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. 2022 Jul 15;14(14):3454.
doi: 10.3390/cancers14143454.

Lung Nodules Missed in Initial Staging of Breast Cancer Patients in PET/MRI-Clinically Relevant?

Kai Jannusch  1 , Nils Martin Bruckmann  1 , Charlotte Johanna Geuting  1 , Janna Morawitz  1 , Frederic Dietzel  1 , Christoph Rischpler  2 , Ken Herrmann  2 , Ann-Kathrin Bittner  3 , Oliver Hoffmann  3 , Svjetlana Mohrmann  4 , Harald H Quick  5   6 , Lale Umutlu  7 , Gerald Antoch  1 , Julian Kirchner  1
Affiliations

Lung Nodules Missed in Initial Staging of Breast Cancer Patients in PET/MRI-Clinically Relevant?

Kai Jannusch et al. Cancers (Basel). .

Abstract

Purpose: The evaluation of the clinical relevance of missed lung nodules at initial staging of breast cancer patients in [18F]FDG-PET/MRI compared with CT.

Methods: A total of 152 patients underwent an initial whole-body [18F]FDG-PET/MRI and a thoracoabdominal CT for staging. Presence, size, shape and location for each lung nodule in [18F]FDG-PET/MRI was noted. The reference standard was established by taking initial CT and follow-up imaging into account (a two-step approach) to identify clinically-relevant lung nodules. Patient-based and lesion-based data analysis was performed.

Results: No patient with clinically-relevant lung nodules was missed on a patient-based analysis with MRI VIBE, while 1/84 females was missed with MRI HASTE (1%). Lesion-based analysis revealed 4/96 (4%, VIBE) and 8/138 (6%, HASTE) missed clinically-relevant lung nodules. The average size of missed lung nodules was 3.2 mm ± 1.2 mm (VIBE) and 3.6 mm ± 1.4 mm (HASTE) and the predominant location was in the left lower quadrant and close to the hilum.

Conclusion: All patients with newly-diagnosed breast cancer and clinically-relevant lung nodules were detected at initial [18F]FDG-PET/MRI staging. However, due to the lower sensitivity in detecting lung nodules, a small proportion of clinically-relevant lung nodules were missed. Thus, supplemental low-dose chest CT after neoadjuvant therapy should be considered for backup.

Keywords: PET/MRI; breast cancer; lung nodules; staging.

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Conflict of interest statement

Christoph Rischpler reports a research grant from Pfizer; a consultancy for Adacap and Pfizer; and speaker honoraria from Adacap, Alnylam, BTG, GE Healthcare, Pfizer, and Siemens Healthineers outside of the submitted work. No other potential conflicts of interests relevant to this article exist. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Examples of lung nodule contrast categorization ((A): very low contrast; (B): low contrast; (C): moderate contrast; (D): high contrast) and density categorization ((E): solid; (F): part-solid; (G): pure ground glass) at CT.
Figure 2
Figure 2
Images of a 46-year-old woman. Four-millimeter lung nodule located in right lower quadrant (red circle) identified on the CT image (A) but not recognizable in VIBE (B) nor HASTE (C) sequence.
Figure 3
Figure 3
Images of a 62-year-old woman. Three-millimeter lung nodule located in right lower quadrant (red circle) identified at HASTE sequence (A) that turned out as vessel in CT (1–3), continuous structure) due to slice-thickness artifact, evaluated as false-finding.
Figure 4
Figure 4
Sizes of missed lung nodules at (A) MRI VIBE (n = 96) and (B) MRI HASTE (n = 138) measured on initial CT. Average size (broken line) of nodules was 3.2 mm (range 1–8 mm) in MRI VIBE and 3.6 mm (range 1–9 mm) in MRI HASTE.
See this image and copyright information in PMC

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