (nodal+ vs. nodal-). Histopathology served as reference standard in all patients. The diagnostic performance of breast MRI, thoracal MRI, thoracal PET/MRI and axillary sonography in detecting nodal positive patients was tested by creating receiver-operating-characteristic curves (ROC) with a calculated area under the curve (AUC). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for all four modalities. A McNemar test was used to assess differences. Results: 112 female patients (mean age 53.04 ± 12.6 years) were evaluated. Thoracal PET/MRI showed the highest ROC-AUC with a value of 0.892. The AUC for breast MRI, thoracal MRI and sonography were 0.782, 0.814 and 0.834, respectively. Differences between thoracal PET/MRI and axillary sonography, thoracal MRI and breast MRI were statistically significant (PET/MRI vs. axillary sonography, P = 0.01; PET/MRI vs. thoracal MRI, P = 0.02; PET/MRI vs. breast MRI, P = 0.03). PET/MRI showed the highest sensitivity (81.8%, 36/44) (95%-CI: 67.29-91.81%) while axillary sonography had the highest specificity (98.5%, 65/66), 95%-CI: 91.84-99.96%). Conclusion: 18F-FDG PET/MRI outperforms axillary sonography, breast MRI and thoracal MRI in determining the axillary lymph node status. In a clinical setting, the combination of 18F-FDG PET/MRI and axillary sonography might be considered to provide even more accuracy in diagnosis.
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Affiliation(s)
- Janna Morawitz
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Germany
| | - Nils-Martin Bruckmann
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Germany
| | - Frederic Dietzel
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Germany
| | - Tim Ullrich
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Germany
| | | | - Oliver Hoffmann
- University Hospital Essen, Department of Gynecology and Obstetrics, Germany
| | | | - Lena Haeberle
- University Dusseldorf, Medical Faculty, Institute of Pathology, Germany
| | | | - Lale Umutlu
- University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Germany
| | | | - Tanja Fehm
- University Dusseldorf, Medical Faculty, Department of Gynecology, Germany
| | - Ken Herrmann
- University Hospital Essen, Department of Nuclear Medicine, Germany
| | - Gerald Antoch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Germany
| | - Lino Morris Sawicki
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Germany
| | - Julian Kirchner
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Germany
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de Mooij CM, Sunen I, Mitea C, Lalji UC, Vanwetswinkel S, Smidt ML, van Nijnatten TJ. Diagnostic performance of PET/computed tomography versus PET/MRI and diffusion-weighted imaging in the N- and M-staging of breast cancer patients. Nucl Med Commun 2020; 41:995-1004. [PMID: 32769814 PMCID: PMC7497599 DOI: 10.1097/mnm.0000000000001254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/22/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To provide a systematic review regarding the diagnostic performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) and diffusion-weighted imaging (DWI) compared to 18F-FDG PET/computed tomography (CT) focused on nodal and distant staging in breast cancer patients. METHODS The PubMed and Embase databases were searched for relevant publications until April 2020. Two independent reviewers searched for eligible articles based on predefined in- and exclusion criteria, assessed quality and extracted data. RESULTS Eleven eligible studies were selected from 561 publications identified by the search. In seven studies, PET/CT was compared with PET/MRI, and in five, PET/CT with DWI. Significantly higher sensitivity for PET/MRI compared to PET/CT in a lesion-based analysis was reported for all lesions together (77% versus 89%) in one study, osseous metastases (69-99% versus 92-98%) in two studies and hepatic metastases (70-75% versus 80-100%) in one study. Moreover, PET/MRI revealed a significantly higher amount of osseous metastases (90 versus 141) than PET/CT. PET/CT is associated with a statistically higher specificity than PET/MRI in the lesion detection of all lesions together (98% versus 96%) and of osseous metastases (100% versus 95%), both in one study. None of the reviewed studies reported significant differences between PET/CT and DWI for any of the evaluated sites. There is a trend toward higher specificity for PET/CT. CONCLUSION In general, there is a trend toward higher sensitivity and lower specificity of PET/MRI when compared to PET/CT. Results on the diagnostic performance of DWI are conflicting. Rather than evaluating it separate, it seems to have complementary value when combined with other MR sequences.
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Affiliation(s)
- Cornelis Maarten de Mooij
- Departments of Radiology and Nuclear Medicine
- Surgery
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Inés Sunen
- Departments of Radiology and Nuclear Medicine
- Department of Radiology, Miguel Servet Hospital, Zaragoza, Spain
| | - Cristina Mitea
- Departments of Radiology and Nuclear Medicine
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | | | - Marjolein L. Smidt
- Surgery
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Thiemo J.A. van Nijnatten
- Departments of Radiology and Nuclear Medicine
- GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
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