GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands.
Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Eur J Nucl Med Mol Imaging. 2017 Oct;44(11):1796-1805. doi: 10.1007/s00259-017-3745-x. Epub 2017 Jun 10.
Our purpose in this study was to assess the added clinical value of hybrid F-FDG-PET/MRI compared to conventional imaging for locoregional staging in breast cancer patients undergoing neoadjuvant chemotherapy (NAC).
In this prospective study, primary invasive cT2-4 N0 or cT1-4 N+ breast cancer patients undergoing NAC were included. A PET/MRI breast protocol was performed before treatment. MR images were evaluated by a breast radiologist, blinded for PET images. PET images were evaluated by a nuclear physician. Afterwards, a combined PET/MRI report was written. PET/MRI staging was compared to conventional imaging, i.e., mammography, ultrasound and MRI. The proportion of patients with a modified treatment plan based on PET/MRI findings was analyzed.
A total of 40 patients was included. PET/MRI was of added clinical value in 20.0% (8/40) of patients, changing the treatment plan in 10% and confirming the malignancy of suspicious lesions on MRI in another 10%. In seven (17.5%) patients radiotherapy fields were extended because of additional or affirmative PET/MRI findings being lymph node metastases (n = 5) and sternal bone metastases (n = 2). In one (2.5%) patient radiotherapy fields were reduced because of fewer lymph node metastases on PET/MRI compared to conventional imaging. Interestingly, all treatment changes were based on differences in number of lymph nodes suspicious for metastasis or number of distant metastasis, whereas differences in intramammary tumor extent were not observed.
Prior to NAC, PET/MRI shows promising results for locoregional staging compared to conventional imaging, changing the treatment plan in 10% of patients and potentially replacing PET/CT or tissue sampling in another 10% of patients.
本研究旨在评估与传统影像学相比，在接受新辅助化疗（NAC）的乳腺癌患者中，混合 F-FDG-PET/MRI 在局部区域分期方面的附加临床价值。
在这项前瞻性研究中，纳入了接受 NAC 的原发性浸润性 cT2-4 N0 或 cT1-4 N+乳腺癌患者。在治疗前进行了 PET/MRI 乳腺方案检查。MR 图像由一位乳腺放射科医生进行评估，该医生对 PET 图像不知情。然后，编写了一份联合 PET/MRI 报告。将 PET/MRI 分期与传统影像学（即乳房 X 线摄影、超声和 MRI）进行比较。分析了基于 PET/MRI 结果修改治疗计划的患者比例。
共纳入 40 例患者。在 20.0%（8/40）的患者中，PET/MRI 具有附加的临床价值，改变了 10%的治疗计划，并在另外 10%的患者中确认了 MRI 上可疑病变的恶性程度。在 7 例（17.5%）患者中，由于额外的或阳性的 PET/MRI 发现为淋巴结转移（n=5）和胸骨骨转移（n=2），放疗野被扩展。在 1 例（2.5%）患者中，由于与传统影像学相比，PET/MRI 上的淋巴结转移数量较少，放疗野被减少。有趣的是，所有治疗变化都是基于可疑淋巴结转移的数量或远处转移的数量的差异，而不是乳腺内肿瘤范围的差异。
在 NAC 之前，与传统影像学相比，PET/MRI 显示出在局部区域分期方面有良好的结果，改变了 10%的患者的治疗计划，并可能在另外 10%的患者中替代 PET/CT 或组织取样。
