Julian Kirchner1, Ole Martin2, Lale Umutlu3, Ken Herrmann4, Ann-Kathrin Bittner5, Oliver Hoffmann5, Swetlana Mohrmann6, Thomas Gauler7, Sarah Theurer8, Christina Antke9, Irene Esposito10, Sonja Kinner3, Benedikt M Schaarschmidt3, Bernd Kowall11, Diana Lütke-Brintrup11, Andreas Stang11, Anton S Becker12, Gerald Antoch2, Christian Buchbender2. 1. Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225, Dusseldorf, Germany. Electronic address: Julian.Kirchner@med.uni-duesseldorf.de. 2. Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, D-40225, Dusseldorf, Germany. 3. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany. 4. Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany. 5. Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany. 6. Department of Gynecology, University Dusseldorf, Medical Faculty, D-40225, Dusseldorf, Germany. 7. Department of Radiation Oncology, West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstr. 55, 45122, Essen, Germany. 8. Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany. 9. Department of Nuclear Medicine, University Dusseldorf, Medical Faculty, D-40225, Dusseldorf, Germany. 10. Institute of Pathology, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany. 11. Institute of Medical Informatics, Biometry and Epidemiology, Essen University Medical Center, Essen, Germany. 12. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
Abstract
PURPOSE: To investigate whether potential differences in staging between a traditional staging imaging algorithm and 18F-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 18F-FDG PET/MR for the TNM classification. METHOD: 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 18F-FDG PET/MR including dedicated 18F-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 18F-FDG PET/MR, and (3) 18F-FDG PET/MR only. Major changes in therapy recommendations and differences between the traditional staging algorithm and 18F-FDG PET/MR for the TNM classification were evaluated. RESULTS: Staging by 18F-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 18F-FDG PET/MRI without statistical significance (p = 0.3827). CONCLUSION: 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 18F-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 18F-FDG-PET/MR in this setting is necessary to assess the true value of this modality.
PURPOSE: To investigate whether potential differences in staging between a traditional staging imaging algorithm and 18F-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 18F-FDG PET/MR for the TNM classification. METHOD: 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 18F-FDG PET/MR including dedicated 18F-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 18F-FDG PET/MR, and (3) 18F-FDG PET/MR only. Major changes in therapy recommendations and differences between the traditional staging algorithm and 18F-FDG PET/MR for the TNM classification were evaluated. RESULTS: Staging by 18F-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 18F-FDG PET/MRI without statistical significance (p = 0.3827). CONCLUSION: 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 18F-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 18F-FDG-PET/MR in this setting is necessary to assess the true value of this modality.
Authors: F Cardoso; E Senkus; A Costa; E Papadopoulos; M Aapro; F André; N Harbeck; B Aguilar Lopez; C H Barrios; J Bergh; L Biganzoli; C B Boers-Doets; M J Cardoso; L A Carey; J Cortés; G Curigliano; V Diéras; N S El Saghir; A Eniu; L Fallowfield; P A Francis; K Gelmon; S R D Johnston; B Kaufman; S Koppikar; I E Krop; M Mayer; G Nakigudde; B V Offersen; S Ohno; O Pagani; S Paluch-Shimon; F Penault-Llorca; A Prat; H S Rugo; G W Sledge; D Spence; C Thomssen; D A Vorobiof; B Xu; L Norton; E P Winer Journal: Ann Oncol Date: 2018-08-01 Impact factor: 32.976
Authors: F Cardoso; A Costa; L Norton; E Senkus; M Aapro; F André; C H Barrios; J Bergh; L Biganzoli; K L Blackwell; M J Cardoso; T Cufer; N El Saghir; L Fallowfield; D Fenech; P Francis; K Gelmon; S H Giordano; J Gligorov; A Goldhirsch; N Harbeck; N Houssami; C Hudis; B Kaufman; I Krop; S Kyriakides; U N Lin; M Mayer; S D Merjaver; E B Nordström; O Pagani; A Partridge; F Penault-Llorca; M J Piccart; H Rugo; G Sledge; C Thomssen; L Van't Veer; D Vorobiof; C Vrieling; N West; B Xu; E Winer Journal: Breast Date: 2014-09-20 Impact factor: 4.380
Authors: Armando E Giuliano; James L Connolly; Stephen B Edge; Elizabeth A Mittendorf; Hope S Rugo; Lawrence J Solin; Donald L Weaver; David J Winchester; Gabriel N Hortobagyi Journal: CA Cancer J Clin Date: 2017-03-14 Impact factor: 508.702
Authors: M Bernsdorf; A K Berthelsen; V T Wielenga; N Kroman; D Teilum; T Binderup; U B Tange; M Andersson; A Kjær; A Loft; J Graff Journal: Ann Oncol Date: 2012-02-21 Impact factor: 32.976
Authors: Achim Wöckel; Jasmin Festl; Tanja Stüber; Katharina Brust; Mathias Krockenberger; Peter U Heuschmann; Steffi Jírů-Hillmann; Ute-Susann Albert; Wilfried Budach; Markus Follmann; Wolfgang Janni; Ina Kopp; Rolf Kreienberg; Thorsten Kühn; Thomas Langer; Monika Nothacker; Anton Scharl; Ingrid Schreer; Hartmut Link; Jutta Engel; Tanja Fehm; Joachim Weis; Anja Welt; Anke Steckelberg; Petra Feyer; Klaus König; Andrea Hahne; Traudl Baumgartner; Hans H Kreipe; Wolfram Trudo Knoefel; Michael Denkinger; Sara Brucker; Diana Lüftner; Christian Kubisch; Christina Gerlach; Annette Lebeau; Friederike Siedentopf; Cordula Petersen; Hans Helge Bartsch; Rüdiger Schulz-Wendtland; Markus Hahn; Volker Hanf; Markus Müller-Schimpfle; Ulla Henscher; Renza Roncarati; Alexander Katalinic; Christoph Heitmann; Christoph Honegger; Kerstin Paradies; Vesna Bjelic-Radisic; Friedrich Degenhardt; Frederik Wenz; Oliver Rick; Dieter Hölzel; Matthias Zaiss; Gudrun Kemper; Volker Budach; Carsten Denkert; Bernd Gerber; Hans Tesch; Susanne Hirsmüller; Hans-Peter Sinn; Jürgen Dunst; Karsten Münstedt; Ulrich Bick; Eva Fallenberg; Reina Tholen; Roswita Hung; Freerk Baumann; Matthias W Beckmann; Jens Blohmer; Peter Fasching; Michael P Lux; Nadia Harbeck; Peyman Hadji; Hans Hauner; Sylvia Heywang-Köbrunner; Jens Huober; Jutta Hübner; Christian Jackisch; Sibylle Loibl; Hans-Jürgen Lück; Gunter von Minckwitz; Volker Möbus; Volkmar Müller; Ute Nöthlings; Marcus Schmidt; Rita Schmutzler; Andreas Schneeweiss; Florian Schütz; Elmar Stickeler; Christoph Thomssen; Michael Untch; Simone Wesselmann; Arno Bücker; Andreas Buck; Stephanie Stangl Journal: Geburtshilfe Frauenheilkd Date: 2018-11-26 Impact factor: 2.915
Authors: J Orcajo-Rincon; J Muñoz-Langa; J M Sepúlveda-Sánchez; G C Fernández-Pérez; M Martínez; E Noriega-Álvarez; S Sanz-Viedma; J C Vilanova; A Luna Journal: Clin Transl Oncol Date: 2022-02-13 Impact factor: 3.340