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Peer-reviewedCC BY 4.0European Journal of Nuclear Medicine and Molecular Imaging

Stage-dependent performance and molecular subtype-specific relapse patterns on same-session [18F]FDG PET/contrast-enhanced CT in breast cancer

  • Agostino Chiaravalloti1,2
  • Shyqyri Samarxhiu1
  • Ilaria Portarena3
  • Valeria Flaminio3
  • Nicola D’Ascenzo4,5
  • Orazio Schillaci1
  • Gianluca Vanni6
6 affiliations
  1. 1Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, Rome, 00133 Italy
  2. 2IRCCS Neuromed, Via Atinense 18, Pozzilli, 86077 IS Italy
  3. 3Medical Oncology Unit, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, Rome, 00133 Italy
  4. 4Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, Anhui China
  5. 5Department of Biomedical Engineering, Huazhong University of Science and Technology, Wuhan, Hubei China
  6. 6Breast Unit, Department of Surgical Sciences, Fondazione PTV Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, 00133 Italy
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Abstract

Purpose: To evaluate stage-dependent performance of same-session [18F]FDG PET/contrast-enhanced CT (PET/ceCT) for initial breast cancer staging and PET/ceCT-detected relapse patterns during follow-up.

Methods: This retrospective single-centre study included a primary staging cohort with one index PET/ceCT per patient and a longitudinal cohort of follow-up/restaging examinations. PET/ceCT-derived endpoints were assessed against clinically adjudicated reference standards established through multidisciplinary team review, pathology when available and follow-up imaging. SUVmax and ceCT lesion diameter were analysed as exploratory biomarkers.

Results: The staging cohort included 116 patients. Baseline stage was evaluable in 106 patients: 65 had cN-positive disease, 9 had cT3-4 cN0 disease and 32 had cT1-2 cN0 disease. Overall nodal staging performance showed sensitivity 64.8%, specificity 88.9%, PPV 92.0%, NPV 56.1% and accuracy 72.9%. In cT3-4 and/or cN-positive disease, PET-positive nodal findings had a PPV of 100%. Baseline M-stage assessment was limited by the low number of clinically confirmed M1 cases. SUVmax correlated with Ki-67 (rho = 0.322, p = 0.003, q = 0.022). The longitudinal cohort included 176 patients and 429 examinations. In 311 adjudicated examinations, restaging performance for disease progression showed sensitivity 100%, specificity 93.5%, PPV 97.3%, NPV 100% and accuracy 98.1%. First confirmed relapse was multiorgan/multisystem in 48/82 patients and visceral-only in 15/82; visceral conversion occurred in 5/16 patients with initial bone-only or nodal/locoregional relapse.

Conclusion: Same-session [18F]FDG PET/ceCT showed greatest baseline utility in higher-risk breast cancer and was useful for longitudinal characterization of relapse phenotype and metastatic evolution.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08077-w.

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Cite

BibTeXRIS
BibTeX
@article{chiaravalloti2026stagedependent,
  title = {{Stage-dependent performance and molecular subtype-specific relapse patterns on same-session [18F]FDG PET/contrast-enhanced CT in breast cancer}},
  author = {Agostino Chiaravalloti and Shyqyri Samarxhiu and Ilaria Portarena and Valeria Flaminio and Nicola D’Ascenzo and Orazio Schillaci and Gianluca Vanni},
  journal = {European Journal of Nuclear Medicine and Molecular Imaging},
  year = {2026},
  month = aug,
  doi = {10.1007/s00259-026-08077-w},
  url = {https://doi.org/10.1007/s00259-026-08077-w},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Stage-dependent performance and molecular subtype-specific relapse patterns on same-session [18F]FDG PET/contrast-enhanced CT in breast cancer
AU  - Agostino Chiaravalloti
AU  - Shyqyri Samarxhiu
AU  - Ilaria Portarena
AU  - Valeria Flaminio
AU  - Nicola D’Ascenzo
AU  - Orazio Schillaci
AU  - Gianluca Vanni
PY  - 2026
DA  - 2026/08/07
JO  - European Journal of Nuclear Medicine and Molecular Imaging
DO  - 10.1007/s00259-026-08077-w
UR  - https://doi.org/10.1007/s00259-026-08077-w
AB  - Purpose: To evaluate stage-dependent performance of same-session [18F]FDG PET/contrast-enhanced CT (PET/ceCT) for initial breast cancer staging and PET/ceCT-detected relapse patterns during follow-up.  Methods: This retrospective single-centre study included a primary staging cohort with one index PET/ceCT per patient and a longitudinal cohort of follow-up/restaging examinations. PET/ceCT-derived endpoints were assessed against clinically adjudicated reference standards established through multidisciplinary team review, pathology when available and follow-up imaging. SUVmax and ceCT lesion diameter were analysed as exploratory biomarkers.  Results: The staging cohort included 116 patients. Baseline stage was evaluable in 106 patients: 65 had cN-positive disease, 9 had cT3-4 cN0 disease and 32 had cT1-2 cN0 disease. Overall nodal staging performance showed sensitivity 64.8%, specificity 88.9%, PPV 92.0%, NPV 56.1% and accuracy 72.9%. In cT3-4 and/or cN-positive disease, PET-positive nodal findings had a PPV of 100%. Baseline M-stage assessment was limited by the low number of clinically confirmed M1 cases. SUVmax correlated with Ki-67 (rho = 0.322, p = 0.003, q = 0.022). The longitudinal cohort included 176 patients and 429 examinations. In 311 adjudicated examinations, restaging performance for disease progression showed sensitivity 100%, specificity 93.5%, PPV 97.3%, NPV 100% and accuracy 98.1%. First confirmed relapse was multiorgan/multisystem in 48/82 patients and visceral-only in 15/82; visceral conversion occurred in 5/16 patients with initial bone-only or nodal/locoregional relapse.  Conclusion: Same-session [18F]FDG PET/ceCT showed greatest baseline utility in higher-risk breast cancer and was useful for longitudinal characterization of relapse phenotype and metastatic evolution.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08077-w.
SN  - 1619-7070
SN  - 1619-7089
ER  -