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.
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.
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.
• 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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The authors state that this work has not received any funding.
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.
Written informed consent was obtained from all subjects (patients) in this study.
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.
• 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