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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-03-2014 | Original Article

Detection of internal mammary lymph node metastasis with ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with stage III breast cancer

Authors: Min Jung Seo, Jong Jin Lee, Hye Ok Kim, Sun-Young Chae, Seol Hoon Park, Jin-Sook Ryu, Sei Hyun Ahn, Jong Won Lee, Byung Ho Son, Gyung-Yub Gong, Dae Hyuk Moon

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2014

Abstract

Purpose

The present study assessed the positive predictive value (PPV) of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the detection of internal mammary node (IMN) metastasis in patients with clinical stage III breast cancer.

Methods

Patients who were diagnosed with clinical stage III breast cancer and underwent pretreatment ¹⁸F-FDG PET/CT were retrospectively analyzed. The ¹⁸F-FDG PET/CT scans were prospectively reviewed by two board-certified nuclear medicine physicians in a blinded manner. The intensities of IMNs were graded into four categories (no activity and lower, similar, and higher activities than that of the mediastinal blood pool). IMNs were measured from the combined CT (largest diameter of the short axis). Histologic data of the IMNs were obtained by ultrasonography-guided fine-needle aspiration biopsy or surgical excision. The PPV was calculated for pathologically confirmed IMNs. Visual grade, maximum standardized uptake values (SUV_max), and sizes were analyzed according to the pathology results.

Results

There were 249 clinical stage III breast cancer patients (age 48.0 ± 10.1 years, range 26–79 years) who had undergone initial ¹⁸F-FDG PET/CT prior to treatment. Excluding 33 cases of stage IV breast cancer, 62 of 216 patients had visible IMNs on ¹⁸F-FDG PET/CT, and histologic confirmation was obtained in 31 patients. There were 27 metastatic and four nonmetastatic nodes (PPV 87.1 %). Metastatic nodes mostly presented with visual grade 3 (83.9 %), and SUV_max and size were 3.5 ± 4.3 and 5.6 ± 2.0 mm, respectively.

Conclusion

¹⁸F-FDG PET/CT has a high PPV for IMN metastasis in clinical stage III breast cancer, indicating the possibility of metastasis in IMNs with FDG uptake similar to/lower than that of the blood pool or small-sized nodes.

Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893–917.PubMedCrossRef

Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer 2013;132:1133–45.PubMedCrossRef

van der Ent FW, Kengen RA, van der Pol HA, Povel JA, Stroeken HJ, Hoofwijk AG. Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer. Ann Surg 2001;234:79–84.PubMedCrossRef

Lohrisch C, Jackson J, Jones A, Mates D, Olivotto IA. Relationship between tumor location and relapse in 6,781 women with early invasive breast cancer. J Clin Oncol 2000;18:2828–35.PubMed

Klauber-DeMore N, Bevilacqua JL, Van Zee KJ, Borgen P, Cody 3rd HS. Comprehensive review of the management of internal mammary lymph node metastases in breast cancer. J Am Coll Surg 2001;193:547–55.PubMedCrossRef

Chen RC, Lin NU, Golshan M, Harris JR, Bellon JR. Internal mammary nodes in breast cancer: diagnosis and implications for patient management—a systematic review. J Clin Oncol 2008;26:4981–9.PubMedCrossRef

Yang WT. Staging of breast cancer with ultrasound. Semin Ultrasound CT MR 2011;32:331–41.PubMedCrossRef

Kinoshita T, Odagiri K, Andoh K, Doiuchi T, Sugimura K, Shiotani S, et al. Evaluation of small internal mammary lymph node metastases in breast cancer by MRI. Radiat Med 1999;17:189–93.PubMed

Groheux D, Espié M, Giacchetti S, Hindié E. Performance of FDG PET/CT in the clinical management of breast cancer. Radiology 2013;266:388–405.PubMedCrossRef

10.

Robertson IJ, Hand F, Kell MR. FDG-PET/CT in the staging of local/regional metastases in breast cancer. Breast 2011;20:491–4.PubMedCrossRef

11.

Eubank WB, Mankoff DA, Takasugi J, Vesselle H, Eary JF, Shanley TJ, et al. 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J Clin Oncol 2001;19:3516–23.PubMed

12.

Danforth Jr DN, Aloj L, Carrasquillo JA, Bacharach SL, Chow C, Zujewski J, et al. The role of 18F-FDG-PET in the local/regional evaluation of women with breast cancer. Breast Cancer Res Treat 2002;75:135–46.PubMedCrossRef

13.

Bellon JR, Livingston RB, Eubank WB, Gralow JR, Ellis GK, Dunnwald LK, et al. Evaluation of the internal mammary lymph nodes by FDG-PET in locally advanced breast cancer (LABC). Am J Clin Oncol 2004;27:407–10.PubMedCrossRef

14.

Cermik TF, Mavi A, Basu S, Alavi A. Impact of FDG PET on the preoperative staging of newly diagnosed breast cancer. Eur J Nucl Med Mol Imaging 2008;35:475–83.PubMedCrossRef

15.

Groheux D, Moretti JL, Baillet G, Espie M, Giacchetti S, Hindie E, et al. Effect of (18)F-FDG PET/CT imaging in patients with clinical stage II and III breast cancer. Int J Radiat Oncol Biol Phys 2008;71:695–704.PubMedCrossRef

16.

Aukema TS, Straver ME, Peeters MJ, Russell NS, Gilhuijs KG, Vogel WV, et al. Detection of extra-axillary lymph node involvement with FDG PET/CT in patients with stage II-III breast cancer. Eur J Cancer 2010;46:3205–10.PubMedCrossRef

17.

Grassetto G, Fornasiero A, Otello D, Bonciarelli G, Rossi E, Nashimben O, et al. 18F-FDG-PET/CT in patients with breast cancer and rising Ca 15–3 with negative conventional imaging: a multicentre study. Eur J Radiol 2011;80:828–33.PubMedCrossRef

18.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines). Breast Cancer 2012.

19.

Jin S, Kim SB, Ahn JH, Jung KH, Ahn SH, Son BH, et al. (18) F-fluorodeoxyglucose uptake predicts pathological complete response after neoadjuvant chemotherapy for breast cancer: a retrospective cohort study. J Surg Oncol 2013;107:180–7.PubMedCrossRef

20.

Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thürlimann B, Senn HJ et al. Strategies for subtypes–dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 2011;22:1736–47.PubMedCrossRef

21.

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

22.

Wang CL, Eissa MJ, Rogers JV, Aravkin AY, Porter BA, Beatty JD. (18)F-FDG PET/CT-positive internal mammary lymph nodes: pathologic correlation by ultrasound-guided fine-needle aspiration and assessment of associated risk factors. AJR Am J Roentgenol 2013;200:1138–44.PubMedCrossRef

23.

Sharma A, Fidias P, Hayman LA, Loomis SL, Taber KH, Aquino SL. Patterns of lymphadenopathy in thoracic malignancies. Radiographics 2004;24:419–34.PubMedCrossRef

24.

Esen G. Ultrasound of superficial lymph nodes. Eur J Radiol 2006;58:345–59.PubMedCrossRef

Title: Detection of internal mammary lymph node metastasis with 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with stage III breast cancer
Authors: Min Jung Seo
Jong Jin Lee
Hye Ok Kim
Sun-Young Chae
Seol Hoon Park
Jin-Sook Ryu
Sei Hyun Ahn
Jong Won Lee
Byung Ho Son
Gyung-Yub Gong
Dae Hyuk Moon
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-013-2600-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Detection of internal mammary lymph node metastasis with ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with stage III breast cancer

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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