Hybrid F-FDG PET/MRI Might Improve Locoregional Staging of Breast Cancer Patients Prior to Neoadjuvant Chemotherapy

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2017 Jun 11

PMID 28600647

Citations 15

Authors

Briete Goorts

Stefan Voo

Thiemo J A van Nijnatten

Loes F S Kooreman

Maaike de Boer

Kristien B M I Keymeulen

Romy Aarnoutse

Joachim E Wildberger

Felix M Mottaghy

Marc B I Lobbes

Marjolein L Smidt

Affiliations

Soon will be listed here.

Abstract

Purpose: 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).

Methods: 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.

Results: 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.

Conclusion: 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.

Citing Articles

[Molecular breast imaging : Positron emission tomography/magnetic resonance imaging and targeted tracers].

Panagiotis K, Gullo R, Resch D, Pinker K Radiologie (Heidelb). 2025; 65(3):170-177.

PMID: 39900666 DOI: 10.1007/s00117-024-01403-z.

The role of F-FDG PET/MRI in assessing pathological complete response to neoadjuvant chemotherapy in patients with breast cancer: a systematic review and meta-analysis.

Ghanikolahloo M, Taher H, Abdullah A, Asadi Anar M, Tayebi A, Rahimi R Radiat Oncol. 2024; 19(1):164.

PMID: 39563327 PMC: 11577720. DOI: 10.1186/s13014-024-02507-5.

[F]FDG whole-body PET-MR including an integrated breast MR protocol for locoregional and distant staging in breast cancer patients-a feasibility study.

van Nijnatten T, de Mooij C, Mitea C, Houwers J, de Boer M, Smidt M Insights Imaging. 2024; 15(1):243.

PMID: 39382796 PMC: 11464706. DOI: 10.1186/s13244-024-01830-5.

Joint EANM-SNMMI guideline on the role of 2-[F]FDG PET/CT in no special type breast cancer : (endorsed by the ACR, ESSO, ESTRO, EUSOBI/ESR, and EUSOMA).

Vaz S, Pilkington Woll J, Cardoso F, Groheux D, Cook G, Ulaner G Eur J Nucl Med Mol Imaging. 2024; 51(9):2706-2732.

PMID: 38740576 PMC: 11224102. DOI: 10.1007/s00259-024-06696-9.

PET/MRI and Novel Targets for Breast Cancer.

Chung H, Park K, Lim I, Noh W, Yoo Y, Nam S Biomedicines. 2024; 12(1).

PMID: 38255277 PMC: 10813582. DOI: 10.3390/biomedicines12010172.

References

Pediconi F, Miglio E, Telesca M, Luciani M, Kirchin M, Passariello R . Effect of preoperative breast magnetic resonance imaging on surgical decision making and cancer recurrence rates. Invest Radiol. 2011; 47(2):128-35. DOI: 10.1097/RLI.0b013e318230061c. View

Cooper K, Harnan S, Meng Y, Ward S, Fitzgerald P, Papaioannou D . Positron emission tomography (PET) for assessment of axillary lymph node status in early breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2011; 37(3):187-98. DOI: 10.1016/j.ejso.2011.01.003. View

Koolen B, Olmos R, Elkhuizen P, Vogel W, Vrancken Peeters M, Rodenhuis S . Locoregional lymph node involvement on 18F-FDG PET/CT in breast cancer patients scheduled for neoadjuvant chemotherapy. Breast Cancer Res Treat. 2012; 135(1):231-40. DOI: 10.1007/s10549-012-2179-1. View

Lambregts D, Heijnen L, Maas M, Rutten I, Martens M, Backes W . Gadofosveset-enhanced MRI for the assessment of rectal cancer lymph nodes: predictive criteria. Abdom Imaging. 2012; 38(4):720-7. DOI: 10.1007/s00261-012-9957-4. View

Koolen B, Olmos R, Vogel W, Vrancken Peeters M, Rodenhuis S, Rutgers E . Pre-chemotherapy 18F-FDG PET/CT upstages nodal stage in stage II-III breast cancer patients treated with neoadjuvant chemotherapy. Breast Cancer Res Treat. 2013; 141(2):249-54. DOI: 10.1007/s10549-013-2678-8. View

Liu Y . Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer. World J Clin Oncol. 2014; 5(5):982-9. PMC: 4259958. DOI: 10.5306/wjco.v5.i5.982. View

Neal C, Daly C, Nees A, Helvie M . Can preoperative axillary US help exclude N2 and N3 metastatic breast cancer?. Radiology. 2010; 257(2):335-41. DOI: 10.1148/radiol.10100296. View

Baltzer P, Dietzel M, Burmeister H, Zoubi R, Gajda M, Camara O . Application of MR mammography beyond local staging: is there a potential to accurately assess axillary lymph nodes? evaluation of an extended protocol in an initial prospective study. AJR Am J Roentgenol. 2011; 196(5):W641-7. DOI: 10.2214/AJR.10.4889. View

Gruber I, Rueckert M, Kagan K, Staebler A, Siegmann K, Hartkopf A . Measurement of tumour size with mammography, sonography and magnetic resonance imaging as compared to histological tumour size in primary breast cancer. BMC Cancer. 2013; 13:328. PMC: 3704854. DOI: 10.1186/1471-2407-13-328. View

10.

Schipper R, van Roozendaal L, de Vries B, Pijnappel R, Beets-Tan R, Lobbes M . Axillary ultrasound for preoperative nodal staging in breast cancer patients: is it of added value?. Breast. 2013; 22(6):1108-13. DOI: 10.1016/j.breast.2013.09.002. View

11.

An Y, Lee D, Yoon J, Lee S, Kim T, Kang D . Diagnostic performance of 18F-FDG PET/CT, ultrasonography and MRI. Detection of axillary lymph node metastasis in breast cancer patients. Nuklearmedizin. 2013; 53(3):89-94. DOI: 10.3413/Nukmed-0605-13-06. View

12.

Aukema T, Straver M, Vrancken Peeters M, Russell N, Gilhuijs K, Vogel W . Detection of extra-axillary lymph node involvement with FDG PET/CT in patients with stage II-III breast cancer. Eur J Cancer. 2010; 46(18):3205-10. DOI: 10.1016/j.ejca.2010.07.034. View

13.

Segaert I, Mottaghy F, Ceyssens S, De Wever W, Stroobants S, Van Ongeval C . Additional value of PET-CT in staging of clinical stage IIB and III breast cancer. Breast J. 2010; 16(6):617-24. DOI: 10.1111/j.1524-4741.2010.00987.x. View

14.

van Nijnatten T, Ploumen E, Schipper R, Goorts B, Andriessen E, Vanwetswinkel S . Routine use of standard breast MRI compared to axillary ultrasound for differentiating between no, limited and advanced axillary nodal disease in newly diagnosed breast cancer patients. Eur J Radiol. 2016; 85(12):2288-2294. DOI: 10.1016/j.ejrad.2016.10.030. View

15.

Groheux D, Mankoff D, Espie M, Hindie E . ¹⁸F-FDG PET/CT in the early prediction of pathological response in aggressive subtypes of breast cancer: review of the literature and recommendations for use in clinical trials. Eur J Nucl Med Mol Imaging. 2016; 43(5):983-993. DOI: 10.1007/s00259-015-3295-z. View

16.

Noguchi S, Miyauchi K, Nishizawa Y, Imaoka S, Koyama H, Iwanaga T . Results of surgical treatment for sternal metastasis of breast cancer. Cancer. 1988; 62(7):1397-401. DOI: 10.1002/1097-0142(19881001)62:7<1397::aid-cncr2820620726>3.0.co;2-2. View

17.

Ng S, David S, Alamgeer M, Ganju V . Impact of Pretreatment Combined (18)F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Staging on Radiation Therapy Treatment Decisions in Locally Advanced Breast Cancer. Int J Radiat Oncol Biol Phys. 2015; 93(1):111-7. DOI: 10.1016/j.ijrobp.2015.05.012. View

18.

Boellaard R, Delgado-Bolton R, Oyen W, Giammarile F, Tatsch K, Eschner W . FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2014; 42(2):328-54. PMC: 4315529. DOI: 10.1007/s00259-014-2961-x. View

19.

Farshchian N, Tamari S, Farshchian N, Madani H, Rezaie M, Mohammadi-Motlagh H . Diagnostic value of chemical shift artifact in distinguishing benign lymphadenopathy. Eur J Radiol. 2010; 80(2):594-7. DOI: 10.1016/j.ejrad.2010.10.005. View

20.

Ozdemir H, Atilla S, Ilgit E, Isik S . Parasternal sonography of the internal mammary lymphatics in breast cancer: CT correlation. Eur J Radiol. 1995; 19(2):114-7. DOI: 10.1016/0720-048x(94)00575-w. View