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Clinical utility of 18F-FDG-PET/MR for preoperative breast cancer staging

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Abstract

Objective

To evaluate the performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography magnetic resonance imaging (PET/MR) for preoperative breast cancer staging.

Methods

Preoperative PET/MR exams of 58 consecutive women with breast cancer were retrospectively reviewed. Histology and mean follow-up of 26 months served as gold standard. Four experienced readers evaluated primary lesions, lymph nodes and distant metastases with contrast-enhanced MRI, qualitative/quantitative PET, and combined PET/MR. ROC curves were calculated for all modalities and their combinations.

Results

The study included 101 breast lesions (83 malignant, 18 benign) and 198 lymph node groups, (34 malignant, 164 benign). Two patients had distant metastases. Areas under the curve (AUC) for breast cancer were 0.9558, 0.8347 and 0.8855 with MRI, and with qualitative and quantitative PET/MR, respectively (p = 0.066). Sensitivity for primary cancers with MRI and quantitative PET/MR was 100 % and 77 % (p = 0.004), and for lymph nodes 88 % and 79 % (p = 0.25), respectively. Specificity for MRI and PET/MR for primary cancers was 67 % and 100 % (p = 0.03) and for lymph nodes 98 % and 100 % (p = 0.25).

Conclusions

In breast cancer patients, MRI alone has the highest sensitivity for primary tumours. For nodal metastases, both MRI and PET/MR are highly specific.

Key points

• MRI alone and PET/MR have a similar overall diagnostic performance.

• MRI alone has a higher sensitivity than PET/MR for local tumour assessment.

• Both MRI and PET/MR have a limited sensitivity for nodal metastases.

• Positive lymph nodes on MRI or PET/MR do not require presurgical biopsy.

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Abbreviations

18-FDG-:

18F-fluorodeoxyglucose

PET/MR:

Positron emission tomography combined with magnetic resonance imaging

SUV:

Standard Uptake Value

PET/CT:

Positron emission tomography/computed tomography

SUVmax:

Maximum SUV corrected for time

SUVratio:

Ratio of the breast lesions SUVmax to the SUVmax of the healthy breast parenchyma

NAC:

Neoadjuvant chemotherapy

ALND:

Axillary lymph node dissection

ROC curves:

Receiver operating characteristic curves

AUC:

Area under the curve

PPV:

Positive predictive value

NPV:

Negative predictive value

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Acknowledgments

The scientific guarantor of this publication is Diomidis BOTSIKAS. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.

Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Imaging, Division of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland

    Diomidis Botsikas, Anastasia Kalovidouri, Minerva Becker, Michele Copercini, Dahila Amal Djema, Christoph D. Becker, Xavier Montet & Benedicte M. A. Delattre

  2. Department of Internal Medicine, Division of Oncology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland

    Alexandre Bodmer

  3. Department of Obstetrics and Gynaecology, Division of Gynaecology, Geneva University Hospital, Boulevard de la Cluse 30, 1211, Geneva, Switzerland

    Sindy Monnier

  4. Department of Imaging, Division of Nuclear Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland

    Osman Ratib, Valentina Garibotto & Claire Tabouret-Viaud

Authors
  1. Diomidis Botsikas
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  2. Anastasia Kalovidouri
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  3. Minerva Becker
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  4. Michele Copercini
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  5. Dahila Amal Djema
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  6. Alexandre Bodmer
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  7. Sindy Monnier
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  8. Christoph D. Becker
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  9. Xavier Montet
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  10. Benedicte M. A. Delattre
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  11. Osman Ratib
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  12. Valentina Garibotto
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  13. Claire Tabouret-Viaud
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Correspondence to Diomidis Botsikas.

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Botsikas, D., Kalovidouri, A., Becker, M. et al. Clinical utility of 18F-FDG-PET/MR for preoperative breast cancer staging. Eur Radiol 26, 2297–2307 (2016). https://doi.org/10.1007/s00330-015-4054-z

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  • DOI: https://doi.org/10.1007/s00330-015-4054-z

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