Geneva University Hospital, Radiology Department, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Centre Hospitallier Universitaire Vaudois, Radiology Department, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Eur Radiol. 2019 Apr;29(4):1787-1798. doi: 10.1007/s00330-018-5720-8. Epub 2018 Sep 28.
To compare the diagnostic performance of 18-FDG-PET/MR and PET/CT for the N- and M- staging of breast cancer.
Two independent readers blinded to clinical/follow-up data reviewed PET/MR and PET/CT examinations performed for initial or recurrent breast cancer staging in 80 consecutive patients (mean age = 48 ± 12.9 years). The diagnostic confidence for lesions in the contralateral breast, axillary/internal mammary nodes, bones and other distant sites were recorded. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. The standard of reference included pathology and/or follow-up > 12 months.
Nine of 80 patients had bone metastases; 13/80 had other distant metastases, 44/80 had axillary, 9/80 had internal mammary and 3/80 had contralateral breast tumours. Inter-reader agreement for lesions was excellent (weighted kappa = 0.833 for PET/CT and 0.823 for PET/MR) with similar reader confidence for the two tests (ICC = 0.875). In the patient-per-patient analysis, sensitivity and specificity of PET/MRI and PET/CT were similar (p > 0.05). In the lesion-per-lesion analysis, the sensitivity of PET/MR and PET/CT for bone metastases, other metastases, axillary and internal mammary nodes, contralateral tumours and all lesions together was 0.924 and 0.6923 (p = 0.0034), 0.923 and 0.923 (p = 1), 0.854 and 0.812 (p = 0.157), 0.9 and 0.9 (p = 1), 1 and 0.25 (p = 0.083), and 0.89 and 0.77 (p = 0.0013) respectively. The corresponding specificity was 0.953 and 1 (p = 0.0081), 1 and 1 (p = 1), 0.893 and 0.92 (p = 0.257), 1 and 1 (p = 1), 0.987 and 0.99 (p = 1) and 0.96 and 0.98 (p = 0.0075) respectively.
Reader confidence, inter-reader agreement and diagnostic performance per patient were similar with PET/MR and PET/CT. However, for all lesions together, PET/MR had a superior sensitivity and lower specificity in the lesion-per-lesion analysis.
• N and M breast cancer staging performance of PET/MR and PET/CT is similar per patient. • In a lesion-per-lesion analysis PET/MR is more sensitive than PET/CT especially for bone metastasis. • Readers' diagnostic confidence is similar for both tests.
比较 18-FDG-PET/MR 和 PET/CT 在乳腺癌 N 和 M 分期中的诊断性能。
两位独立的读者对 80 例连续接受初始或复发性乳腺癌分期的患者的 PET/MR 和 PET/CT 检查进行了盲法回顾，（平均年龄=48±12.9 岁）。记录了对对侧乳房、腋窝/内乳淋巴结、骨骼和其他远处部位病变的诊断信心。计算了敏感性、特异性、阳性（PPV）和阴性预测值（NPV）。参考标准包括病理和/或随访>12 个月。
80 例患者中有 9 例发生骨转移；13/80 例有其他远处转移，44/80 例有腋窝，9/80 例有内乳，3/80 例有对侧乳房肿瘤。两位读者对病变的一致性非常好（PET/CT 的加权 Kappa 值为 0.833，PET/MR 的加权 Kappa 值为 0.823），两种检测的读者信心相似（ICC=0.875）。在逐例患者分析中，PET/MRI 和 PET/CT 的敏感性和特异性相似（p>0.05）。在病变逐例分析中，PET/MR 和 PET/CT 对骨转移、其他转移、腋窝和内乳淋巴结、对侧肿瘤和所有病变的敏感性分别为 0.924 和 0.6923（p=0.0034），0.923 和 0.923（p=1），0.854 和 0.812（p=0.157），0.9 和 0.9（p=1），1 和 0.25（p=0.083），0.89 和 0.77（p=0.0013）。相应的特异性分别为 0.953 和 1（p=0.0081）、1 和 1（p=1）、0.893 和 0.92（p=0.257）、1 和 1（p=1）、0.987 和 0.99（p=1）和 0.96 和 0.98（p=0.0075）。
读者信心、读者间一致性和每位患者的诊断性能在 PET/MR 和 PET/CT 之间相似。然而，在所有病变的分析中，PET/MR 在病变逐例分析中具有更高的敏感性和更低的特异性。
每位患者的 PET/MR 和 PET/CT 乳腺癌 N 和 M 分期性能相似。
在病变逐例分析中，PET/MR 比 PET/CT 更敏感，尤其是在骨转移方面。
两种检测的读者诊断信心相似。
