DOI: 10.1007/s00259-018-4102-4Pages: 2328-2337

Local and whole-body staging in patients with primary breast cancer: a comparison of one-step to two-step staging utilizing 18F-FDG-PET/MRI

1. University Dusseldorf, Department of Diagnostic and Interventional Radiology, Medical Faculty

2. University Hospital Essen, University of Duisburg-Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology

3. High-Field and Hybrid MR Imaging, University Hospital Essen

4. University Duisburg-Essen, Erwin L. Hahn Institute for MR Imaging

5. University Hospital Essen, University of Duisburg-Essen, Department of Gynecology and Obstetrics

6. University Duisburg-Essen and the German Cancer Consortium (DKTK) Essen, Institute of Pathology, University Hospital Essen, West German Cancer Center

7. Abdominal Imaging and Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School

8. University Hospital Essen, University of Duisburg-Essen, Department of Nuclear Medicine

Correspondence to:
Julian Kirchner
Tel: +49-211-8-117552




The purpose of this study was to compare the diagnostic value of a one-step to a two-step staging algorithm utilizing 18F-FDG PET/MRI in breast cancer patients.


A total of 38 patients (37 females and one male, mean age 57 ± 10 years; range 31–78 years) with newly diagnosed, histopathologically proven breast cancer were prospectively enrolled in this trial. All PET/MRI examinations were assessed for local tumor burden and metastatic spread in two separate reading sessions: (1) One-step algorithm comprising supine whole-body 18F-FDG PET/MRI, and (2) Two-step algorithm comprising a dedicated prone 18F-FDG breast PET/MRI and supine whole-body 18F-FDG PET/MRI.


On a patient based analysis the two-step algorithm correctly identified 37 out of 38 patients with breast carcinoma (97%), while five patients were missed by the one-step 18F-FDG PET/MRI algorithm (33/38; 87% correct identification). On a lesion-based analysis 56 breast cancer lesions were detected in the two-step algorithm and 44 breast cancer lesions could be correctly identified in the one-step 18F-FDG PET/MRI (79%), resulting in statistically significant differences between the two algorithms (p = 0.0015). For axillary lymph node evaluation sensitivity, specificity and accuracy was 93%, 95 and 94%, respectively. Furthermore, distant metastases could be detected in seven patients in both algorithms.


The results demonstrate the necessity and superiority of a two-step 18F-FDG PET/MRI algorithm, comprising dedicated prone breast imaging and supine whole-body imaging, when compared to the one-step algorithm for local and whole-body staging in breast cancer patients.

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  • Accepted: Jul 18, 2018
  • Online: Jul 28, 2018

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