Diagnostic performance of ¹⁸F-FDG PET/CT, ultrasonography and MRI

Summary

The aim of this study was to evaluate the diagnostic abilities of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) compared with those of ultrasonography and magnetic resonance imaging (MRI) for axillary lymph node staging in breast cancer patients. Patients, methods: Pre- operative ¹⁸F-FDG PET/non-contrast CT, ultrasonography and MRI were performed in 215 women with breast cancer. Axillary lymph node dissection was performed in all patients and the diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. ROC curves were compared to evaluate the diagnostic ability of several imaging modalities (i. e., ultrasonography, MRI and ¹⁸F-FDG PET/CT). Results: In total, 132 patients (61.4%) had axillary lymph node metastasis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of axillary lymph node metastasis were 72.3%, 77.3%, 66.7%, 81.6%, 75.3% for ultrasonography, 67.5%, 78.0%, 65.9%, 79.2%, 74.0% for MRI, and 62.7%, 88.6%, 77.6%, 79.1%, 78.6% for ¹⁸F-FDG PET/CT, respectively. There was no significant difference in diagnostic ability among the imaging modalities (i.e., ultrasonography, MRI and ¹⁸F-FDG PET/CT). The diagnostic ability of ¹⁸F-FDG PET/CT was significantly improved by combination with MRI (p = 0.0002) or ultrasonography (p < 0.0001). The combination of ¹⁸F-FDG PET/CT with ultrasonography had a similar diagnostic ability to that of all three modalities combined (¹⁸F-FDG PET/CT+ultraso- nography+MRI, p = 0.05). Conclusion: The diagnostic performance of ¹⁸F-FDG PET/CT for detection of axillary node metastasis was not significantly different from that of ultrasonography or MRI in breast cancer patients. Combining ¹⁸F-FDG PET/CT with ultrasonography or MRI could improve the diagnostic performance compared to ¹⁸F-FDG PET/CT alone.

Zusammenfassung

Ziel dieser Studie war die Evaluierung der diagnostischen Bedeutung der ¹⁸F-Fluor deoxyglucose(FDG)-Positronenemissionstomo grafie/Computertomografie (PET/CT), verglichen mit Sonografie und Magnetresonanzto- mografie, im Staging axillärer Lymphknoten bei Brustkrebspatientinnen. Patientinnen, Methoden: Präoperativ wurden 215 Frauen mit Brustkrebs mittels ¹⁸F-FDG/CT (ohne Kontrastmittel), Sonografie oder MRT untersucht. Allen Patientinnen wurden axilläre Lymphknoten entnommen; die diagnostische jeder Methode wurde mit histopathologischen Ergebnissen als Referenzstandard evaluiert. Zur Beurteilung der diagnostischen Aussage wurden die ROC-Kurven der drei bildgebenden Methoden verglichen. Ergebnisse: Insgesamt wiesen 132 Patientinnen (61,4%) axilläre Lymphknotenmetastasen auf. Sensitivität, Spezifität, positiver bzw. negativer Vorhersagewert und Genauigkeit beim Nachweis axillärer Lymphknotenmetastasen lagen bei 72,3%, 77,3%, 66,7%, 81,6%, 75.3% für Sonografie, 67,5%, 78,0%, 65,9%, 79,2%, 74,0% für MRT sowie 62,7%, 88,6%, 77,6%, 79,1%, 78,6% für ¹⁸F-FDG-PET/CT. Hinsichtlich der diagnostischen Aussage bestand kein signifikanter Unterschied zwischen den drei Methoden. Die diagnostische Leistungsfähigkeit der ¹⁸F-FDG PET/CT konnte durch Kombination mit MRT (p = 0,0002) oder Sonografie (p < 0,0001) deutlich gesteigert werden. Die Kombination aus ¹⁸F-FDG-PET/CT und Sonografie war diagnostisch ähnlich aussagekräftig wie die aus den drei Methoden (¹⁸F-FDG-PET/CT + MRT + Sonografie, p = 0,05). Schlussfolgerung: Zum Nachweis axillärer Lymphknotenmetastasen bei Brustkrebspatientinnen unterschied sich die diagnostische Aussagekraft der ¹⁸F-FDG- PET/CT nicht signifikant von der der Sonogra- fie oder MRT. Kombinationen aus ¹⁸F-FDG- PET/CT und Sonografie oder MRT könnten die diagnostische Leistungsfähigkeit gegenüber der ¹⁸F-FDG-PET/CT jedoch verbessern.

Keywords

¹⁸F-FDG PET/CT - ultrasonography - MRI - breast cancer - axillary lymph node

Schlüsselwörter

¹⁸F-FDG PET/CT - Sonografie - MRT - Brustkrebs - axilläre Lymphknoten

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