The clinical value and cost-effectiveness of Using 18F-FDG PET/MR as an staging procedure for breast cancer patients

Introduction: The purpose of this study was to determine the clinical value and cost-effectiveness of PET/MR as an staging procedure for breast cancer compared with the PET/CT.

Methods: From May 2017 to December 2022, 425 breast cancer patients confirmed by pathology in our center were included in this study. Among them, 165 patients underwent PET/MR before treatment and 260 underwent PET/CT. Charges were used as issued in 2021 by the Medical Insurance Administration Bureau of Zhejiang, China. Each patient should be followed up for at least 1 year, with the final clinical staging as the gold standard. Incremental costeffectiveness ratio (ICER) measured cost of using PET/MR per percent of patients who avoid missed or misdiagnosis.

Results: A total of 45 patients with missed or misdiagnosis results were observed. More patients with missed or misdiagnosis results were observed in the PET/CT group (14.2% vs. 4.8%, p<0.001). Small lung metastases (3 cases) and false positive lymph nodes (5 cases) resulted in missed diagnosis and misdiagnosis in the PET/MR group. However, the missed lesions in the PET/CT group mainly appeared in the liver (10 cases), bones (7 cases)，brest(5 cases), and brain (2 cases), with false positive (7 cases) and false negative (6 cases) lymph nodes simultaneously.The mean interval from pathological diagnosis to initiation of treatment was 12.5 days in the PET/CT group versus 7.4 days in the PET/MR group (p< 0.001). Mean cost per patient was $739 for PET/CT and $1381 for PET/MR. The ICER was $68 for each percent of patients who avoided a missed or misdiagnosis results.

Conclusions: Compared with PET/CT, PET/MR reduced missed or misdiagnosed cases risk and decreased workup of incidental findings, allowing for earlier treatment start. Meanwhile, PET/MR can significantly reduce radiation exposure in patients during examination. It may be cost-effective in initial staging procedure for breast cancer patients.

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