Abstract
Purpose
To compare the diagnostic accuracy of prone 18F-FDG PET/CT with that of contrast-enhanced MRI (CE-MRI) at 3 T in suspicious breast lesions. To evaluate the influence of tumour size on diagnostic accuracy and the use of maximum standardized uptake value (SUVMAX) thresholds to differentiate malignant from benign breast lesions.
Methods
A total of 172 consecutive patients with an imaging abnormality were included in this IRB-approved prospective study. All patients underwent 18F-FDG PET/CT and CE-MRI of the breast at 3 T in the prone position. Two reader teams independently evaluated the likelihood of malignancy as determined by 18F-FDG PET/CT and CE-MRI independently. 18F-FDG PET/CT data were qualitatively evaluated by visual interpretation. Quantitative assessment was performed by calculation of SUVMAX. Sensitivity, specificity, diagnostic accuracy, area under the curve and interreader agreement were calculated for all lesions and for lesions <10 mm. Histopathology was used as the standard of reference.
Results
There were 132 malignant and 40 benign lesions; 23 lesions (13.4 %) were <10 mm. Both 18F-FDG PET/CT and CE-MRI achieved an overall diagnostic accuracy of 93 %. There were no significant differences in sensitivity (p = 0.125), specificity (p = 0.344) or diagnostic accuracy (p = 1). For lesions <10 mm, diagnostic accuracy deteriorated to 91 % with both 18F-FDG PET/CT and CE-MRI. Although no significant difference was found for lesions <10 mm, CE-MRI at 3 T seemed to be more sensitive but less specific than 18F-FDG PET/CT. Interreader agreement was excellent (κ = 0.85 and κ = 0.92). SUVMAX threshold was not helpful in differentiating benign from malignant lesions.
Conclusion
18F-FDG PET/CT and CE-MRI at 3 T showed equal diagnostic accuracies in breast cancer diagnosis. For lesions <10 mm, diagnostic accuracy deteriorated, but was equal for 18F-FDG PET/CT and CE-MRI at 3 T. For lesions <10 mm, CE-MRI at 3 T seemed to be more sensitive but less specific than 18F-FDG PET/CT. Quantitative assessment using an SUVMAX threshold for differentiating benign from malignant lesions was not helpful in breast cancer diagnosis.
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Grants
Funding was provided by the Austrian Nationalbank ‘Jubiläumsfond’ Project Nr. 13652 and seed grants from Novomed, Austria, Medicor Austria and Guerbet, France.
Ethical approval
All human and animal studies were approved by the appropriate ethics committee and were, therefore, performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written, informed consent was obtained from all patients before the examinations.
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Magometschnigg, H.F., Baltzer, P.A., Fueger, B. et al. Diagnostic accuracy of 18F-FDG PET/CT compared with that of contrast-enhanced MRI of the breast at 3 T. Eur J Nucl Med Mol Imaging 42, 1656–1665 (2015). https://doi.org/10.1007/s00259-015-3099-1
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DOI: https://doi.org/10.1007/s00259-015-3099-1