The Pattern of Metastatic Breast Cancer: A Prospective Head-to-Head Comparison of [¹⁸F]FDG-PET/CT and CE-CT

The study aimed to compare the metastatic pattern of breast cancer and the intermodality proportion of agreement between [¹⁸F]FDG-PET/CT and CE-CT. Women with metastatic breast cancer (MBC) were enrolled prospectively and underwent a combined [¹⁸F]FDG-PET/CT and CE-CT scan to diagnose MBC. Experienced nuclear medicine and radiology physicians evaluated the scans blinded to the opposite scan results. Descriptive statistics were applied, and the intermodality proportion of agreement was used to compare [¹⁸F]FDG-PET/CT and CE-CT. In total, 76 women with verified MBC were enrolled in the study. The reported number of site-specific metastases for [¹⁸F]FDG-PET/CT vs. CE-CT was 53 (69.7%) vs. 44 (57.9%) for bone lesions, 31 (40.8%) vs. 43 (56.6%) for lung lesions, and 16 (21.1%) vs. 23 (30.3%) for liver lesions, respectively. The proportion of agreement between imaging modalities was 76.3% (95% CI 65.2-85.3) for bone lesions; 82.9% (95% CI 72.5-90.6) for liver lesions; 57.9% (95% CI 46.0-69.1) for lung lesions; and 59.2% (95% CI 47.3-70.4) for lymph nodes. In conclusion, bone and distant lymph node metastases were reported more often by [¹⁸F]FDG-PET/CT than CE-CT, while liver and lung metastases were reported more often by CE-CT than [¹⁸F]FDG-PET/CT. Agreement between scans was highest for bone and liver lesions and lowest for lymph node metastases.