Detección de la infiltración de la cadena mamaria interna en pacientes con cáncer de mama mediante PET/RM con 18F-FDG y sus implicaciones terapéuticas / Detection of internal mammary chain infiltration in breast cancer patients by [18F]FDG PET/MRI: Therapy implications

Objetivo: Evaluar la tasa de detección y la implicación terapéutica de la infiltración de la cadena mamaria interna (ICMI) mediante tomografía por emisión de positrones (PET) y resonancia magnética (RM) con 18F-fluorodesoxiglucosa (18F-PET/RM) en la estadificación de pacientes con cáncer de mama. Método: Estudio prospectivo, 41 mujeres con cáncer de mama (estadio ≥ IIB) estadificadas mediante 18F-FDG-PET/RM. Estudio en dos fases: imágenes mamarias (decúbito prono), cuerpo completo (supino). Estadificación TNM por consenso entre especialista en Medicina Nuclear y Radiología. Estudio vaso aferente (VA) a cadena mamaria interna (CMI) por RM mamaria. Correlación ICMI con edad, VA-CMI, estadificación T, cuadrante, infiltración axilar y a distancia. Revaloración terapéutica en comité multidisciplinar. Resultados: Tasa de detección de ICMN de 34% (14/41), siendo 8/14 < 55 años. Todas las 14 pacientes con ICMI muestran VA-CMI, en seis de ellas (43,9%) sin VA-axilar. De 27/41 sin ICMI, en 13 (48,1%) solo VA-axilar, en los 14 restantes (51,9%) VA-axilar y VA-CMI. Un total de 57% (8/14) son multicéntricos y 42% (6/14) focales, en cuadrantes internos en 4/6 (66,7%). En 1/14 (7,1%) solo ICMI, en 9/14 (64,3%) axilar y CMI y en 4/14 (28,6%) lesiones a distancia. Decisión del comité: sin tratamiento adicional en 27/41 (65,8%), radioterapia torácica en 10/41 (24,4%) y terapia sistémica en 4/41 (9,7%). Conclusión: La tasa de detección de la ICMI en la estadificación del cáncer de mama mediante 18F-FDG PET/RM es de 34%. Son factores asociados la edad, los tumores multicéntricos, los de cuadrantes internos, la existencia de VA-CMI, la estadificación NM. La evidencia de ICMI permite la individualización de la terapia, indicando la radioterapia torácica en 24,4%.(AU)

Objective: To evaluate the detection rate and therapeutic implication of the infiltration of the internal mammary chain (IMCI) by [18F]FDG PET/MRI for staging of patients with breast cancer. Methods: Prospective study including 41 women with breast cancer (stage ≥IIB) staged by [18F]FDG PET/MR. Two-phase exam: breast imaging (prone), whole-body (supine). TNM stage assessed by peer consensus with Nuclear Medicine and Radiology specialists. Study of the afferent vessel (AV) to IMC by breast MRI. IMCI was correlated with age, AV-IMC, T stage, breast quadrants, axillary and distant infiltration. Therapeutic re-evaluation by a multidisciplinary committee. Results: IMCI detection rate of 34% (14/41), with 8/14 patients under 55 years of age. All 14 patients with IMCI showed AV-IMC, 6 of them (43.9%) without VA-axillary. Of 27/41 patients without IMCI, in 13 (48.1%) only AV-axillary was found, in the remaining 14 (51.9%), AV-axillary and AV-IMC was found. In 57% (8/14) tumours were multicentric and 42% (6/14) focal, in inner quadrants in 4/6 (66.7%). In 1/14 patient (7.1%) only IMCI was found, in 9/14 (64.3%) axillary and IMC, in 4/14 patients (28.6%) distant lesions were detected. Committee re-evaluation: no further treatment in 27/41 patients (65.8%), thoracic radiotherapy in 10/41 patients (24.4%), systemic therapy in 4/41 patients (9.7%). Conclusion: Our detection rate of IMCI in breast cancer staging by [18F]FDG PET/MR was 34%. Related factors were age, multicentric tumours, inner quadrants, detection of AV-IMC, NM staging.The evidence of IMCI allowed tailored therapy, with thoracic radiotherapy implementation in 24.4% of patients.(AU)

Detection of internal mammary chain infiltration in breast cancer patients by [18F]FDG PET/MRI. Therapy implications.

OBJECTIVE: To evaluate the detection rate and therapeutic implication of the infiltration of the internal mammary chain (IMCI) by [18F]FDG PET/MRI for staging of patients with breast cancer. METHODS: Prospective study including 41 women with breast cancer (stage ≥ IIB) staged by [18F]FDG PET/MR. Two-phase exam: breast imaging (prone), whole-body (supine). Tumor node metastases (TNM) stage assessed by peer consensus with Nuclear Medicine and Radiology specialists. Study of the afferent vessel (AV) to IMC by breast MRI. IMCI was correlated with age, AV-IMC, T stage, breast quadrants, axillary and distant infiltration. Therapeutic re-evaluation by a multidisciplinary committee. RESULTS: IMCI detection rate of 34% (14/41), with 8/14 patients under 55 years of age. All 14 patients with IMCI showed AV-IMC, 6 of them (43.9%) without VA-axillary. Of 27/41 patients without IMCI, in 13 (48.1%) only AV-axillary was found, in the remaining 14 (51.9%), AV-axillary and AV-IMC was found. In 57% (8/14) tumours were multicentric and 42% (6/14) focal, in inner quadrants in 4/6 (66.7%). In 1/14 patient (7.1%) only IMCI was found, in 9/14 (64.3%) axillary and IMC, in 4/14 patients (28.6%) distant lesions were detected. Committee re-evaluation: no further treatment in 27/41 patients (65.8%), thoracic radiotherapy in 10/41 patients (24.4%), systemic therapy in 4/41 patients (9.7%). CONCLUSION: Our detection rate of IMCI in breast cancer staging by [18F]FDG PET/MR was 34%. Related factors were age, multicentric tumours, inner quadrants, detection of AV-IMC, NM staging. The evidence of IMCI allowed tailored therapy, with thoracic radiotherapy implementation in 24.4% of patients.

18F-choline PET/MRI on initial staging of prostate cancer. Impact on therapy approach. / La PET/RM con 18F-colina en el diagnóstico inicial del cáncer de próstata. Impacto en la estrategia terapéutica.

AIM: Evaluate the therapy impact of initial staging in patients diagnosed with prostate cancer by 18 F-choline PET/MRI hybrid technique. MATERIAL: A prospective study which included 31 patients diagnosed with prostate cancer; Gleason > 7; mean PSA 13.6 ng/mL (range 6.3-20.6). PET/MRI studies were acquired simultaneously with hybrid equipment (SIGNA.3T, GE) following intravenous injection of 185 ± 18.5MBq of 18F-choline: - Early/prostate imaging: PET emission + multiparametric MR: DIXON-T1-T2-diffusion-gadolinium. - Late/whole-body imaging: PET emission + MR: DIXON-T1-T2-diffusion-STIR sequences. Images were visually evaluated. SUV & ADC & textures were also calculated. Treatment selection was based upon Oncology Committee consensus decision. RESULTS: Procedure was well tolerated in all patients, and no artifacts were reported. MRI was superior in T staging in eight patients (25.8%) (Likert: 2-3), whereas PET increased MRI sensitivity in three patients (9.7%) (PIRADS: 3). PROSTATE LESION LOCATION: Peripheral 91.4%, transitional 8.6%. SUVmax threshold: 2.95: sensitivity 92.9%, specificity 66.7%. No correlation SUV vs. ADC. Better distinction between stage T2 vs. T3 using the DiscrLin model with NG = 16 (AUC 0.7767 ± 0.3386). PET was superior to T2 in textures analysis (0.588 vs. 0.412). Seventeen patients (54.8%) were staged ≥ T3, with surgical treatment being contraindicated. Fifteen patients (48.4%) presented with extra-prostatic disease: 8/31 oligometastatic and 7/31 multiple metastasis. Therapy approach following PET/MRI was: radical treatment in 24/31 patients (77.4%), 14 radical prostatectomy and 10 MRI-guided radiotherapy; systemic treatment in 7/31 patients (22.6%). CONCLUSION: 18F-choline PET/MRI had a complementary role for the T staging, with a high detection rate for NM infiltration. PET/MRI findings allowed patients to be directed either to prostatectomy or MRI-guided radiotherapy, and thus avoiding radicaltreatment in 22.6% of patients.