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Local and whole-body staging in patients with primary breast cancer: a comparison of one-step to two-step staging utilizing 18F-FDG-PET/MRI

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this study was to compare the diagnostic value of a one-step to a two-step staging algorithm utilizing 18F-FDG PET/MRI in breast cancer patients.

Methods

A total of 38 patients (37 females and one male, mean age 57 ± 10 years; range 31–78 years) with newly diagnosed, histopathologically proven breast cancer were prospectively enrolled in this trial. All PET/MRI examinations were assessed for local tumor burden and metastatic spread in two separate reading sessions: (1) One-step algorithm comprising supine whole-body 18F-FDG PET/MRI, and (2) Two-step algorithm comprising a dedicated prone 18F-FDG breast PET/MRI and supine whole-body 18F-FDG PET/MRI.

Results

On a patient based analysis the two-step algorithm correctly identified 37 out of 38 patients with breast carcinoma (97%), while five patients were missed by the one-step 18F-FDG PET/MRI algorithm (33/38; 87% correct identification). On a lesion-based analysis 56 breast cancer lesions were detected in the two-step algorithm and 44 breast cancer lesions could be correctly identified in the one-step 18F-FDG PET/MRI (79%), resulting in statistically significant differences between the two algorithms (p = 0.0015). For axillary lymph node evaluation sensitivity, specificity and accuracy was 93%, 95 and 94%, respectively. Furthermore, distant metastases could be detected in seven patients in both algorithms.

Conclusion

The results demonstrate the necessity and superiority of a two-step 18F-FDG PET/MRI algorithm, comprising dedicated prone breast imaging and supine whole-body imaging, when compared to the one-step algorithm for local and whole-body staging in breast cancer patients.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany

    Julian Kirchner, Ole Martin, Philipp Heusch, Christian Buchbender & Gerald Antoch

  2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany

    Johannes Grueneisen, Michael Forsting & Lale Umutlu

  3. High-Field and Hybrid MR Imaging, University Hospital Essen, 45147, Essen, Germany

    Mark Oehmigen & Harald H. Quick

  4. Erwin L. Hahn Institute for MR Imaging, University Duisburg-Essen, 45141, Essen, Germany

    Harald H. Quick

  5. Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany

    Ann-Kathrin Bittner & Oliver Hoffmann

  6. Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK) Essen, Essen, Germany

    Marc Ingenwerth

  7. Abdominal Imaging and Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Onofrio Antonio Catalano

  8. Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany

    Ken Herrmann

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  1. Julian Kirchner
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Correspondence to Julian Kirchner.

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All procedures performed were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Kirchner, J., Grueneisen, J., Martin, O. et al. Local and whole-body staging in patients with primary breast cancer: a comparison of one-step to two-step staging utilizing 18F-FDG-PET/MRI. Eur J Nucl Med Mol Imaging 45, 2328–2337 (2018). https://doi.org/10.1007/s00259-018-4102-4

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