Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225, Dusseldorf, Germany.
Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225, Dusseldorf, Germany.
Eur J Radiol. 2020 Jul;128:108975. doi: 10.1016/j.ejrad.2020.108975. Epub 2020 Apr 24.
To investigate whether potential differences in staging between a traditional staging imaging algorithm and F-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 F-FDG PET/MR for the TNM classification.
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 F-FDG PET/MR including dedicated F-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 F-FDG PET/MR, and (3) F-FDG PET/MR only. Major changes in therapy recommendations and differences between the traditional staging algorithm and F-FDG PET/MR for the TNM classification were evaluated.
Staging by F-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 F-FDG PET/MRI without statistical significance (p = 0.3827).
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 F-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 F-FDG-PET/MR in this setting is necessary to assess the true value of this modality.
研究传统分期成像算法与 F-FDG PET/MR 之间潜在的分期差异是否会导致乳腺癌患者管理方式的改变，并比较传统分期算法与 F-FDG PET/MR 对 TNM 分类的诊断准确性。
在这项来自两家大学医院的前瞻性队列研究中，纳入了 56 例新诊断、未经治疗的乳腺癌且远处转移预测试验概率增加的患者。所有患者均接受传统分期成像算法（X 射线乳腺摄影、乳腺超声、胸部 X 线摄影、骨闪烁扫描以及肝脏和腋窝的超声检查）和全身 F-FDG PET/MR 检查，包括专门的 F-FDG PET/MR 乳腺检查。每位患者在单独的肿瘤委员会会议上讨论两次，根据原发肿瘤的组织病理学数据，共确定了三种治疗建议，包括（1）仅基于传统算法，（2）传统算法和 F-FDG PET/MR，以及（3）仅基于 F-FDG PET/MR。评估了治疗建议的主要变化以及传统分期算法与 F-FDG PET/MR 对 TNM 分类的差异。
F-FDG PET/MR 分期与传统分期算法相比，在 56 例患者中的 8 例（14%）中导致了治疗方法的差异。治疗改变包括乳腺、局部区域淋巴结和全身治疗。F-FDG PET/MRI 分期具有优势的趋势，但无统计学意义（p=0.3827）。
总之，对于远处转移预测试验概率升高的乳腺癌患者，与传统分期算法相比，通过 F-FDG PET/MR 分期并结合组织病理学检查，有 14%的患者的治疗方案发生改变。特别是在指南修订方面，有必要进一步评估 F-FDG-PET/MR 在这种情况下的真正价值。
