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AzTrials

Breast Cancer FemaleNCT04826211

Axillary Staging in Node Positive Breast Cancer Patients Receiving PST. SNB vs PET/MRI

A study testing PET/MRI in people with Breast Cancer Female and Node-positive Breast Cancer, run by IRCCS San Raffaele at 1 site in Italy.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The management of axillary nodes in breast cancer patients is a highly debated and evolving field. To date, an increasing number of patients with positive lymph nodes receives primary systemic therapy (PST) prior to surgery leading to down-staging axillary nodes in about 40% of women. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
PET/MRI
Could I receive a placebo?
No, everyone receives an active treatment
How many people
109 participants
Where
1 siteItaly
Study dates
4 Nov 2019to 31 Dec 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Signed informed consent;
  • Age > 18 years;
  • Proven diagnosis of early BC of any size;
  • Patients candidate to primary systemic therapy (PST);
  • Positive axillary nodes at diagnosis, confirmed by either citology or histology confirmation. Patients with clear overt clinical and radiological nodal involvement might be enrolled as well without FNA or microhystology

Who cannot join

  • inflammatory BC;
  • pregnancy;
  • contraindication to PET;
  • distant metastases;
  • no surgery after PST;
  • contraindication to MRI;
Show all 9Show fewer
  • claustrophobia;
  • allergy to the MR contrast agent;
  • severe renal insufficiency.

Trial locations and contacts

1 site in 1 country.

Italy1 site
  • Ospedale San Raffaele

    Milan, MI, 20132

Other trials in Italy

About this study

Official title: Targeting the Future of Axillary Staging in Node Positive Breast Cancer Patients Receiving Primary Systemic Therapy. A Comparative Study Between Sentinel Node Biopsy vs PET/MRI.

The management of axillary nodes in breast cancer patients is a highly debated and evolving field. To date, an increasing number of patients with positive lymph nodes receives primary systemic therapy (PST) prior to surgery leading to down-staging axillary nodes in about 40% of women. However, the available diagnostic methods have several limitations in properly evaluating the response after treatment both in the breast and in the nodes and might lead to either under or over-treatment in these patients. Fully integrated scanners capable of simultaneous acquisition of PET and MRI have now been developed, with the potential to combine the specificity obtained by the functional imaging of PET, with the superior sensitivity of MRI, to provide higher diagnostic accuracy.

It is expected that PET/MRI could better determine the response after PST to distinguish patients with negative versus patients with positive axillary nodes after medical treatment. As the excision of axillary nodes has mainly a staging purpose, the reliable identification of node negative patients might eventually spare women from unnecessary surgery. An accurate over-time and final imaging work-up might help choose the appropriate type of surgery according to the extent of nodal involvement: either SNB or complete axillary clearance.

Read the detailed description

HYPOTHESIS: Hybrid PET/MRI might be a non-invasive, one-stage, operator-independent imaging modality to accurately define nodal status after PST, properly select type of surgical approach and might eventually lead to the omission of axillar surgery in some breast cancer patients showing complete imaging response.

AIMS: The primary endpoint is to compare the staging power between SNB (or lymphoadenectomy) vs PET/MRI in detecting axillary lymph node macro-metastases (>2 mm).Additionally the PET/MRI and A-US results will be confronted and ultimately related to pathology result, calculating the concordance rate in terms of positive vs negative nodes and number of positive nodes detected by each method. The staging power of both preoperative exams will be evaluated by considering how many times the results from PET/MRI or A-US could have indicated the most appropriate axillary treatment according to pathological findings.

EXPERIMENTAL DESIGN: Patients with breast cancer of any size with positive axillary nodes and candidates to PST will undergo PET/MRI prior to PST.

The study population will then be split into two groups:

  • women with positive axillary lymph nodes after PST (Group 1, 60% of the total)
  • women with negative axillary lymph nodes after PST (Group 2, 40% of the total).

A total of 110 women will guarantee two well-powered independent analysis. one for Group 1 (n=66; power>90%; Type I error rate of 0.05) and one for Group 2 (n=44; power>80%; Type I error rate of 0.05).

Being tested
PET/MRI
Keywords
primary systemic therapy, node positive breast cancer, surgery after primary systemic therapy, PET/MRI

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PET/MRIDiagnostic test

    All included patients will undergo PET/MRI both prior to PST and prior to surgery. In order to analyze results the population will be divided into two groups: women with positive axillary lymph nodes after PST (Group 1) and women with negative axillary lymph nodes after PST (Group 2).

Study groups in NCT04826211
Study groupRoleWhat they receive
Node positive BC patients undergoing PSTExperimentalPatients with breast cancer of any size with positive axillary nodes and candidates to PST will undergo PET/MRI both prior to PST and after PST before surgery
Receives: Diagnostic Test: PET/MRI

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Axillary surgery vs PET/MRI.

    Results from SNB (Sentinel Node Biopsy), AD (Axillary Dissection) or any axillary surgery will be compared to results from preoperative PET/MRI.

    Measured: Within 1 month after surgery results from axillary surgery will be available and compared to preoperative PET/MRI

Secondary outcomes (2)
  1. Staging power of PET/MRI will be compared to preoperative A-US (Axillary ultrasound)

    Results on the status of axillary nodes from preoperative A-US will be compared to results of preoperative PET/MRI.

    Measured: At 12 months

  2. Correlation between PET/MRI parameters and prognosis

    Quantitative analysis of PET/MRI exams will allow to extract standard imaging biomarkers to be correlated with tumour clinical and pathological data. Image analysis will be carried out both at staging and at the end of PST.

    Functional parameters from PET image analysis include Standardized Uptake Value and Metabolic Tumor Volume.

    From breast MR images, the quantitative and semiquantitative data are related to DWI and DCE MR sequences. Specifically, from the so-called Time Intensity Curve (TIC) obtained from the dynamic DCE some parameters can be extracted, for example Time To Peak, Peak Enhancement Percentage, Signal Enhancement Ratio and Initial Enhancement Percentage. From DWI MR sequence Apparent Diffusion Coefficient map can be calculated.

    Measured: At baseline and at 5 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Apr 2021
  2. Study start4 Nov 2019
  3. Primary completion30 Apr 2024
  4. Study completion31 Dec 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
109 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04826211
Sponsor's protocol ID
SNB vs PET/MRI 1
Status last verified
Jul 2025
First submitted
25 May 2020
Last updated
1 Aug 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Taneja S, Jena A, Goel R, Sarin R, Kaul S. Simultaneous whole-body (1)(8)F-FDG PET-MRI in primary staging of breast cancer: a pilot study. Eur J Radiol. 2014 Dec;83(12):2231-2239. doi: 10.1016/j.ejrad.2014.09.008. Epub 2014 Sep 28.

    PubMed 25282709
  • Melsaether AN, Raad RA, Pujara AC, Ponzo FD, Pysarenko KM, Jhaveri K, Babb JS, Sigmund EE, Kim SG, Moy LA. Comparison of Whole-Body (18)F FDG PET/MR Imaging and Whole-Body (18)F FDG PET/CT in Terms of Lesion Detection and Radiation Dose in Patients with Breast Cancer. Radiology. 2016 Oct;281(1):193-202. doi: 10.1148/radiol.2016151155. Epub 2016 Mar 29.

    PubMed 27023002
  • Veronesi U, De Cicco C, Galimberti VE, Fernandez JR, Rotmensz N, Viale G, Spano G, Luini A, Intra M, Veronesi P, Berrettini A, Paganelli G. A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol. 2007 Mar;18(3):473-8. doi: 10.1093/annonc/mdl425. Epub 2006 Dec 12.

    PubMed 17164229
  • Gentilini O, Veronesi U. Staging the Axilla in Early Breast Cancer: Will Imaging Replace Surgery? JAMA Oncol. 2015 Nov;1(8):1031-2. doi: 10.1001/jamaoncol.2015.2337. No abstract available.

    PubMed 26291922
  • van Nijnatten TJA, Goorts B, Voo S, de Boer M, Kooreman LFS, Heuts EM, Wildberger JE, Mottaghy FM, Lobbes MBI, Smidt ML. Added value of dedicated axillary hybrid 18F-FDG PET/MRI for improved axillary nodal staging in clinically node-positive breast cancer patients: a feasibility study. Eur J Nucl Med Mol Imaging. 2018 Feb;45(2):179-186. doi: 10.1007/s00259-017-3823-0. Epub 2017 Sep 14.

    PubMed 28905091
  • Heusch P, Nensa F, Schaarschmidt B, Sivanesapillai R, Beiderwellen K, Gomez B, Kohler J, Reis H, Ruhlmann V, Buchbender C. Diagnostic accuracy of whole-body PET/MRI and whole-body PET/CT for TNM staging in oncology. Eur J Nucl Med Mol Imaging. 2015 Jan;42(1):42-8. doi: 10.1007/s00259-014-2885-5. Epub 2014 Aug 12.

    PubMed 25112399
  • Stadnik TW, Everaert H, Makkat S, Sacre R, Lamote J, Bourgain C. Breast imaging. Preoperative breast cancer staging: comparison of USPIO-enhanced MR imaging and 18F-fluorodeoxyglucose (FDC) positron emission tomography (PET) imaging for axillary lymph node staging--initial findings. Eur Radiol. 2006 Oct;16(10):2153-60. doi: 10.1007/s00330-006-0276-4. Epub 2006 May 3.

    PubMed 16670863
  • Di Micco R, Botteri E, Canevari C, Gallivanone F, Antunovic L, Scifo P, Neri I, Gelardi F, Magnani P, Losio C, Venturini E, Della Vecchia G, Ferrarese G, Rotmensz N, Zuber V, Baleri S, Cisternino G, Calabretto F, Corona SP, Rampa M, Hammami DWS, Scaduto V, Morgante MM, Viale G, Piras M, Licata L, Sassi I, Bianchini G, Panizza P, Chiti A, Gentilini OD. [18F]FDG PET/MRI for axillary staging in node positive breast cancer patients receiving primary systemic therapy. A prospective single arm trial. Breast. 2026 Jul 20;89:104875. doi: 10.1016/j.breast.2026.104875. Online ahead of print.

    PubMed 42492092
  • Di Micco R, Saracoglu S, Pfob A, Canevari C, Gallivanone F, Antunovic L, Gelardi F, Scifo P, Neri I, Losio C, Venturini E, Della Vecchia G, Ferrarese G, Rotmensz N, Zuber V, Baleri S, Cisternino G, Corona SP, Calabretto F, Rampa M, Licata L, Viale G, Zambelli S, Sassi I, Bianchini G, Panizza P, Chiti A, Heil J, Gentilini OD. Diagnostic accuracy of modern imaging following neoadjuvant therapy for breast cancer: a comparative analysis of ultrasound versus [18F] FDG PET/MRI in breast response assessment. Front Oncol. 2026 Jun 18;16:1845216. doi: 10.3389/fonc.2026.1845216. eCollection 2026.

    PubMed 42394696

Questions about this trial

What is this clinical trial studying?

A study testing PET/MRI in people with Breast Cancer Female and Node-positive Breast Cancer, run by IRCCS San Raffaele at 1 site in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 1 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Axillary surgery vs PET/MRI. (time frame: Within 1 month after surgery results from axillary surgery will be available and compared to preoperative PET/MRI). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04826211, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Aug 2025.

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