scholarly journals Prospective comparison of the diagnostic accuracy of 18F-FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients

2021 ◽  
Author(s):  
Nils Martin Bruckmann ◽  
Julian Kirchner ◽  
Lale Umutlu ◽  
Wolfgang Peter Fendler ◽  
Robert Seifert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastases ◽  
Cancer Patients ◽  
Bone Scintigraphy ◽  
Fdg Pet ◽  
Primary Breast Cancer ◽  
Whole Body ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Initial Staging

Abstract Objectives To compare the diagnostic performance of [18F]FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients. Material and methods A cohort of 154 therapy-naive patients with newly diagnosed, histopathologically proven breast cancer was enrolled in this study prospectively. All patients underwent a whole-body [18F]FDG PET/MRI, computed tomography (CT) scan, and a bone scintigraphy prior to therapy. All datasets were evaluated regarding the presence of bone metastases. McNemar χ2 test was performed to compare sensitivity and specificity between the modalities. Results Forty-one bone metastases were present in 7/154 patients (4.5%). Both [18F]FDG PET/MRI and MRI alone were able to detect all of the patients with histopathologically proven bone metastases (sensitivity 100%; specificity 100%) and did not miss any of the 41 malignant lesions (sensitivity 100%). CT detected 5/7 patients (sensitivity 71.4%; specificity 98.6%) and 23/41 lesions (sensitivity 56.1%). Bone scintigraphy detected only 2/7 patients (sensitivity 28.6%) and 15/41 lesions (sensitivity 36.6%). Furthermore, CT and scintigraphy led to false-positive findings of bone metastases in 2 patients and in 1 patient, respectively. The sensitivity of PET/MRI and MRI alone was significantly better compared with CT (p < 0.01, difference 43.9%) and bone scintigraphy (p < 0.01, difference 63.4%). Conclusion [18F]FDG PET/MRI and MRI are significantly better than CT or bone scintigraphy for the detection of bone metastases in patients with newly diagnosed breast cancer. Both CT and bone scintigraphy show a substantially limited sensitivity in detection of bone metastases. Key Points • [18F]FDG PET/MRI and MRI alone are significantly superior to CT and bone scintigraphy for the detection of bone metastases in patients with newly diagnosed breast cancer. • Radiation-free whole-body MRI might serve as modality of choice in detection of bone metastases in breast cancer patients.

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

2020 ◽  
Vol 47 (12) ◽  
pp. 2816-2825 ◽  
Author(s):  
Nils Martin Bruckmann ◽  
Lino M. Sawicki ◽  
Julian Kirchner ◽  
Ole Martin ◽  
Lale Umutlu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Predictive Value ◽  
Fdg Pet ◽  
Primary Breast Cancer ◽  
Whole Body ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Diagnostic Confidence ◽  
Whole Body Mri

Abstract Objectives To evaluate and compare the diagnostic potential of whole-body MRI and whole-body 18F-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 18F-FDG PET/MRI. MRI and 18F-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 18F-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 chi2 test was performed to compare sensitivity and specificity of the N and M stages between 18F-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 18F-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 18F-FDG PET/MRI determining malignant lymph nodes (p = 0.008). The M stage was identified correctly in MRI and 18F-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, 18F-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 18F-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.

Comparison of FDG-PET/CT and bone scintigraphy for detection of bone metastases in breast cancer

2011 ◽  
Vol 52 (9) ◽  
pp. 1009-1014 ◽  
Author(s):  
Steffen Hahn ◽  
Till Heusner ◽  
Sherko Kümmel ◽  
Angelika Köninger ◽  
James Nagarajah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastases ◽  
Bone Scintigraphy ◽  
Fdg Pet ◽  
Whole Body ◽  
Reference Standard ◽  
Breast Cancer Patients ◽  
Pet Ct ◽  
Fdg Pet Ct

Background Bone scintigraphy is the standard procedure for the detection of bone metastases in breast cancer patients. FDG-PET/CT has been reported to be a sensitive tool for tumor staging in different malignant diseases. However, its accuracy for the detection of bone metastases has not been compared to bone scintigraphy. Purpose To compare whole-body FDG-PET/CT and bone scintigraphy for the detection of bone metastases on a lesion basis in breast cancer patients. Material and Methods Twenty-nine consecutive women (mean age 58 years, range 35-78 years) with histologically proven breast cancer were assessed with bone scintigraphy and whole-body FDG-PET/CT. Twenty-one patients (72%) were suffering from primary breast cancer and eight patients (28%) were in aftercare with a history of advanced breast cancer. Both imaging procedures were assessed for bone metastases by a radiologist and a nuclear medicine physician. Concordant readings between bone scintigraphy and FDG-PET/CT were taken as true. Discordant readings were verified with additional MRI imaging in all patients and follow-up studies in most patients. Results A total of 132 lesions were detected on bone scintigraphy, FDG-PET/CT or both. According to the reference standard, 70/132 lesions (53%) were bone metastases, 59/132 lesions (45%) were benign, and three lesions (2%) remained unclear. The sensitivity of bone scintigraphy was 76% (53/70) compared to 96% (67/70) for FDG-PET/CT. The specificity of bone scintigraphy and FDG-PET/CT was 95% (56/59) and 92% (54/59), respectively. According to the reference standard bone metastases were present in eight out of the 29 patients (28%), whereas 20 patients (69%) were free of bone metastases. One (3%) patient had inconclusive readings on both modalities as well as on MRI and follow-up studies. Bone scintigraphy and FDG-PET/CT correctly identified seven out of eight patients with bone metastases and 20 out of 20 patients free of metastases. Conclusion On a lesion-basis whole-body FDG-PET/CT is more sensitive and equally specific for the detection of bone metastases compared with bone scintigraphy.

FDG PET-CT in breast cancer: A single institution experience from India.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11027-e11027
Author(s):  
Nalini K Rao ◽  
Basavalinga S Ajaikumar ◽  
Kumar G Kallur ◽  
P S Sridhar ◽  
Bhattacharjee Somorat ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Treatment Plan ◽  
Whole Body ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
New Findings ◽  
Pet Ct ◽  
Fdg Pet Ct

e11027 Background: Whole body FDG PET CT is a useful tool in diagnosis, staging and prognosis; and its timely use is critical for early intervention and achieving long term survival in patients with early and advanced breast cancer. Methods: In this observational retrospective study, we report FDG PET CT findings of all breast cancer patients enrolled in our hospital based cancer registry between the years 2008 to 2011. Results: One thousand and fifty three women underwent a total of 1638 scans. Two hundred and forty five scans (14.96%) were done for staging /restaging/diagnosis, 1208 (73.75%) were for response evaluation to chemotherapy and 185 (11.29%) were for surveillance. The median age at diagnosis was 53 years. We identified a possible synchronous breast primary in 28 (2.66%) women and a probable new or existing second non-breast primary in 21(1.99%) women. Internal nodal metastasis was identified in 76 (7.21%) women at diagnosis. There were 26 (2.47%) patients with multicentric tumors. There was an increased uptake in the thyroid gland in 49(2.99%) and in the adrenal in 41 (2.50%) women. There were other random ‘Incidental findings of concern’ in 7 (0.37%) of women, diagnosed either on the CT or PET-CT component. Findings on PET-CT, including- upstaging of the breast primary and unexpected new findings, unrelated to the breast primary, changed the treatment plan in approximately 7% -10% of the patients. We did find that PET-CT did not impact early tumors; however, it did contribute in, 1) the assessment of internal mammary nodes, 2) prognostication based on tumor burden and, 3) aggressive management of oligometastases. Conclusions: Whole body FDG PET CT is a useful tool for staging and prognostication in breast cancer patients. However, the timing of such scans for surveillance needs to be defined for early detection of progression to have an impact on survival.

scholarly journals 0173 Predictive value of 18F-FDG PET-CT in primary breast cancer patients receiving neoadjuvant chemotherapy

The Breast ◽  
2009 ◽  
Vol 18 ◽  
pp. S61-S62
Author(s):  
J.W.H. Tsang ◽  
D. Yeung ◽  
A.C.Y. Chan ◽  
C.H.N. Wong ◽  
L.W.S. Leung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Predictive Value ◽  
Fdg Pet ◽  
Primary Breast Cancer ◽  
Breast Cancer Patients ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

scholarly journals The Added Benefit of Hybrid SPECT/CT in the Diagnosis of Bone Metastasis in Patients with Breast Cancer

2015 ◽  
Vol 17 (1) ◽  
pp. 38-49
Author(s):  
Nasim Khan ◽  
SM Moinul Islam ◽  
Abrar Al Sakib ◽  
Saiyeeda Mahmood ◽  
Gazi Abul Hossian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Computed Tomography ◽  
Nuclear Medicine ◽  
Breast Carcinoma ◽  
Cancer Patients ◽  
Bone Scintigraphy ◽  
Whole Body ◽  
Emission Computed Tomography ◽  
Breast Cancer Patients ◽  
Medicine Physician

The purpose of this study was to investigate the additional benefit of single photon emission computed tomography/computed tomography (SPECT/CT) over whole-body planar bone scintigraphy (planar BS) and SPECT for the detection of bone metastases in breast cancer patients. Materials & methods: Of 112 consecutively examined patients with histologically confirmed breast carcinoma who underwent bone scintigraphy, 39 required further evaluation by SPECT/CT (n= 23) and SPECT alone (n = 16) because a definite diagnosis could not be established using whole body planar BS alone. The 23 SPECT/CT studies were retrospectively evaluated by two nuclear medicine physicians for planar BS and SPECT images, and one nuclear medicine physician and one radiologist for SPECT/CT on consensus. Each focus of abnormal tracer uptake was recorded for differentiating malignant from benign bone lesions. Clinical and imaging follow-up were used as a reference standard. Results: A total of 72 lesions were evaluated in 23 patients examined by three types of imaging modalities. In 57 of the 72 evaluated lesions, the results of planar BS, SPECT and SPECT/CT were concordant; 52 of the 57 lesions were interpreted as malignant and 5 lesions as benign by all modalities. In 15 of the 72 lesions, consensus reading of fused SPECT/CT images changed the image interpretation of 15 planar BS scans and 9 of the 15 SPECT scans: 7 lesions previously interpreted as benign (on both planar BS and SPECT) were re-classified as malignant and 8 lesions (8 by planar BS and 2/8 by SPECT) previously interpreted as malignant were reevaluated as benign. The highest diagnostic gain was in the thoracolumbar spine, thoracic cage & pelvis. The overall accuracy of SPECT/CT was significantly higher on a lesion-based analysis than planar BS and SPECT (100%vs 79%, p < 0.0001 and 100% vs 83%, p = 0.003). Compared to planar BS and SPECT, the results of SPECT/CT changed diagnosis or treatment in 5/23 patients (21.7%). 39 Conclusion: The hybrid imaging system with SPECT/CT is a feasible technique yielding coregistered dual-modality images. The addition of SPECT/CT improves the diagnostic accuracy for the correct interpretation of bony lesions in breast cancer patients undergoing bone scanning for metastases. SPECT/CT should be routinely used in the work up of postoperative breast carcinoma patients with simultaneous CT evaluation to identify metastatic lesions not detected on bone scintigraphy. DOI: http://dx.doi.org/10.3329/bjnm.v17i1.22490 Bangladesh J. Nuclear Med. 17(1): 38-49, January 2014

A62 FDG PET for prediction of chemotherapy response in primary breast cancer patients

2006 ◽  
Vol 27 (3) ◽  
pp. 297
Author(s):  
G.M. McDermott ◽  
A. Welch ◽  
R.T. Staff ◽  
F.J. Gilbert ◽  
L. Schweiger ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Primary Breast Cancer ◽  
Chemotherapy Response ◽  
Breast Cancer Patients
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