Added value of dedicated axillary hybrid 18F-FDG PET/MRI for improved axillary nodal staging in clinically node-positive breast cancer patients: a feasibility study

Thiemo J A van Nijnatten, B Goorts, S Vöö, M de Boer, L F S Kooreman, E M Heuts, J E Wildberger, F M Mottaghy, M B I Lobbes, M L Smidt, Thiemo J A van Nijnatten, B Goorts, S Vöö, M de Boer, L F S Kooreman, E M Heuts, J E Wildberger, F M Mottaghy, M B I Lobbes, M L Smidt

Abstract

Purpose: To investigate the feasibility and potential added value of dedicated axillary 18F-FDG hybrid PET/MRI, compared to standard imaging modalities (i.e. ultrasound [US], MRI and PET/CT), for axillary nodal staging in clinically node-positive breast cancer.

Methods: Twelve patients with clinically node-positive breast cancer underwent axillary US and dedicated axillary hybrid 18F-FDG PET/MRI. Nine of the 12 patients also underwent whole-body PET/CT. Maximum standardized uptake values (SUVmax) were measured for the primary breast tumor and the most FDG-avid axillary lymph node. A positive axillary lymph node on dedicated axillary hybrid PET/MRI was defined as a moderate to very intense FDG-avid lymph node. The diagnostic performance of dedicated axillary hybrid PET/MRI was calculated by comparing quantitative and its qualitative measurements to results of axillary US, MRI and PET/CT. The number of suspicious axillary lymph nodes was subdivided as follows: N0 (0 nodes), N1 (1-3 nodes), N2 (4-9 nodes) and N3 (≥ 10 nodes).

Results: According to dedicated axillary hybrid PET/MRI findings, seven patients were diagnosed with N1, four with N2 and one with N3. With regard to mean SUVmax, there was no significant difference in the primary tumor (9.0 [±5.0] vs. 8.6 [±5.7], p = 0.678) or the most FDG-avid axillary lymph node (7.8 [±5.3] vs. 7.7 [±4.3], p = 0.767) between dedicated axillary PET/MRI and PET/CT. Compared to standard imaging modalities, dedicated axillary hybrid PET/MRI resulted in changes in nodal status as follows: 40% compared to US, 75% compared to T2-weighted MRI, 40% compared to contrast-enhanced MRI, and 22% compared to PET/CT.

Conclusions: Adding dedicated axillary 18F-FDG hybrid PET/MRI to diagnostic work-up may improve the diagnostic performance of axillary nodal staging in clinically node-positive breast cancer patients.

Keywords: Axilla; Breast cancer; Hybrid PET/MRI; Lymph node imaging.

Conflict of interest statement

Conflict of interest

J.E.W. has received institutional research grants from Agfa, Bayer, BRACCO, GE, Philips and Siemens, and speaker honoraria from Bayer and Siemens. F.M.M. has received institutional grants from Bayer, Siemens and Philips, and speaker honoraria from Bayer. M.L.S. received a speaker honorarium from Roche Nederland B.V. None of these relationships had a direct impact on the current project.

All other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Example of a patient with a 35-mm invasive carcinoma of no special type in her right breast. One cross-sectional PET/CT image (left) of the right axilla demonstrates three suspicious lymph nodes (red arrows) out of a total of five suspicious lymph nodes on PET/CT. One coronal dedicated axillary hybrid PET/MRI image (right) demonstrates four suspicious lymph nodes (red arrows), with a total of eight suspicious lymph nodes on dedicated axillary hybrid PET/MRI. The most dorsally located suspicious lymph node on (low-dose) PET/CT consists of two suspicious lymph nodes on dedicated axillary hybrid PET/MRI
Fig. 2
Fig. 2
Example of a patient with a 31-mm invasive carcinoma of no special type in her right breast. A coronal T2-weighted MR image (left) of the right axilla demonstrates two (red arrows) of four suspicious nodes. A coronal dedicated axillary hybrid PET/MRI image (right) demonstrates no FDG-uptake in any of the four nodes (green arrows), which resulted in four negative nodes on dedicated axillary hybrid PET/MRI

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Source: PubMed

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