Comparison of nodal staging between CT, MRI, and [18F]-FDG PET/MRI in patients with newly diagnosed breast cancer

Abstract

Purpose To compare CT, MRI, and [18F]-fluorodeoxyglucose positron emission tomography ([18F]-FDG PET/MRI) for nodal status, regarding quantity and location of metastatic locoregional lymph nodes in patients with newly diagnosed breast cancer. Materials and methods One hundred eighty-two patients (mean age 52.7 ± 11.9 years) were included in this prospective double-center study. Patients underwent dedicated contrast-enhanced chest/abdomen/pelvis computed tomography (CT) and whole-body ([18F]-FDG PET/) magnet resonance imaging (MRI). Thoracal datasets were evaluated separately regarding quantity, lymph node station (axillary levels I–III, supraclavicular, internal mammary chain), and lesion character (benign vs. malign). Histopathology served as reference standard for patient-based analysis. Patient-based and lesion-based analyses were compared by a McNemar test. Sensitivity, specificity, positive and negative predictive values, and accuracy were assessed for all three imaging modalities. Results On a patient-based analysis, PET/MRI correctly detected significantly more nodal positive patients than MRI (p < 0.0001) and CT (p < 0.0001). No statistically significant difference was seen between CT and MRI. PET/MRI detected 193 lesions in 75 patients (41.2%), while MRI detected 123 lesions in 56 patients (30.8%) and CT detected 104 lesions in 50 patients, respectively. Differences were statistically significant on a lesion-based analysis (PET/MRI vs. MRI, p < 0.0001; PET/MRI vs. CT, p < 0.0001; MRI vs. CT, p = 0.015). Subgroup analysis for different lymph node stations showed that PET/MRI detected significantly more lymph node metastases than MRI and CT in each location (axillary levels I–III, supraclavicular, mammary internal chain). MRI was superior to CT only in axillary level I (p = 0.0291). Conclusion [18F]-FDG PET/MRI outperforms CT or MRI in detecting nodal involvement on a patient-based analysis and on a lesion-based analysis. Furthermore, PET/MRI was superior to CT or MRI in detecting lymph node metastases in all lymph node stations. Of all the tested imaging modalities, PET/MRI showed the highest sensitivity, whereas CT showed the lowest sensitivity, but was most specific.

Breast PET/MRI Hybrid Imaging and Targeted Tracers

“…In a more recent paper, a prospective comparison of nodal staging between CT, MRI, and 18 F‐FDG PET/MRI was performed in 182 breast cancer patients. The authors found that 18 F‐FDG PET/MRI outperformed CT and MRI in detecting axillary lymph node metastases at every level, revealing the presence of 193 lesions, whereas 123 and 104 lesions were detected by MRI and CT, respectively 56 . Recent evidence supporting the good performance of PET/MRI for the preoperative assessment of axillary lymph nodes has led to dedicated prospective clinical trials aiming to compare PET/MRI with axillary surgery or sentinel lymph node biopsy in early and advanced breast cancer 57 .…”

Imaging in translational cancer research

“…However, the prospects of correlating metabolic functional imaging with functional and structural MRI parameters may be attractive not only for answering research questions but ultimately for translation to clinical imaging 207 . E.g., FDG-PET-MRI has been found to outperform MRI in evaluating tumor size and nodal metastases in rectal cancer 208 , and MRI and CT for nodal staging in breast cancer 209 .…”

The Effect of PACS in Breast Tumor Diagnosis Based on Numerical Analysis

“…Currently, the diagnosis of molecular subtypes of breast tumor is mainly based on surgical or puncture biopsy immunohistochemistry, which is the gold standard for the detection of ER, PR, HER-2, and Ki-67 expression, and the reliability of its tests also depends on the handling of the tissue, which may sometimes lead to false positives and false negatives [ 15 ]. Therefore, predicting the molecular subtype of breast tumor by imaging signs can further improve the reliability of preoperative treatment strategies, which is of great value for the precise treatment of breast tumor and improving the prognosis.…”