Cancers (Jul 2023)

Conventional Imaging, MRI and <sup>18</sup>F-FDG PET/MRI for N and M Staging in Patients with Newly Diagnosed Breast Cancer

  • Janna Morawitz,
  • Nils-Martin Bruckmann,
  • Kai Jannusch,
  • Frederic Dietzel,
  • Aleksandar Milosevic,
  • Ann-Kathrin Bittner,
  • Oliver Hoffmann,
  • Svjetlana Mohrmann,
  • Eugen Ruckhäberle,
  • Lena Häberle,
  • Wolfgang Peter Fendler,
  • Ken Herrmann,
  • Frederik Lars Giesel,
  • Gerald Antoch,
  • Lale Umutlu,
  • Bernd Kowall,
  • Andreas Stang,
  • Julian Kirchner

DOI
https://doi.org/10.3390/cancers15143646
Journal volume & issue
Vol. 15, no. 14
p. 3646

Abstract

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Background: This study compares the diagnostic potential of conventional staging (computed tomography (CT), axillary sonography and bone scintigraphy), whole-body magnetic resonance imaging (MRI) and whole-body 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/)MRI for N and M staging in newly diagnosed breast cancer. Methods: A total of 208 patients with newly diagnosed breast cancer were prospectively included in this study and underwent contrast-enhanced thoracoabdominal CT, bone scintigraphy and axillary sonography as well as contrast-enhanced whole-body 18F-FDG PET/MRI. The datasets were analyzed with respect to lesion localization and characterization. Histopathology and follow-up imaging served as the reference standard. A McNemar test was used to compare the diagnostic performance of conventional staging, MRI and 18F-FDG PET/MRI and a Wilcoxon test was used to compare differences in true positive findings for nodal staging. Results: Conventional staging determined the N stage with a sensitivity of 80.9%, a specificity of 99.2%, a PPV (positive predictive value) of 98.6% and a NPV (negative predictive value) of 87.4%. The corresponding results for MRI were 79.6%, 100%, 100% and 87.0%, and were 86.5%, 94.1%, 91.7% and 90.3% for 18F-FDG PET/MRI. 18F-FDG PET/MRI was significantly more sensitive in determining malignant lymph nodes than conventional imaging and MRI (p p = 0.0005). Furthermore, 18F-FDG PET/MRI accurately estimated the clinical lymph node stage in significantly more cases than conventional imaging and MRI (each p 18F-FDG PET/MRI were 100.0%, 98.5%, 80.0% and 100.0%. No significant differences between the imaging modalities were seen for the staging of distant metastases. Conclusions:18F-FDG PET/MRI detects lymph node metastases in significantly more patients and estimates clinical lymph node stage more accurately than conventional imaging and MRI. No significant differences were found between imaging modalities with respect to the detection of distant metastases.

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