Positron emission tomography (PET) combined with magnetic resonance imaging (MRI) could be a new scanning technique which may help doctors spot signs that a patient’s tumor had begun to spread. These patients could therefore benefit from alternative treatments and potentially be given the best chance of long-term survival. This is the main topic of a study presented by Dr. Rosa Di Micco, a breast surgeon at IRCCS San Raffaele University and Research Hospital in Milan, Italy.

THE STUDY

As Dr. Di Micco herself states, “the standard approach for patients with early breast cancer includes mammography, ultrasound, and sometimes MRI”. Combining PET-MRI is a new approach as until now it has been used in clinical research only.

The study was led by Professor Oreste Gentilini, a breast surgeon at San Raffaele Hospital in Milan, which included 205 patients who were being treated at San Raffaele between July 2020 and October 2023. Each of these patients was given a PET-MRI scan which intended to spot signs of cancer spread in the affected breasts, in the surrounding area and in the rest of the body.

That scan led to the conclusion that it was necessary to change the therapy of 57 patients out of 205 (c.a. 28%), 18 of whom were prescribed chemotherapy as a first-line treatment, while the remaining 39 underwent different surgical treatments, such as mastectomy, removal of extra lymph nodes, and surgery on both breasts.

According to Dr. Di Micco, this research suggests that providing a PET-MRI scan to patients with early breast cancer could help doctors make better informed decisions about their best treatment pathway, even though “results of this technique are still affected by a high percentage of false positives and should therefore be confirmed by further testing”.

Prof. Gentilini states that “these are early results from an ongoing study, but they suggest that a PET-MRI scan could refine treatment for some breast cancer patients. They also suggest that this is an area where more research could be beneficial”.

FUTURE DEVELOPMENTS

This study could open new pathways in treating breast cancer. For this reason, Dr. Di Micco and her colleagues are beginning a new study, that uses a slightly different PET-MRI approach, which should help detect breast cancer cells growing in response to female hormone estrogen. This study may be particularly helpful for patients with lobular breast cancer, which is generally harder to spot on mammograms or ultrasounds scans.

Dr. Michail Ignatiadis from the Institute Jules Bordet in Brussels, Belgium, argues that once complete, this will be one of the largest studies of its kind looking at PET-MRI before surgery for patients with early breast cancer. Dr. Ignatiadis says: “We look forward to more results from this study, but these findings suggest that PET-MRI could help spot early signs that breast cancer has begun to spread. Spotting these signs might give people the best chance of long-term survival. We now need studies to prospectively test this hypothesis.”