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Open Access 01-11-2021 | Magnetic Resonance Imaging | Oncology

Prospective comparison of the diagnostic accuracy 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

Authors: Nils Martin Bruckmann, Julian Kirchner, Lale Umutlu, Wolfgang Peter Fendler, Robert Seifert, Ken Herrmann, Ann-Kathrin Bittner, Oliver Hoffmann, Svjetlana Mohrmann, Christina Antke, Lars Schimmöller, Marc Ingenwerth, Katharina Breuckmann, Andreas Stang, Christian Buchbender, Gerald Antoch, Lino M. Sawicki

Published in: European Radiology | Issue 11/2021

Abstract

Objectives

To 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 methods

A 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.

Results

Forty-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.

The Global Cancer Observatory G (2018) Breast cancer. Source: Globocan 2018. World Health Organ 876:2018–2019

Wockel A, Festl J, Stuber T et al (2018) Interdisciplinary screening, diagnosis, therapy and follow-up of breast cancer. Guideline of the DGGG and the DKG (S3-level, AWMF registry number 032/045OL, December 2017) - part 2 with recommendations for the therapy of primary, recurrent and advanced breast cancer. Geburtshilfe Frauenheilkd 78:1056–1088. https://doi.org/10.1055/a-0646-4630CrossRefPubMedPubMedCentral

Parkes A, Clifton K, Al-Awadhi A et al (2018) Characterization of bone only metastasis patients with respect to tumor subtypes. NPJ Breast Cancer 4:2. https://doi.org/10.1038/s41523-018-0054-xCrossRefPubMedPubMedCentral

Coleman RE, Rubens RD (1987) The clinical course of bone metastases from breast cancer. Br J Cancer 55:61–66. https://doi.org/10.1038/bjc.1987.13CrossRefPubMedPubMedCentral

Liede A, Jerzak KJ, Hernandez RK, Wade SW, Sun P, Narod SA (2016) The incidence of bone metastasis after early-stage breast cancer in Canada. Breast Cancer Res Treat 156:587–595. https://doi.org/10.1007/s10549-016-3782-3CrossRefPubMed

Brockton NT, Gill SJ, Laborge SL et al (2015) The breast cancer to bone (B2B) metastases research program: a multi-disciplinary investigation of bone metastases from breast cancer. BMC Cancer 15:512. https://doi.org/10.1186/s12885-015-1528-yCrossRefPubMedPubMedCentral

Jung SY, Rosenzweig M, Sereika SM, Linkov F, Brufsky A, Weissfeld JL (2012) Factors associated with mortality after breast cancer metastasis. Cancer Causes Control 23:103–112. https://doi.org/10.1007/s10552-011-9859-8CrossRefPubMed

Hortobagyi GN, Theriault RL, Lipton A et al (1998) Long-term prevention of skeletal complications of metastatic breast cancer with pamidronate. J Clin Oncol 16:2038–2044. https://doi.org/10.1200/JCO.1998.16.6.2038CrossRefPubMed

Liu T, Cheng T, Xu W, Yan W-L, Liu J, Yang H-L (2011) A meta-analysis of 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with breast cancer. Skeletal Radiol 40:523–531. https://doi.org/10.1007/s00256-010-0963-8CrossRefPubMed

10.

Rossi L, Longhitano C, Kola F, Del Grande M (2020) State of art and advances on the treatment of bone metastases from breast cancer: a concise review. Chin Clin Oncol 9:18. https://doi.org/10.21037/cco.2020.01.07

11.

Senkus E, Kyriakides S, Ohno S et al (2015) Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(Suppl 5):v8–v30. https://doi.org/10.1093/annonc/mdv298CrossRefPubMed

12.

Cardoso F, Senkus E, Costa A et al (2018) 4th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4)dagger. Ann Oncol 29:1634–1657. https://doi.org/10.1093/annonc/mdy192CrossRefPubMed

13.

Gradishar WJ, Anderson BO, Balassanian R et al (2018) Breast cancer, version 4.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 16:310–320. https://doi.org/10.6004/jnccn.2018.0012CrossRefPubMed

14.

Cardoso F, Paluch-Shimon S, Senkus E et al (2020) 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5). Ann Oncol 31:1623–1649. https://doi.org/10.1016/j.annonc.2020.09.010CrossRef

15.

Ohlmann-Knafo S, Pickuth D, Kirschbaum M, Fenzl G (2009) Diagnostic value of whole-body MRI and bone scintigraphy in the detection of osseous metastases in patients with breast cancer - a prospective double-blinded study at two hospital centers. RoFo 181:255–263. https://doi.org/10.1055/s-0028-1109104CrossRefPubMed

16.

Hausmann D, Kern C, Schröder M et al (2011) Whole-body MRI in preoperative diagnostics of breast cancer-a comparison with [corrected] staging methods according to the S 3 guidelines. Rofo 183:1130–1137CrossRef

17.

Hildebrandt MG, Gerke O, Baun C et al (2016) [181F] fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in suspected recurrent breast cancer: a prospective comparative study of dual-time-point FDG-PET/CT, contrast-enhanced CT, and bone scintigraphy. J Clin Oncol 34:1889–1897. https://doi.org/10.1200/JCO.2015.63.5185CrossRefPubMed

18.

Bitencourt AGV, Andrade WP, da Cunha RR et al (2017) Detection of distant metastases in patients with locally advanced breast cancer: role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging with computed tomography scans. Radiol Bras 50:211–215. https://doi.org/10.1590/0100-3984.2015-0232CrossRefPubMedPubMedCentral

19.

Park S, Yoon J-K, Lee SJ, Kang SY, Yim H, An Y-S (2017) Prognostic utility of FDG PET/CT and bone scintigraphy in breast cancer patients with bone-only metastasis. Medicine (United States) 96:e8985. https://doi.org/10.1097/MD.0000000000008985CrossRef

20.

Hahn S, Heusner T, Kümmel S et al (2011) Comparison of FDG-PET/CT and bone scintigraphy for detection of bone metastases in breast cancer. Acta Radiol 52:1009–1014. https://doi.org/10.1258/ar.2011.100507CrossRefPubMed

21.

Heindel W, Gübitz R, Vieth V et al (2014) The diagnostic imaging of bone metastases. Dtsch Arztebl Int 111:741–747. https://doi.org/10.3238/arztebl.2014.0741CrossRefPubMedPubMedCentral

22.

Catalano OA, Nicolai E, Rosen BR et al (2015) Comparison of CE-FDG-PET/CT with CE-FDG-PET/MR in the evaluation of osseous metastases in breast cancer patients. Br J Cancer 112:1452–1460. https://doi.org/10.1038/bjc.2015.112CrossRefPubMedPubMedCentral

23.

Sonni I, Minamimoto R, Baratto L et al (2020) Simultaneous PET/MRI in the evaluation of breast and prostate cancer using combined Na[18F] F and [18F]FDG: a focus on skeletal lesions. Mol Imaging Biol 22:397–406. https://doi.org/10.1007/s11307-019-01392-9CrossRefPubMed

24.

Blumhagen JO, Ladebeck R, Fenchel M, Scheffler K (2013) MR-based field-of-view extension in MR/PET: B0 homogenization using gradient enhancement (HUGE). Magn Reson Med 70:1047–1057. https://doi.org/10.1002/mrm.24555CrossRefPubMed

25.

Genders TSS, Spronk S, Stijnen T, Steyerberg EW, Lesaffre E, Hunink MGM (2012) Methods for calculating sensitivity and specificity of clustered data: a tutorial. Radiology 265:910–916. https://doi.org/10.1148/radiol.12120509CrossRefPubMed

26.

Muindi J, Coombes RC, Powles GSTJ, Khan O, Husband J (1983) The role of computed tomography in the detection of bone metastases in breast cancer patients. Br J Radiol 56:233–236. https://doi.org/10.1259/0007-1285-56-664-233CrossRefPubMed

27.

Bristow AR, Agrawal A, Evans AJ et al (2008) Can computerised tomography replace bone scintigraphy in detecting bone metastases from breast cancer? A prospective study. Breast 17:98–103. https://doi.org/10.1016/j.breast.2007.07.042CrossRefPubMed

28.

Engelhard K, Hollenbach HP, Wohlfart K et al (2004) Comparison of whole-body MRI with automatic moving table technique and bone scintigraphy for screening for bone metastases in patients with breast cancer. Eur Radiol 14:99–105. https://doi.org/10.1007/s00330-003-1968-7CrossRefPubMed

29.

Avrahami E, Tadmor R, Dally O, Hadar H (1989) Early MR demonstration of spinal metastases in patients with normal radiographs and CT and radionuclide bone scans. J Comput Assist Tomogr 13:598–602. https://doi.org/10.1097/00004728-198907000-00008CrossRefPubMed

30.

Steinborn M, Tiling R, Heuck A et al (2000) Diagnosis of bone marrow metastases with MRI. Diagnostik der metastasierung im knochenmark mittels MRT. Radiologe 40:826–834. https://doi.org/10.1007/s001170050830CrossRef

31.

Rybak LD, Rosenthal DI (2001) Radiological imaging for the diagnosis of bone metastases. Q J Nucl Med 45:53–64PubMed

32.

Hildebrandt M, Falch K, Baun C et al (2015) Imaging of bone metastases in suspected recurrent breast cancer. J Nucl Med 56:560CrossRef

33.

Mavriopoulou E, Zampakis P, Smpiliri E et al (2018) Whole body bone SPET/CT can successfully replace the conventional bone scan in breast cancer patients. A prospective study of 257 patients. Hell J Nucl Med 21:125–133PubMed

34.

Morris PG, Lynch C, Feeney JN et al (2010) Integrated positron emission tomography/computed tomography may render bone scintigraphy unnecessary to investigate suspected metastatic breast cancer. J Clin Oncol 28:3154–3159. https://doi.org/10.1200/JCO.2009.27.5743CrossRefPubMedPubMedCentral

35.

Sawicki LM, Grueneisen J, Schaarschmidt BM et al (2016) Evaluation of ¹⁸F-FDG PET/MRI, ¹⁸F-FDG PET/CT, MRI, and CT in whole-body staging of recurrent breast cancer. Eur J Radiol 85:459–465. https://doi.org/10.1016/j.ejrad.2015.12.010CrossRefPubMed

36.

Heusner T, Gölitz P, Hamami M et al (2011) “One-stop-shop” staging: should we prefer FDG-PET/CT or MRI for the detection of bone metastases? Eur J Radiol 78:430–435. https://doi.org/10.1016/j.ejrad.2009.10.031CrossRefPubMed

37.

Jambor I, Kuisma A, Ramadan S et al (2016) Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1.5T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial. Acta Oncol (Madr) 55:59–67. https://doi.org/10.3109/0284186X.2015.1027411CrossRef

38.

Löfgren J, Mortensen J, Rasmussen SH et al (2017) A prospective study comparing99mTc-hydroxyethylene-diphosphonate planar bone scintigraphy and whole-body SPECT/CT with18F-fluoride PET/CT and18F-fluoride PET/MRI for diagnosing bone metastases. J Nucl Med 58:1778–1785. https://doi.org/10.2967/jnumed.116.189183CrossRefPubMed

39.

Sawicki LM, Kirchner J, Umutlu L et al (2017) Comparison of 18F–FDG PET/MRI and MRI alone for whole-body staging and potential impact on therapeutic management of women with suspected recurrent pelvic cancer: a follow-up study. Eur J Nucl Med Mol Imaging 45:622–629. https://doi.org/10.1007/s00259-017-3881-3CrossRefPubMed

40.

Kakhki VRD, Anvari K, Sadeghi R et al (2013) Pattern and distribution of bone metastases in common malignant tumors. Nucl Med Rev 16:66–69. https://doi.org/10.5603/NMR.2013.0037CrossRef

Title: Prospective comparison of the diagnostic accuracy 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
Authors: Nils Martin Bruckmann
Julian Kirchner
Lale Umutlu
Wolfgang Peter Fendler
Robert Seifert
Ken Herrmann
Ann-Kathrin Bittner
Oliver Hoffmann
Svjetlana Mohrmann
Christina Antke
Lars Schimmöller
Marc Ingenwerth
Katharina Breuckmann
Andreas Stang
Christian Buchbender
Gerald Antoch
Lino M. Sawicki
Publication date: 01-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Computed Tomography
Metastasis
Computed Tomography
Breast Cancer
Breast Cancer
Positron Emission Tomography
Scintigraphy
Published in: European Radiology / Issue 11/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-021-07956-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prospective comparison of the diagnostic accuracy 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

Abstract

Objectives

Material and methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Material and methods

Results

Conclusion

Key Points

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