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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-10-2009 | Original Article

Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients

Authors: Till A. Heusner, Sherko Kuemmel, Steffen Hahn, Angela Koeninger, Friedrich Otterbach, Monia E. Hamami, Klaus R. Kimmig, Michael Forsting, Andreas Bockisch, Gerald Antoch, Alexander Stahl

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2009

Abstract

Purpose

The aims of this study were (1) to evaluate FDG PET/CT and CT for the detection of axillary lymph node metastases in breast cancer (BC) patients and (2) to evaluate FDG PET/CT as a pre-test for the triage to sentinel lymph node biopsy (SLNB) versus axillary lymph node dissection (ALND).

Methods

The sensitivity, specificity, positive and negative predictive value (PPV, NPV), and accuracy of FDG PET/CT and CT for axillary lymph node metastases were determined in 61 patients (gold standard: histopathology). According to the equation “NPV = specificity ∙ (1-prevalence) / [specificity ∙ (1-prevalence) + (1-sensitivity) ∙ prevalence]” FDG PET/CT was evaluated as a triage tool for SLNB versus ALND.

Results

The sensitivity, specificity, PPV, NPV and accuracy of FDG PET/CT was 58, 92, 82, 77 and 79% and of CT 46, 89, 72, 71 and 72%, respectively. Patients with an up to ~60% risk for axillary lymph node metastases appear to be candidates for SLNB provided that the axilla is unremarkable on FDG PET/CT.

Conclusion

FDG PET/CT cannot replace invasive approaches for axillary staging but may extend the indication for SLNB.

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Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106–30. doi:10.3322/canjclin.56.2.106.PubMedCrossRef

Miller WR, Ellis IO, Sainsbury JR, Dixon JM. ABC of breast diseases. Prognostic factors. BMJ 1994;309:1573–6.PubMed

Amersi F, Hansen NM. The benefits and limitations of sentinel lymph node biopsy. Curr Treat Options Oncol 2006;7:141–51. doi:10.1007/s11864-006-0049-y.PubMedCrossRef

Eubank WB, Mankoff DA. Evolving role of positron emission tomography in breast cancer imaging. Semin Nucl Med 2005;35:84–99. doi:10.1053/j.semnuclmed.2004.11.001.PubMedCrossRef

Ranaboldo CJ, Mitchel A, Royle GT, Theaker GM, Taylor I. Axillary nodal status in women with screen-detected breast cancer. Eur J Surg Oncol 1993;19:130–3.PubMed

Walls J, Boggis CR, Wilson M, Asbury DL, Roberts JV, Bundred NJ, et al. Treatment of the axilla in patients with screen-detected breast cancer. Br J Surg 1993;80:436–8. doi:10.1002/bjs.1800800409.PubMedCrossRef

Peintinger F, Reitsamer R, Stranzl H, Ralph G. Comparison of quality of life and arm complaints after axillary lymph node dissection vs sentinel lymph node biopsy in breast cancer patients. Br J Cancer 2003;89:648–52. doi:10.1038/sj.bjc.6601150.PubMedCrossRef

Schulze T, Mucke J, Markwardt J, Schlag PM, Bembenek A. Long-term morbidity of patients with early breast cancer after sentinel lymph node biopsy compared to axillary lymph node dissection. J Surg Oncol 2006;93:109–19. doi:10.1002/jso.20406.PubMedCrossRef

Kühn T, Bembenek A, Büchels H, Decker T, Dunst J, Müllerleile U, et al. Sentinel node biopsy in breast carcinoma. Interdisciplinary agreement consensus of the German Society for Serology for quality controlled application in routine clinical testing (in German). Pathologe 2004;25:238–43. doi:10.1007/s00292-003-0661-6. discussion 244.PubMedCrossRef

10.

Bedrosian I, Reynolds C, Mick R, Callans LS, Grant CS, Donohue JH, et al. Accuracy of sentinel lymph node biopsy in patients with large primary breast tumors. Cancer 2000;88:2540–5. doi:10.1002/1097-0142(20000601) 88:11<2540::AID-CNCR16>3.0.CO;2-A.PubMedCrossRef

11.

Kuehn T, Bembenek A, Decker T, Munz DL, Sautter-Bihl ML, Untch M, et al. A concept for the clinical implementation of sentinel lymph node biopsy in patients with breast carcinoma with special regard to quality assurance. Cancer 2005;103:451–61. doi:10.1002/cncr.20786.PubMedCrossRef

12.

Chung MH, Ye W, Giuliano AE. Role for sentinel lymph node dissection in the management of large (> or = 5 cm) invasive breast cancer. Ann Surg Oncol 2001;8:688–92.PubMed

13.

Schwartz GF. Clinical practice guidelines for the use of axillary sentinel lymph node biopsy in carcinoma of the breast: current update. Breast J 2004;10:85–8. doi:10.1111/j.1075-122X.2004.21439.x.PubMedCrossRef

14.

Lyman GH, Giuliano AE, Somerfield MR, Benson AB 3rd, Bodurka DC, Burstein HJ, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005;23:7703–20. doi:10.1200/JCO.2005.08.001.PubMedCrossRef

15.

Specht MC, Fey JV, Borgen PI, Cody HS 3rd. Is the clinically positive axilla in breast cancer really a contraindication to sentinel lymph node biopsy? J Am Coll Surg 2005;200:10–4. doi:10.1016/j.jamcollsurg.2004.09.010.PubMedCrossRef

16.

Kumar R, Alavi A. PET imaging in gynecologic malignancies. Radiol Clin North Am 2004;42:1155–67. doi:10.1016/j.rcl.2004.08.006.PubMedCrossRef

17.

Kumar R, Alavi A. Fluorodeoxyglucose-PET in the management of breast cancer. Radiol Clin North Am 2004;42:1113–22. doi:10.1016/j.rcl.2004.08.005.PubMedCrossRef

18.

Blodgett TM, Meltzer CC, Townsend DW. PET/CT: form and function. Radiology 2007;242:360–85. doi:10.1148/radiol.2422051113.PubMedCrossRef

19.

Hodgson NC, Gulenchyn KY. Is there a role for positron emission tomography in breast cancer staging? J Clin Oncol 2008;26:712–20. doi:10.1200/JCO.2007.13.8412.PubMedCrossRef

20.

Veronesi U, De Cicco C, Galimberti VE, Fernandez JR, Rotmensz N, Viale G, et al. A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol 2007;18:473–8. doi:10.1093/annonc/mdl425.PubMedCrossRef

21.

Wahl RL, Siegel BA, Coleman RE, Gatsonis CG, PET Study Group. Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J Clin Oncol 2004;22:277–85. doi:10.1200/JCO.2004.04.148.PubMedCrossRef

22.

Weir L, Worsley D, Bernstein V. The value of FDG positron emission tomography in the management of patients with breast cancer. Breast J 2005;11:204–9. doi:10.1111/j.1075-122X.2005.21625.x.PubMedCrossRef

23.

Heusner TA, Kuemmel S, Umutlu L, Koeninger A, Freudenberg LS, Hauth EA, et al. Breast cancer staging in a single session: whole-body PET/CT mammography. J Nucl Med 2008;49:1215–22. doi:10.2967/jnumed.108.052050.PubMedCrossRef

24.

Kreienberg R, Kopp I, Lorenz W, Budach W, Dunst J, Lebeau A, et al. Diagnostik, Therapie und Nachsorge des Mammakarzinoms der Frau. Informationszentrum für Standards in der Onkologie; 2004:1–172.

25.

Antoch G, Kuehl H, Kanja J, Lauenstein TC, Schneemann H, Hauth E, et al. Dual-modality PET/CT scanning with negative oral contrast agent to avoid artifacts: introduction and evaluation. Radiology 2004;230:879–85. doi:10.1148/radiol.2303021287.PubMedCrossRef

26.

Beyer T, Antoch G, Blodgett T, Freudenberg LF, Akhurst T, Mueller S. Dual-modality PET/CT imaging: the effect of respiratory motion on combined image quality in clinical oncology. Eur J Nucl Med Mol Imaging 2003;30:588–96.PubMed

27.

March DE, Wechsler RJ, Kurtz AB, Rosenberg AL, Needleman L. CT-pathologic correlation of axillary lymph nodes in breast carcinoma. J Comput Assist Tomogr 1991;15:440–4. doi:10.1097/00004728-199105000-00017.PubMedCrossRef

28.

Alvarez S, Añorbe E, Alcorta P, López F, Alonso I, Cortés J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol 2006;186:1342–8. doi:10.2214/AJR.05.0936.PubMedCrossRef

29.

Ueda S, Tsuda H, Asakawa H, Shigekawa T, Fukatsu K, Kondo N, et al. Clinicopathological and prognostic relevance of uptake level using 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in primary breast cancer. Jpn J Clin Oncol 2008;38:250–8. doi:10.1093/jjco/hyn019.PubMedCrossRef

30.

Avril N, Rosé CA, Schelling M, Dose J, Kuhn W, Bense S, et al. Breast imaging with positron emission tomography and fluorine-18 fluorodeoxyglucose: use and limitations. J Clin Oncol 2000;18:3495–502.PubMed

31.

Lewellen TK. Recent developments in PET detector technology. Phys Med Biol 2008;53:R287–317. doi:10.1088/0031-9155/53/17/R01.PubMedCrossRef

32.

Teräs M, Tolvanen T, Johansson JJ, Williams JJ, Knuuti J. Performance of the new generation of whole-body PET/CT scanners: Discovery STE and Discovery VCT. Eur J Nucl Med Mol Imaging 2007;34:1683–92. doi:10.1007/s00259-007-0493-3.PubMedCrossRef

33.

Krag DN. The sentinel node for staging breast cancer: current review. Breast Cancer 1999;6:233–6. doi:10.1007/BF02967176.PubMedCrossRef

34.

Veronesi U, Galimberti V, Mariani L, Gatti G, Paganelli G, Viale G, et al. Sentinel node biopsy in breast cancer: early results in 953 patients with negative sentinel node biopsy and no axillary dissection. Eur J Cancer 2005;41:231–7. doi:10.1016/j.ejca.2004.05.009.PubMedCrossRef

35.

Bass SS, Lyman GH, McCann CR, Ku NN, Berman C, Durand K, et al. Lymphatic mapping and sentinel lymph node biopsy. Breast J 1999;5:288–95. doi:10.1046/j.1524-4741.1999.00001.x.PubMedCrossRef

36.

Borgstein PJ, Pijpers R, Comans EF, van Diest PJ, Boom RP, Meijer S. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 1998;186:275–83. doi:10.1016/S1072-7515(98)00011-8.PubMedCrossRef

37.

Roy P, Bobin JY, Estève J. Methodological questions in sentinel lymph node analysis in breast cancer patients. Ann Oncol 2000;11:1381–5. doi:10.1023/A:1026743914286.PubMedCrossRef

38.

Fraile M, Rull M, Julián FJ, Fusté F, Barnadas A, Llatjós M, et al. Sentinel node biopsy as a practical alternative to axillary lymph node dissection in breast cancer patients: an approach to its validity. Ann Oncol 2000;11:701–5. doi:10.1023/A:1008377910967.PubMedCrossRef

39.

Chua B, Ung O, Taylor R, Boyages J. Frequency and predictors of axillary lymph node metastases in invasive breast cancer. ANZ J Surg 2001;71:723–8. doi:10.1046/j.1445-1433.2001.02266.x.PubMedCrossRef

40.

Abner AL, Collins L, Peiro G, Recht A, Come S, Shulman LN, et al. Correlation of tumor size and axillary lymph node involvement with prognosis in patients with T1 breast carcinoma. Cancer 1998;83:2502–8. doi:10.1002/(SICI)1097-0142(19981215) 83:12<2502::AID-CNCR14>3.0.CO;2-I.PubMedCrossRef

41.

Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989;63:181–7. doi:10.1002/1097-0142(19890101)63:1<181::AID-CNCR2820630129>3.0.CO;2-H.PubMedCrossRef

Title: Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients
Authors: Till A. Heusner
Sherko Kuemmel
Steffen Hahn
Angela Koeninger
Friedrich Otterbach
Monia E. Hamami
Klaus R. Kimmig
Michael Forsting
Andreas Bockisch
Gerald Antoch
Alexander Stahl
Publication date: 01-10-2009
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2009
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-009-1145-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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