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All patients had preoperative \u2076\u2078Ga-FAPI PET\/CT, \u00b9\u2078F-FDG PET\/CT, and breast MRI. Primary tumor size, multifocality\/multicentricity (MF\/MC), and ALNM were evaluated for each modality. FAPI and FDG were additionally assessed for extra-axillary lymph nodes, internal mammary nodes, and distant metastases. Agreement between imaging- and pathology-based tumor size measurements, as well as the diagnostic performance for MF\/MC and ALNM, were evaluated using correlation analyses and standard diagnostic accuracy metrics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      MRI (\u03c1\u2009=\u20090.866) and \u2076\u2078Ga-FAPI PET\/CT (\u03c1\u2009=\u20090.844) demonstrated the strongest correlation with pathologic tumor size, whereas \u00b9\u2078F-FDG PET\/CT showed lower agreement (\u03c1\u2009=\u20090.780). Breast MRI (45.0%) and \u2076\u2078Ga-FAPI-PET\/CT (38.3%) were significantly superior to \u00b9\u2078F-FDG PET\/CT (18.3%) in detecting multifocal or multicentric disease (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                    <jats:p>For ALNM detection, breast MRI achieved the highest sensitivity (87.5%) but showed lower specificity (72.7%). In contrast, \u2076\u2078Ga-FAPI PET\/CT combined high sensitivity (81.2%) with perfect specificity (100.0%), outperforming \u00b9\u2078F-FDG PET\/CT, which demonstrated lower sensitivity (43.8%) despite high specificity (93.2%).<\/jats:p>\n                    <jats:p>Additionally, \u2076\u2078Ga-FAPIPET\/CT identified metastatic findings not detected by \u00b9\u2078F-FDG PET\/CT, including seven axillary lymph nodes (11.7%), 29 additional intramammary tumor foci (48.3%), and four distant metastases (6.7%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\u2076\u2078Ga-FAPI PET\/CT demonstrated higher diagnostic performance than \u00b9\u2078F-FDG PET\/CT and accuracy comparable to breast MRI for primary tumor size estimation and detection of multifocal or multicentric disease. FAPI-PET\/CT also provided higher specificity than MRI for ALNM assessment and identified additional metastatic lesions not detected by FDG-PET\/CT, supporting its potential role as a complementary modality to MRI and an alternative functional imaging technique in selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-026-07953-9","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T23:12:31Z","timestamp":1781565151000},"page":"6311-6327","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Performance of \u2076\u2078Ga-FAPI PET\/CT, \u00b9\u2078F-FDG PET\/CT, and Breast MRI for Assessing Tumor Extent and Axillary Metastasis in Breast Cancer: A Histopathology-Referenced Retrospective Study"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6545-5757","authenticated-orcid":false,"given":"Deniz Esin","family":"Tekcan Sanli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3650-8258","authenticated-orcid":false,"given":"Umut","family":"Elboga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8990-2438","authenticated-orcid":false,"given":"Enes","family":"Yerdes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1483-8176","authenticated-orcid":false,"given":"Ahmet Necati","family":"Sanli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"7953_CR1","doi-asserted-by":"publisher","unstructured":"Siegel RL, Giaquinto AN, Jemal A, Cancer statistics, Cancer JC. 2024 Jan-Feb;74(1):12\u201349. doi: 10.3322\/caac.21820. 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