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

Kirchner, Julian; Grueneisen, Johannes; Martin, Ole; Oehmigen, Mark; Quick, Harald H.; Bittner, Ann‐Kathrin; Hoffmann, Oliver; Ingenwerth, Marc; Catalano, Onofrio A.; Heusch, Philipp; Buchbender, Christian; Forsting, Michael; Antoch, Gerald; Herrmann, Ken; Umutlu, Lale

doi:10.1007/s00259-018-4102-4

Cited by 32 publications

(36 citation statements)

References 42 publications

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“…With tumor-induced paraneoplastic limbic encephalitis being one of the three major causes of limbic encephalitis, patients suspected of LE commonly undergo whole-body imaging to rule out underlying oncologic diseases. As reported in a vast amount of previous publications integrated PET/MRI facilitates a highly valuable platform for whole-body staging [15,[41][42][43]. In our study, an underlying oncologic disease could be ruled out in 18 patients, while one patient with rectal cancer could be correctly identified, and one suspicious subcutaneous lesion in another patient was false positive in MRI as well as PET.…”

Section: Discussionsupporting

confidence: 51%

18F-FDG-PET/MRI in the diagnostic work-up of limbic encephalitis

et al. 2020

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Section: Discussionsupporting

confidence: 51%

18F-FDG-PET/MRI in the diagnostic work-up of limbic encephalitis

et al. 2020

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“…This applies to axillary lymph node metastases, to liver and bone metastases, and to the total tumor stage [21,31,32]. It was emphasized in former studies that in combination with a dedicated breast PET/MRI protocol, 18 F-FDG PET/MRI has the appealing potential of a one-stop-shop solution for patients with primary breast cancer [33,34].The results of our study reveal a significantly better accuracy for determining the correct N stage with 18 F-FDG PET/MRI than with MRI alone. Both modalities showed similarly strong results in specificity on a patient-based analysis for the N and M rating.…”

Section: Discussionmentioning

confidence: 99%

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

Bruckmann

Sawicki

Kirchner

et al. 2020

Eur J Nucl Med Mol Imaging

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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).

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“…All 18 F-FDG PET/MRI examinations were performed on an integrated 3-Tesla PET/MRI system (Biograph mMR, Siemens Healthcare GmbH, Erlangen, Germany) and obtained one hour after injection of a bodyweight-adapted dosage of 18 F-FDG (4 MBq/kg bodyweight). The protocol included a dedicated breast 18 F-FDG PET/MR and a whole-body imaging scan [15]. For this dedicated study, only the PET/MR breast examinations were considered.…”

Section: Pet/mrimentioning

confidence: 99%

“…Please see Figure 1 for an example. body imaging scan [15]. For this dedicated study, only the PET/MR breast examinations were considered.…”

Section: Pet/mrimentioning

confidence: 99%

Multiparametric Integrated 18F-FDG PET/MRI-Based Radiomics for Breast Cancer Phenotyping and Tumor Decoding

Umutlu

Kirchner

Bruckmann

et al. 2021

Cancers

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Background: This study investigated the performance of simultaneous 18F-FDG PET/MRI of the breast as a platform for comprehensive radiomics analysis for breast cancer subtype analysis, hormone receptor status, proliferation rate and lymphonodular and distant metastatic spread. Methods: One hundred and twenty-four patients underwent simultaneous 18F-FDG PET/MRI. Breast tumors were segmented and radiomic features were extracted utilizing CERR software following the IBSI guidelines. LASSO regression was employed to select the most important radiomics features prior to model development. Five-fold cross validation was then utilized alongside support vector machines, resulting in predictive models for various combinations of imaging data series. Results: The highest AUC and accuracy for differentiation between luminal A and B was achieved by all MR sequences (AUC 0.98; accuracy 97.3). The best results in AUC for prediction of hormone receptor status and proliferation rate were found based on all MR and PET data (ER AUC 0.87, PR AUC 0.88, Ki-67 AUC 0.997). PET provided the best determination of grading (AUC 0.71), while all MR and PET analyses yielded the best results for lymphonodular and distant metastatic spread (0.81 and 0.99, respectively). Conclusion: 18F-FDG PET/MRI enables comprehensive high-quality radiomics analysis for breast cancer phenotyping and tumor decoding, utilizing the perks of simultaneously acquired morphologic, functional and metabolic data.

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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

Abstract: The results demonstrate the necessity and superiority of a two-step F-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.

Cited by 32 publications

References 42 publications

18F-FDG-PET/MRI in the diagnostic work-up of limbic encephalitis

18F-FDG-PET/MRI in the diagnostic work-up of limbic encephalitis

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

Multiparametric Integrated 18F-FDG PET/MRI-Based Radiomics for Breast Cancer Phenotyping and Tumor Decoding

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