FDG PET/MR Plus Low-Dose Chest CT Is Cost-Effective for Locally Advanced Breast Cancer Staging

Decision-analytic model: FDG PET/MR + low-dose chest CT achieved 97% staging accuracy (95% UI 94%–99%) vs 70% (64%–76%) for conventional imaging in stage III breast cancer, at an incremental cost of ~$3,000 per additional patient correctly staged (UI $1,500–$6,500).

• Design: Decision-analytic model comparing PET/MR + low-dose chest CT vs contrast-enhanced CT + bone scintigraphy + breast MRI; primary cohort was presumed clinical stage III invasive ductal carcinoma; model inputs drawn from published diagnostic performance data — no prospective head-to-head trial.
• Secondary analysis in high-risk stage IIB patients showed cost-effectiveness was more sensitive to metastatic prevalence, suggesting selective rather than universal implementation; short-term QALY gains favored PET/MR but were described as modest (exact QALY values not reported in source).
• Key limitation: results derive from a modeled simulation, not empirical patient data; generalizability depends on institutional PET/MR availability, reimbursement environment, and local metastatic disease prevalence.

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