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Radiology
12, 2020;297 (3): 622-629.

Comparison of Whole-Body MRI, CT, and Bone Scintigraphy for Response Evaluation of Cancer Therapeutics in Metastatic Breast Cancer to Bone.

Michael Kosmin, Anwar R Padhani, Andrew Gogbashian, David Woolf, Mei-Lin Ah-See, Peter Ostler, Stephanie Sutherland, David Miles, Jillian Noble, Dow-Mu Koh, Andrea Marshall, Janet Dunn, Andreas Makris
Author Information
  1. Michael Kosmin: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.). ORCID
  2. Anwar R Padhani: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.). ORCID
  3. Andrew Gogbashian: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.). ORCID
  4. David Woolf: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.).
  5. Mei-Lin Ah-See: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.).
  6. Peter Ostler: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.).
  7. Stephanie Sutherland: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.).
  8. David Miles: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.).
  9. Jillian Noble: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.).
  10. Dow-Mu Koh: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.).
  11. Andrea Marshall: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.). ORCID
  12. Janet Dunn: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.). ORCID
  13. Andreas Makris: From the Department of Oncology, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, England (M.K.); Paul Strickland Scanner Centre (A.R.P., A.G.) and Breast Cancer Research Unit (P.O., S.S., D.M., A. Makris), Mount Vernon Cancer Centre, Northwood, Middlesex, England; Department of Clinical Oncology, the Christie NHS Foundation Trust, Manchester, England (D.W.); Astra Zeneca UK Limited, Cambridge, England (M.L.A.); the Royal Marsden Hospital, Sutton, Surrey, England (J.N., D.M.K.); and Warwick Clinical Trials Unit, University of Warwick, Coventry, England (A. Marshall, J.D.).
PMID: 33078998 DOI: 10.1148/radiol.2020192683

Abstract

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 ( < .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 ( < .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. © RSNA, 2020

Associated Data

ClinicalTrials.gov | NCT03266744

MeSH Term

Bone Neoplasms
Breast Neoplasms
Contrast Media
Female
Humans
Image Interpretation, Computer-Assisted
Magnetic Resonance Imaging
Middle Aged
Prospective Studies
Radionuclide Imaging
Radiopharmaceuticals
Tomography, X-Ray Computed
Whole Body Imaging

Chemicals

Contrast Media
Radiopharmaceuticals
Comparative Study Journal Article Research Support, Non-U.S. Gov't
Article has an altmetric score of 30

Word Cloud

Created with Highcharts 10.0.0MRICTbonewhole-bodyparticipantsPDscintigraphydiseaseweeksprogressionMBCbone-onlyimagingexcludedevidentmodalitiesMcNemartestSACTmetastasesmetastaticbreastcanceridentificationprogressivestudyevaluatedperformedone13<001BoneCancerBackgroundlimitationsevaluatingsystemicanticancertherapyresponsePurposeevaluatewhetherenablesearlierMaterialsMethodsprospectiveMay2016January2019ClinicalTrialsgovidentifier:NCT03266744ParticipantsenrolledinitiationfirstsubsequentbasedstandardBaselinewithin2entryextraosseousevery12definitivecaseusedassessRadiologistsindependentlyinterpretedimagesblindedresultsSystematicdifferencesperformanceanalyzedusingResultsForty-fivemeanage60years±[standarddeviation]womenMediantime36range1-120Twounequivocalevidenceliverbaselinetwoclinicalshowedparticipantlostfollow-up3367%2233%11concurrentlynoneslightagreementCohenκ015reported50%26and/orConclusionWhole-bodyenabledProgressivehalf©RSNA2020ComparisonWhole-BodyScintigraphyResponseEvaluationTherapeuticsMetastaticBreast

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