Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Dusseldorf, Germany.
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Eur J Nucl Med Mol Imaging. 2020 Nov;47(12):2816-2825. doi: 10.1007/s00259-020-04801-2. Epub 2020 Apr 24.
To evaluate and compare the diagnostic potential of whole-body MRI and whole-body F-FDG PET/MRI for N and M staging in newly diagnosed, histopathologically proven breast cancer.
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 F-FDG PET/MRI. MRI and 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 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 test was performed to compare sensitivity and specificity of the N and M stages between F-FDG PET/MRI and MRI. Differences in diagnostic confidence scores were assessed by Wilcoxon signed rank test.
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 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 F-FDG PET/MRI determining malignant lymph nodes (p = 0.008). The M stage was identified correctly in MRI and 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, 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).
F-FDG PET/MRI has a better diagnostic accuracy for N staging in primary breast cancer patients and provides a significantly higher diagnostic confidence in lesion characterization than MRI alone. But both modalities bear the risk to overestimate the M stage.
评估和比较全身 MRI 和全身 F-FDG PET/MRI 在新诊断的、经组织病理学证实的乳腺癌患者中的 N 和 M 分期的诊断潜力。
本前瞻性研究纳入了 104 例新诊断的、经组织病理学证实的乳腺癌患者（年龄 53.4±12.5 岁）。所有患者均行全身 F-FDG PET/MRI 检查。单独评估 MRI 和 F-FDG PET/MRI 数据集的病变计数、病变定位和病变特征（良恶性）以及诊断信心（5 分有序量表，1-5 分）。根据第八版美国癌症联合委员会（AJCC）分期手册，分别在 MRI 数据集和 F-FDG PET/MRI 数据集中评估 N 和 M 分期。在大多数病变中，组织病理学为参考标准。其余病变通过影像学和临床检查进行随访。对于淋巴结阳性和淋巴结阴性的女性，分别进行 McNemar χ2 检验，比较 F-FDG PET/MRI 和 MRI 之间 N 和 M 分期的敏感性和特异性。使用 Wilcoxon 符号秩检验评估诊断信心评分的差异。
MRI 正确确定了 104 例患者中的 78 例（75%）N 分期，其敏感性为 62.3%（95%CI：0.48-0.75），特异性为 88.2%（95%CI：0.76-0.96），阳性预测值（PPV）为 84.6%（95%CI：69.5-0.94），阴性预测值（NPV）为 69.2%（95%CI：0.57-0.8）。相应的 F-FDG PET/MRI 结果为 87/104（83.7%）、75.5%（95%CI：0.62-0.86）、92.2%（0.81-0.98）、90%（0.78-0.97）和 78.3%（0.66-0.88），F-FDG PET/MRI 确定恶性淋巴结的敏感性明显更高（p=0.008）。MRI 和 F-FDG PET/MRI 在 104 例患者中均正确确定了 M 分期。两种方法均正确分期了所有 7 例远处转移患者，导致每种方法均出现 4 例假阳性（3.8%）。在基于病变的分析中，F-FDG PET/MRI 在正确确定恶性病变方面表现出明显更好的性能（85.8%比 67.1%，差异 18.7%（95%CI：0.13-0.26），p<0.0001），并且与单独使用 MRI 相比，提供了更高的诊断信心（4.1±0.7 比 3.4±0.7，p<0.0001）。
F-FDG PET/MRI 在新诊断的乳腺癌患者中进行 N 分期具有更好的诊断准确性，并在病变特征方面提供了比单独使用 MRI 更高的诊断信心。但是，两种方法都存在高估 M 分期的风险。
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