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Comparison of whole-body MRI, CT, and bone scintigraphy for response evaluation of cancer therapeutics in metastatic breast cancer to bone
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Kosmin, Michael, Padhani, Anwar R., Gogbashian, Andrew, Woolf, David, Ah-See, Mei-Lin, Ostler, Peter, Sutherland, Stephanie, Miles, David, Noble, Jillian, Koh, Dow-Mu, Marshall, Andrea, Dunn, Janet A. and Makris, Andreas (2020) Comparison of whole-body MRI, CT, and bone scintigraphy for response evaluation of cancer therapeutics in metastatic breast cancer to bone. Radiology, 297 (3). pp. 622-629. doi:10.1148/radiol.2020192683
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WRAP-Comparison-whole-body-MRI-CT-bone-Marshall-2020.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (1319Kb) | Preview |
Official URL: http://dx.doi.org/10.1148/radiol.2020192683
Abstract
In participants receiving systemic anticancer therapy for bone-only metastatic breast cancer, whole-body MRI enabled identification of progressive disease earlier than whole-body CT and bone scintigraphy.
Background
CT and bone scintigraphy have limitations in evaluating systemic anticancer therapy (SACT) response in bone metastases from metastatic breast cancer (MBC).
Purpose
To evaluate whether whole-body MRI enables identification of progressive disease (PD) earlier than CT and bone scintigraphy in bone-only MBC.
Materials and Methods
This prospective study evaluated participants with bone-only MBC between May 2016 and January 2019 (ClinicalTrials.gov identifier: NCT03266744). Participants were enrolled at initiation of first or subsequent SACT based on standard CT and bone scintigraphy imaging. Baseline whole-body MRI was performed within 2 weeks of entry; those with extraosseous disease were excluded. CT and whole-body MRI were performed every 12 weeks until definitive PD was evident with one or both modalities. In case of PD, bone scintigraphy was used to assess for bone disease progression. Radiologists independently interpreted images from CT, whole-body MRI, or bone scintigraphy and were blinded to results with the other modalities. Systematic differences in performance between modalities were analyzed by using the McNemar test.
Results
Forty-five participants (mean age, 60 years ± 13 [standard deviation]; all women) were evaluated. Median time on study was 36 weeks (range, 1–120 weeks). Two participants were excluded because of unequivocal evidence of liver metastases at baseline whole-body MRI, two participants were excluded because they had clinical progression before imaging showed PD, and one participant was lost to follow-up. Of the 33 participants with PD at imaging, 67% (22 participants) had PD evident at whole-body MRI only and 33% (11 participants) had PD at CT and whole-body MRI concurrently; none had PD at CT only (P < .001, McNemar test). There was only slight agreement between whole-body MRI and CT (Cohen κ, 0.15). PD at bone scintigraphy was reported in 50% of participants (13 of 26) with bone progression at CT and/or whole-body MRI (P < .001, McNemar test).
Conclusion
Whole-body MRI enabled identification of progressive disease before CT in most participants with bone-only metastatic breast cancer. Progressive disease at bone scintigraphy was evident in only half of participants with bone progression at whole-body MRI.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | ||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Breast -- Cancer , Breast -- Cancer -- Chemotherapy, Bones -- Radionuclide imaging, Medical radiology, Breast -- Cancer -- Imaging, Oncology | ||||||||
| Journal or Publication Title: | Radiology | ||||||||
| Publisher: | Radiological Society of North America, Inc. | ||||||||
| ISSN: | 0033-8419 | ||||||||
| Official Date: | December 2020 | ||||||||
| Dates: |
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| Volume: | 297 | ||||||||
| Number: | 3 | ||||||||
| Page Range: | pp. 622-629 | ||||||||
| DOI: | 10.1148/radiol.2020192683 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||||
| Copyright Holders: | © RSNA, 2020 |
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