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All patients underwent a whole-body <jats:sup>18<\/jats:sup>F-FDG PET\/MRI. MRI and <jats:sup>18<\/jats:sup>F-FDG PET\/MRI datasets were evaluated separately regarding lesion count, lesion localization, and lesion characterization (malignant\/benign) as well as the diagnostic confidence (5-point ordinal scale, 1\u20135). The N and M stages were assessed according to the eighth edition of the American Joint Committee on Cancer staging manual in MRI datasets alone and in <jats:sup>18<\/jats:sup>F-FDG PET\/MRI datasets, respectively. In the majority of lesions histopathology served as the reference standard. The remaining lesions were followed-up by imaging and clinical examination. Separately for nodal-positive and nodal-negative women, a McNemar chi<jats:sup>2<\/jats:sup> test was performed to compare sensitivity and specificity of the N and M stages between <jats:sup>18<\/jats:sup>F-FDG PET\/MRI and MRI. Differences in diagnostic confidence scores were assessed by Wilcoxon signed rank test.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>MRI determined the N stage correctly in 78 of 104 (75%) patients with a sensitivity of 62.3% (95% CI: 0.48\u20130.75), a specificity of 88.2% (95% CI: 0.76\u20130.96), a PPV (positive predictive value) of 84.6% % (95% CI: 69.5\u20130.94), and a NPV (negative predictive value) of 69.2% (95% CI: 0.57\u20130.8). Corresponding results for <jats:sup>18<\/jats:sup>F-FDG PET\/MRI were 87\/104 (83.7%), 75.5% (95% CI: 0.62\u20130.86), 92.2% (0.81\u20130.98), 90% (0.78\u20130.97), and 78.3% (0.66\u20130.88), showing a significantly better sensitivity of <jats:sup>18<\/jats:sup>F-FDG PET\/MRI determining malignant lymph nodes (<jats:italic>p<\/jats:italic>\u2009=\u20090.008). The M stage was identified correctly in MRI and <jats:sup>18<\/jats:sup>F-FDG PET\/MRI in 100 of 104 patients (96.2%). Both modalities correctly staged all 7 patients with distant metastases, leading to false-positive findings in 4 patients in each modality (3.8%). In a lesion-based analysis, <jats:sup>18<\/jats:sup>F-FDG PET\/MRI showed a significantly better performance in correctly determining malignant lesions (85.8% vs. 67.1%, difference 18.7% (95% CI: 0.13\u20130.26), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and offered a superior diagnostic confidence compared with MRI alone (4.1\u2009\u00b1\u20090.7 vs. 3.4\u2009\u00b1\u20090.7, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p><jats:sup>18<\/jats:sup>F-FDG PET\/MRI has a better diagnostic accuracy for N staging in primary breast cancer patients and provides a significantly higher diagnostic confidence in lesion characterization than MRI alone. But both modalities bear the risk to overestimate the M stage.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00259-020-04801-2","type":"journal-article","created":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T06:25:52Z","timestamp":1587709552000},"page":"2816-2825","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Prospective evaluation of whole-body MRI and 18F-FDG PET\/MRI in N and M staging of primary breast cancer patients"],"prefix":"10.1007","volume":"47","author":[{"given":"Nils Martin","family":"Bruckmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lino M.","family":"Sawicki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Kirchner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ole","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lale","family":"Umutlu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Herrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Fendler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann-Kathrin","family":"Bittner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svjetlana","family":"Mohrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic","family":"Dietzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ingenwerth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt M.","family":"Schaarschmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Kowall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Stang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Antoch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Buchbender","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,4,24]]},"reference":[{"key":"4801_CR1","first-page":"2018","volume":"876","author":"The Global Cancer Observatory G","year":"2018","unstructured":"The Global Cancer Observatory G. 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