title: The addition of whole-body magnetic resonance imaging to body computerised tomography alters treatment decisions in patients with metastatic breast cancer.
abstract: Accurate evaluation of distribution of disease and response to systemic anti-cancer therapy (SACT) is important in the optimal management of metastatic breast cancer. Whole-body magnetic resonance imaging (WB-MRI) has increased accuracy over computerised tomography of the chest, abdomen and pelvis (CT-CAP) for detecting liver and bone disease, but its effect on patient management is largely unexplored. This study investigates the effects of using WB-MRI alongside CT-CAP on SACT decisions in standard clinical practice for patients with metastatic breast cancer.
  
  
  
  Metastatic breast cancer patients who had undergone WB-MRI within 14 d of CT-CAP were studied. Data on distribution and extent of disease and SACT response assessment from original WB-MRI and CT-CAP reports were compared. Contemporaneous medical records provided data on therapy decisions at each time point.
  
  
  
  Analyses were performed on 210 pairs of WB-MRI and CT-CAP in 101 patients. In 53.3% of episodes, WB-MRI reported additional sites of disease not reported on CT-CAP. Differences in SACT assessment were found in 28.0% of episodes, most commonly due to progressive disease (PD) on WB-MRI being reported as stable disease on CT-CAP (18.9%). Discordant SACT assessments were less common in first-line SACT than in subsequent lines of SACT (15.0% versus 41.6%; p = 0.0102). In 34.7% of episodes when SACT was changed, PD had been reported on WB-MRI only.
  
  
  
  SACT decisions in routine practice were altered by the use of WB-MRI. Further research is required to investigate whether earlier identification of PD by WB-MRI leads to improved patient outcomes.
authors.affiliation: Breast Cancer Research Unit, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK. Electronic address: michael.kosmin@nhs.net.
authors.forename: Michael
authors.initials: M
authors.lastname: Kosmin
authors.affiliation: Breast Cancer Research Unit, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Makris
authors.affiliation: Breast Cancer Research Unit, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK.
authors.forename: Priya V
authors.initials: PV
authors.lastname: Joshi
authors.affiliation: Breast Cancer Research Unit, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK.
authors.forename: Mei-Lin
authors.initials: ML
authors.lastname: Ah-See
authors.affiliation: The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester M20 4BX, UK.
authors.forename: David
authors.initials: D
authors.lastname: Woolf
authors.affiliation: Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK.
authors.forename: Anwar R
authors.initials: AR
authors.lastname: Padhani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000628:therapy; D000066491:Clinical Decision-Making / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D051598:Whole Body Imaging / Q000379:methods; D055815:Young Adult
keywords: Metastatic breast cancer; Systemic anti-cancer treatment response assessment; Whole-body magnetic resonance imaging