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Prospective evaluation of whole-body MRI and (18)F-FDG PET/MRI in N and M staging of primary breast cancer patients

OBJECTIVES: To evaluate and compare the diagnostic potential of whole-body MRI and whole-body (18)F-FDG PET/MRI for N and M staging in newly diagnosed, histopathologically proven breast cancer. MATERIAL AND METHODS: A total of 104 patients (age 53.4 ± 12.5) with newly diagnosed, histopathologically...

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Autores principales: Bruckmann, Nils Martin, Sawicki, Lino M., Kirchner, Julian, Martin, Ole, Umutlu, Lale, Herrmann, Ken, Fendler, Wolfgang, Bittner, Ann-Kathrin, Hoffmann, Oliver, Mohrmann, Svjetlana, Dietzel, Frederic, Ingenwerth, Marc, Schaarschmidt, Benedikt M., Li, Yan, Kowall, Bernd, Stang, Andreas, Antoch, Gerald, Buchbender, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567721/
https://www.ncbi.nlm.nih.gov/pubmed/32333068
http://dx.doi.org/10.1007/s00259-020-04801-2
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author Bruckmann, Nils Martin
Sawicki, Lino M.
Kirchner, Julian
Martin, Ole
Umutlu, Lale
Herrmann, Ken
Fendler, Wolfgang
Bittner, Ann-Kathrin
Hoffmann, Oliver
Mohrmann, Svjetlana
Dietzel, Frederic
Ingenwerth, Marc
Schaarschmidt, Benedikt M.
Li, Yan
Kowall, Bernd
Stang, Andreas
Antoch, Gerald
Buchbender, Christian
author_facet Bruckmann, Nils Martin
Sawicki, Lino M.
Kirchner, Julian
Martin, Ole
Umutlu, Lale
Herrmann, Ken
Fendler, Wolfgang
Bittner, Ann-Kathrin
Hoffmann, Oliver
Mohrmann, Svjetlana
Dietzel, Frederic
Ingenwerth, Marc
Schaarschmidt, Benedikt M.
Li, Yan
Kowall, Bernd
Stang, Andreas
Antoch, Gerald
Buchbender, Christian
author_sort Bruckmann, Nils Martin
collection PubMed
description OBJECTIVES: To evaluate and compare the diagnostic potential of whole-body MRI and whole-body (18)F-FDG PET/MRI for N and M staging in newly diagnosed, histopathologically proven breast cancer. MATERIAL AND METHODS: A total of 104 patients (age 53.4 ± 12.5) with newly diagnosed, histopathologically proven breast cancer were enrolled in this study prospectively. All patients underwent a whole-body (18)F-FDG PET/MRI. MRI and (18)F-FDG PET/MRI datasets were evaluated separately regarding lesion count, lesion localization, and lesion characterization (malignant/benign) as well as the diagnostic confidence (5-point ordinal scale, 1–5). The N and M stages were assessed according to the eighth edition of the American Joint Committee on Cancer staging manual in MRI datasets alone and in (18)F-FDG PET/MRI datasets, respectively. In the majority of lesions histopathology served as the reference standard. The remaining lesions were followed-up by imaging and clinical examination. Separately for nodal-positive and nodal-negative women, a McNemar chi(2) test was performed to compare sensitivity and specificity of the N and M stages between (18)F-FDG PET/MRI and MRI. Differences in diagnostic confidence scores were assessed by Wilcoxon signed rank test. RESULTS: MRI determined the N stage correctly in 78 of 104 (75%) patients with a sensitivity of 62.3% (95% CI: 0.48–0.75), a specificity of 88.2% (95% CI: 0.76–0.96), a PPV (positive predictive value) of 84.6% % (95% CI: 69.5–0.94), and a NPV (negative predictive value) of 69.2% (95% CI: 0.57–0.8). Corresponding results for (18)F-FDG PET/MRI were 87/104 (83.7%), 75.5% (95% CI: 0.62–0.86), 92.2% (0.81–0.98), 90% (0.78–0.97), and 78.3% (0.66–0.88), showing a significantly better sensitivity of (18)F-FDG PET/MRI determining malignant lymph nodes (p = 0.008). The M stage was identified correctly in MRI and (18)F-FDG PET/MRI in 100 of 104 patients (96.2%). Both modalities correctly staged all 7 patients with distant metastases, leading to false-positive findings in 4 patients in each modality (3.8%). In a lesion-based analysis, (18)F-FDG PET/MRI showed a significantly better performance in correctly determining malignant lesions (85.8% vs. 67.1%, difference 18.7% (95% CI: 0.13–0.26), p < 0.0001) and offered a superior diagnostic confidence compared with MRI alone (4.1 ± 0.7 vs. 3.4 ± 0.7, p < 0.0001). CONCLUSION: (18)F-FDG PET/MRI has a better diagnostic accuracy for N staging in primary breast cancer patients and provides a significantly higher diagnostic confidence in lesion characterization than MRI alone. But both modalities bear the risk to overestimate the M stage.
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spelling pubmed-75677212020-10-19 Prospective evaluation of whole-body MRI and (18)F-FDG PET/MRI in N and M staging of primary breast cancer patients Bruckmann, Nils Martin Sawicki, Lino M. Kirchner, Julian Martin, Ole Umutlu, Lale Herrmann, Ken Fendler, Wolfgang Bittner, Ann-Kathrin Hoffmann, Oliver Mohrmann, Svjetlana Dietzel, Frederic Ingenwerth, Marc Schaarschmidt, Benedikt M. Li, Yan Kowall, Bernd Stang, Andreas Antoch, Gerald Buchbender, Christian Eur J Nucl Med Mol Imaging Original Article OBJECTIVES: To evaluate and compare the diagnostic potential of whole-body MRI and whole-body (18)F-FDG PET/MRI for N and M staging in newly diagnosed, histopathologically proven breast cancer. MATERIAL AND METHODS: A total of 104 patients (age 53.4 ± 12.5) with newly diagnosed, histopathologically proven breast cancer were enrolled in this study prospectively. All patients underwent a whole-body (18)F-FDG PET/MRI. MRI and (18)F-FDG PET/MRI datasets were evaluated separately regarding lesion count, lesion localization, and lesion characterization (malignant/benign) as well as the diagnostic confidence (5-point ordinal scale, 1–5). The N and M stages were assessed according to the eighth edition of the American Joint Committee on Cancer staging manual in MRI datasets alone and in (18)F-FDG PET/MRI datasets, respectively. In the majority of lesions histopathology served as the reference standard. The remaining lesions were followed-up by imaging and clinical examination. Separately for nodal-positive and nodal-negative women, a McNemar chi(2) test was performed to compare sensitivity and specificity of the N and M stages between (18)F-FDG PET/MRI and MRI. Differences in diagnostic confidence scores were assessed by Wilcoxon signed rank test. RESULTS: MRI determined the N stage correctly in 78 of 104 (75%) patients with a sensitivity of 62.3% (95% CI: 0.48–0.75), a specificity of 88.2% (95% CI: 0.76–0.96), a PPV (positive predictive value) of 84.6% % (95% CI: 69.5–0.94), and a NPV (negative predictive value) of 69.2% (95% CI: 0.57–0.8). Corresponding results for (18)F-FDG PET/MRI were 87/104 (83.7%), 75.5% (95% CI: 0.62–0.86), 92.2% (0.81–0.98), 90% (0.78–0.97), and 78.3% (0.66–0.88), showing a significantly better sensitivity of (18)F-FDG PET/MRI determining malignant lymph nodes (p = 0.008). The M stage was identified correctly in MRI and (18)F-FDG PET/MRI in 100 of 104 patients (96.2%). Both modalities correctly staged all 7 patients with distant metastases, leading to false-positive findings in 4 patients in each modality (3.8%). In a lesion-based analysis, (18)F-FDG PET/MRI showed a significantly better performance in correctly determining malignant lesions (85.8% vs. 67.1%, difference 18.7% (95% CI: 0.13–0.26), p < 0.0001) and offered a superior diagnostic confidence compared with MRI alone (4.1 ± 0.7 vs. 3.4 ± 0.7, p < 0.0001). CONCLUSION: (18)F-FDG PET/MRI has a better diagnostic accuracy for N staging in primary breast cancer patients and provides a significantly higher diagnostic confidence in lesion characterization than MRI alone. But both modalities bear the risk to overestimate the M stage. Springer Berlin Heidelberg 2020-04-24 2020 /pmc/articles/PMC7567721/ /pubmed/32333068 http://dx.doi.org/10.1007/s00259-020-04801-2 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Bruckmann, Nils Martin
Sawicki, Lino M.
Kirchner, Julian
Martin, Ole
Umutlu, Lale
Herrmann, Ken
Fendler, Wolfgang
Bittner, Ann-Kathrin
Hoffmann, Oliver
Mohrmann, Svjetlana
Dietzel, Frederic
Ingenwerth, Marc
Schaarschmidt, Benedikt M.
Li, Yan
Kowall, Bernd
Stang, Andreas
Antoch, Gerald
Buchbender, Christian
Prospective evaluation of whole-body MRI and (18)F-FDG PET/MRI in N and M staging of primary breast cancer patients
title Prospective evaluation of whole-body MRI and (18)F-FDG PET/MRI in N and M staging of primary breast cancer patients
title_full Prospective evaluation of whole-body MRI and (18)F-FDG PET/MRI in N and M staging of primary breast cancer patients
title_fullStr Prospective evaluation of whole-body MRI and (18)F-FDG PET/MRI in N and M staging of primary breast cancer patients
title_full_unstemmed Prospective evaluation of whole-body MRI and (18)F-FDG PET/MRI in N and M staging of primary breast cancer patients
title_short Prospective evaluation of whole-body MRI and (18)F-FDG PET/MRI in N and M staging of primary breast cancer patients
title_sort prospective evaluation of whole-body mri and (18)f-fdg pet/mri in n and m staging of primary breast cancer patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567721/
https://www.ncbi.nlm.nih.gov/pubmed/32333068
http://dx.doi.org/10.1007/s00259-020-04801-2
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