Abstract
ObjectivesTo compare the diagnostic performance of [18F]FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients.Material and methodsA cohort of 154 therapy-naive patients with newly diagnosed, histopathologically proven breast cancer was enrolled in this study prospectively. All patients underwent a whole-body [18F]FDG PET/MRI, computed tomography (CT) scan, and a bone scintigraphy prior to therapy. All datasets were evaluated regarding the presence of bone metastases. McNemar χ2 test was performed to compare sensitivity and specificity between the modalities.ResultsForty-one bone metastases were present in 7/154 patients (4.5%). Both [18F]FDG PET/MRI and MRI alone were able to detect all of the patients with histopathologically proven bone metastases (sensitivity 100%; specificity 100%) and did not miss any of the 41 malignant lesions (sensitivity 100%). CT detected 5/7 patients (sensitivity 71.4%; specificity 98.6%) and 23/41 lesions (sensitivity 56.1%). Bone scintigraphy detected only 2/7 patients (sensitivity 28.6%) and 15/41 lesions (sensitivity 36.6%). Furthermore, CT and scintigraphy led to false-positive findings of bone metastases in 2 patients and in 1 patient, respectively. The sensitivity of PET/MRI and MRI alone was significantly better compared with CT (p < 0.01, difference 43.9%) and bone scintigraphy (p < 0.01, difference 63.4%).Conclusion[18F]FDG PET/MRI and MRI are significantly better than CT or bone scintigraphy for the detection of bone metastases in patients with newly diagnosed breast cancer. Both CT and bone scintigraphy show a substantially limited sensitivity in detection of bone metastases.Key Points• [18F]FDG PET/MRI and MRI alone are significantly superior to CT and bone scintigraphy for the detection of bone metastases in patients with newly diagnosed breast cancer.• Radiation-free whole-body MRI might serve as modality of choice in detection of bone metastases in breast cancer patients.
Highlights
Breast cancer is by far the most common solid neoplasm in women worldwide and with 15% the leading cause of tumorrelated deaths in women every year [1]
On a lesion-based analysis, these modalities reveal a considerable advantage especially in the detection of osteolytic metastases. [18F]FDG PET/MRI shows no differences to MRI alone in sensitivity but offers a higher diagnostic confidence in correctly rating bone metastases
The spectrum of available therapeutic options for breast cancer has significantly improved in recent years, distant metastases are still detectable in approximately one-third of patients during the course of the disease [3]
Summary
Breast cancer is by far the most common solid neoplasm in women worldwide and with 15% the leading cause of tumorrelated deaths in women every year [1]. To the assessment of the extent of the primary tumor in the breast and locoregional lymph node involvement, the detection of distant metastases is crucial, since this can result in an extension of the irradiation field or an adjustment of chemotherapy and eventually in a change to a palliative therapy concept [2]. Imaging-based whole-body staging plays a pivotal role in the primary diagnostics of breast cancer patients with a high risk for the presence of distant metastases. Despite the advances in the treatment of breast cancer, up to 30% of patients still develop distant metastases over the course of the disease [3]. Detection can help to better control the disease, minimize complications, and, as a result, achieve a better quality of life [9]
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