Impact of (18)F-FDG PET/MR on therapeutic management in high risk primary breast cancer patients – A prospective evaluation of staging algorithms Journal Article


Authors: Kirchner, J.; Martin, O.; Umutlu, L.; Herrmann, K.; Bittner, A. K.; Hoffmann, O.; Mohrmann, S.; Gauler, T.; Theurer, S.; Antke, C.; Esposito, I.; Kinner, S.; Schaarschmidt, B. M.; Kowall, B.; Lütke-Brintrup, D.; Stang, A.; Becker, A. S.; Antoch, G.; Buchbender, C.
Article Title: Impact of (18)F-FDG PET/MR on therapeutic management in high risk primary breast cancer patients – A prospective evaluation of staging algorithms
Abstract: Purpose: To investigate whether potential differences in staging between a traditional staging imaging algorithm and 18F-FDG PET/MR lead to a change in patient management in breast carcinoma and to compare the diagnostic accuracy between the traditional staging algorithm and 18F-FDG PET/MR for the TNM classification. Method: In this prospective cohort study from two university hospitals 56 women with newly diagnosed, therapy-naive breast cancer and increased pre-test probability for distant metastases were included. All patients were examined by a traditional staging imaging algorithm (X-ray mammography, breast ultrasonography, chest plain radiography, bone scintigraphy, and ultrasonography of the liver and axillary fossa) and whole-body 18F-FDG PET/MR including dedicated 18F-FDG PET/MR breast examinations. Each patient was discussed two times in a separate tumor board session to determine a total of three therapy recommendations based on histopathological data of the primary tumor and (1) traditional algorithm only, (2) traditional algorithm and 18F-FDG PET/MR, and (3) 18F-FDG PET/MR only. Major changes in therapy recommendations and differences between the traditional staging algorithm and 18F-FDG PET/MR for the TNM classification were evaluated. Results: Staging by 18F-FDG PET/MR led to a difference in treatment compared the traditional staging algorithm in 8/56 cases (14%). Therapy changes included therapy of the breast, locoregional nodes and systemic therapy. A trend to staging superiority was found for 18F-FDG PET/MRI without statistical significance (p = 0.3827). Conclusion: In conclusion, for breast cancer patients with elevated pre-test probability for distant metastases a change of the therapy regiment occurs in 14 % of patients when staged by 18F-FDG PET/MR and confirmed by histopathology compared to a traditional staging algorithm. In particular with regard to the amendment of the guideline further assessment of 18F-FDG-PET/MR in this setting is necessary to assess the true value of this modality. © 2020 Elsevier B.V.
Keywords: adult; controlled study; human tissue; major clinical study; histopathology; cancer patient; cancer staging; nuclear magnetic resonance imaging; positron emission tomography; follow up; magnetic resonance imaging; diagnostic accuracy; prospective study; breast cancer; image analysis; echomammography; cohort analysis; distant metastasis; high risk patient; patient care; mammography; probability; breast carcinoma; echography; fluorodeoxyglucose f 18; thorax radiography; cancer classification; bone scintiscanning; diagnostic test accuracy study; liver examination; prone position; tnm staging; supine position; human; female; priority journal; article
Journal Title: European Journal of Radiology
Volume: 128
ISSN: 0720-048X
Publisher: Elsevier B.V  
Date Published: 2020-07-01
Start Page: 108975
Language: English
DOI: 10.1016/j.ejrad.2020.108975
PUBMED: 32371185
PROVIDER: scopus
PMCID: PMC9587896
DOI/URL:
Notes: Article -- Export Date: 1 June 2020 -- Source: Scopus
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  1. Anton Sebastian Becker
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