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What is the diagnostic performance of 18-FDG-PET/MR compared to PET/CT for the N- and M- staging of breast cancer?

European Radiology volume 29, pages 1787–1798 (2019)Cite this article

Abstract

Purpose

To compare the diagnostic performance of 18-FDG-PET/MR and PET/CT for the N- and M- staging of breast cancer.

Methods and materials

Two independent readers blinded to clinical/follow-up data reviewed PET/MR and PET/CT examinations performed for initial or recurrent breast cancer staging in 80 consecutive patients (mean age = 48 ± 12.9 years). The diagnostic confidence for lesions in the contralateral breast, axillary/internal mammary nodes, bones and other distant sites were recorded. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. The standard of reference included pathology and/or follow-up > 12 months.

Results

Nine of 80 patients had bone metastases; 13/80 had other distant metastases, 44/80 had axillary, 9/80 had internal mammary and 3/80 had contralateral breast tumours. Inter-reader agreement for lesions was excellent (weighted kappa = 0.833 for PET/CT and 0.823 for PET/MR) with similar reader confidence for the two tests (ICC = 0.875). In the patient-per-patient analysis, sensitivity and specificity of PET/MRI and PET/CT were similar (p > 0.05). In the lesion-per-lesion analysis, the sensitivity of PET/MR and PET/CT for bone metastases, other metastases, axillary and internal mammary nodes, contralateral tumours and all lesions together was 0.924 and 0.6923 (p = 0.0034), 0.923 and 0.923 (p = 1), 0.854 and 0.812 (p = 0.157), 0.9 and 0.9 (p = 1), 1 and 0.25 (p = 0.083), and 0.89 and 0.77 (p = 0.0013) respectively. The corresponding specificity was 0.953 and 1 (p = 0.0081), 1 and 1 (p = 1), 0.893 and 0.92 (p = 0.257), 1 and 1 (p = 1), 0.987 and 0.99 (p = 1) and 0.96 and 0.98 (p = 0.0075) respectively.

Conclusions

Reader confidence, inter-reader agreement and diagnostic performance per patient were similar with PET/MR and PET/CT. However, for all lesions together, PET/MR had a superior sensitivity and lower specificity in the lesion-per-lesion analysis.

Key Points

• N and M breast cancer staging performance of PET/MR and PET/CT is similar per patient.

• In a lesion-per-lesion analysis PET/MR is more sensitive than PET/CT especially for bone metastasis.

• Readers’ diagnostic confidence is similar for both tests.

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Abbreviations

18-FDG:

2-deoxy-2-(18F) fluoro-D-glucose

MIP:

Maximum intensity projection

NAC:

Neo-adjuvant chemotherapy

NPV:

Negative predictive value

PET/CT:

Positron emission tomography/computed tomography

PET/MR:

Positron emission tomography/magnetic resonance

PPV:

Positive predictive value

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

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

    Diomidis Botsikas, Ilias Bagetakos, Marlise Picarra, Ana Carolina Da Cunha Afonso Barisits, Sana Boudabbous, Xavier Montet, Anastasia Kalovidouri & Minerva Becker

  2. Centre Hospitallier Universitaire Vaudois, Radiology Department, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Marlise Picarra

  3. Geneva University Hospital, Gynecology Department, Boulevard de la Cluse 30, 1211, Geneva, Switzerland

    Giang Thanh Lam

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

    Ismini Mainta

Authors
  1. Diomidis Botsikas
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  2. Ilias Bagetakos
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  3. Marlise Picarra
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  4. Ana Carolina Da Cunha Afonso Barisits
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  5. Sana Boudabbous
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  6. Xavier Montet
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  7. Giang Thanh Lam
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  8. Ismini Mainta
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  9. Anastasia Kalovidouri
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  10. Minerva Becker
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Corresponding author

Correspondence to Diomidis Botsikas.

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Guarantor

The scientific guarantor of this publication is Diomidis Botsikas. MD, Privat Docent (PD).

Conflict of interest

All authors declare no conflict of interest.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this article.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Data of PET/MR examinations of 42 patients were included in the article below. This article focused on the diagnostic performance of PET/MR in loco-regional staging of breast cancer and data of PET/CT were not analysed. This same article also included PET/MR after neoadjuvant systemic treatment while the present manuscript includes only data from the initial PET/MR study.

Clinical utility of 18F-FDG-PET/MR for preoperative breast cancer staging. Botsikas D, Kalovidouri A, Becker M, Copercini M, Djema DA, Bodmer A, Monnier S, Becker CD, Montet X, Delattre BM, Ratib O, Garibotto V, Tabouret-Viaud C. Eur Radiol. 2016 Jul;26(7):2297-307. doi: 10.1007/s00330-015-4054-z. Epub 2015 Oct 17.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

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Botsikas, D., Bagetakos, I., Picarra, M. et al. What is the diagnostic performance of 18-FDG-PET/MR compared to PET/CT for the N- and M- staging of breast cancer?. Eur Radiol 29, 1787–1798 (2019). https://doi.org/10.1007/s00330-018-5720-8

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  • DOI: https://doi.org/10.1007/s00330-018-5720-8

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