Skip to main content
Top
Published in: Annals of Nuclear Medicine 10/2009

01-12-2009 | Original Article

Diagnostic performance of fluorodeoxyglucose-positron emission tomography/computed tomography of breast cancer in detecting axillary lymph node metastasis: comparison with ultrasonography and contrast-enhanced CT

Authors: Shuichi Monzawa, Shuji Adachi, Kayo Suzuki, Koichi Hirokaga, Shintaro Takao, Toshiko Sakuma, Keisuke Hanioka

Published in: Annals of Nuclear Medicine | Issue 10/2009

Login to get access

Abstract

Purpose

The purpose of this retrospective study was to evaluate the diagnostic performance of positron emission tomography/computed tomography (PET/CT) with fluorine-18–labeled 2-fluoro-2-deoxy-d-glucose (FDG) in comparison with that of ultrasonography and contrast-enhanced computed tomography (CT) in detecting axillary lymph node metastasis in patients with breast cancer.

Materials and methods

Fifty patients with invasive breast cancer were recruited. They had received no neoadjuvant chemotherapy and underwent PET/CT, ultrasonography and contrast-enhanced CT before mastectomy. The clinical stage was I in 34 patients, II in 15 patients, and III in one patient. The images of these modalities were interpreted in usual practice before surgery and the diagnostic reports were reviewed for analysis. Sensitivity, specificity, positive predictive value, and negative predictive value of each modality were obtained taking histopathological results of axillary lymph node dissection or sentinel lymph node biopsy as the reference standard.

Results

Axillary lymph node metastasis was confirmed in 15 of 50 patients by histopathological studies. PET/CT identified lymph node metastasis in three of these 15 patients. The overall sensitivity and specificity, positive predictive value, and negative predictive value of PET/CT in the diagnosis of axillary lymph node metastasis were 20, 97, 75, and 74%, and those of ultrasonography were 33, 94, 71, and 77% and those of contrast-enhanced CT were 27, 97, 80, and 76%, respectively.

Conclusions

PET/CT showed poor sensitivity and high specificity in the detection of axillary lymph node metastasis of breast cancer. Diagnostic performance of PET/CT was not superior to that of ultrasonography and contrast-enhanced CT.
Literature
1.
go back to reference Childberg FW, Lohe F. Basic principles and value of lymphadenectomy in breast carcinoma. Chirurg. 1996;67:771–8.CrossRef Childberg FW, Lohe F. Basic principles and value of lymphadenectomy in breast carcinoma. Chirurg. 1996;67:771–8.CrossRef
2.
go back to reference Cody HS III. Current surgical management of breast cancer. Curr Opin Obstet Gynecol. 2002;14:45–52.CrossRefPubMed Cody HS III. Current surgical management of breast cancer. Curr Opin Obstet Gynecol. 2002;14:45–52.CrossRefPubMed
3.
go back to reference Kwan W, Jackson J, Weir LM, Dingee C, McGregor G, Olivotto IA. Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol. 2002;20:4242–8.CrossRefPubMed Kwan W, Jackson J, Weir LM, Dingee C, McGregor G, Olivotto IA. Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol. 2002;20:4242–8.CrossRefPubMed
4.
go back to reference Fleissig A, Fallowfield LJ, Langridge Cl, Johnson L, Newcombe RG, Dixon JM, et al. Post-operative arm morbidity and quality of life: results of the ALMANAC randomized trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat. 2006;95:279–93.CrossRefPubMed Fleissig A, Fallowfield LJ, Langridge Cl, Johnson L, Newcombe RG, Dixon JM, et al. Post-operative arm morbidity and quality of life: results of the ALMANAC randomized trial comparing sentinel node biopsy with standard axillary treatment in the management of patients with early breast cancer. Breast Cancer Res Treat. 2006;95:279–93.CrossRefPubMed
5.
go back to reference Chao C, McMasters K. The current status of sentinel lymph node biopsy for breast cancer. Adv Surg. 2002;36:167–92.PubMed Chao C, McMasters K. The current status of sentinel lymph node biopsy for breast cancer. Adv Surg. 2002;36:167–92.PubMed
6.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
7.
go back to reference Cox CE, Pendas S, Cox JM, Joseph E, Shons AR, Yeatman T, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg. 1998;227:645–51.CrossRefPubMed Cox CE, Pendas S, Cox JM, Joseph E, Shons AR, Yeatman T, et al. Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg. 1998;227:645–51.CrossRefPubMed
8.
go back to reference O’Hea BJ, Hill ADK, El-Shirbany AM, Yeh SD, Rosen PP, Coit DG, et al. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center. J Am Coll Surg. 1998;186:423–7.CrossRefPubMed O’Hea BJ, Hill ADK, El-Shirbany AM, Yeh SD, Rosen PP, Coit DG, et al. Sentinel lymph node biopsy in breast cancer: initial experience at Memorial Sloan-Kettering Cancer Center. J Am Coll Surg. 1998;186:423–7.CrossRefPubMed
9.
go back to reference Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, et al. The sentinel node in breast cancer: a multicenter validation study. N Engl J Med. 1998;339:941–6.CrossRefPubMed Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, et al. The sentinel node in breast cancer: a multicenter validation study. N Engl J Med. 1998;339:941–6.CrossRefPubMed
10.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
12.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
13.
go back to reference Adler LP, Crowe JP, al-Kaisi NK, Sunshine JL. Evaluation of breast masses and axillary lymph nodes with [F-18] 2-deoxy-2-fluoro-d-glucose PET. Radiology. 1993;187:743–50.PubMed Adler LP, Crowe JP, al-Kaisi NK, Sunshine JL. Evaluation of breast masses and axillary lymph nodes with [F-18] 2-deoxy-2-fluoro-d-glucose PET. Radiology. 1993;187:743–50.PubMed
14.
go back to reference Utech CI, Young CS, Winter PF. Prospective evaluation of fluorine-18 fluorodeoxyglucose positron emission tomography in breast cancer for staging of the axilla related to surgery and immunocytochemistry. Eur J Nucl Med. 1996;23:1588–93.CrossRefPubMed Utech CI, Young CS, Winter PF. Prospective evaluation of fluorine-18 fluorodeoxyglucose positron emission tomography in breast cancer for staging of the axilla related to surgery and immunocytochemistry. Eur J Nucl Med. 1996;23:1588–93.CrossRefPubMed
15.
go back to reference Avril N, Dose J, Jänicke F, Ziegler S, Römer W, Weber W, et al. Assessment of axillary lymph node involvement in breast cancer patients with positron emission tomography using radiolabeled 2-(fluorine-18)-fluoro-2-deoxy-d-glucose. J Natl Cancer Inst. 1996;88:1204–9.CrossRefPubMed Avril N, Dose J, Jänicke F, Ziegler S, Römer W, Weber W, et al. Assessment of axillary lymph node involvement in breast cancer patients with positron emission tomography using radiolabeled 2-(fluorine-18)-fluoro-2-deoxy-d-glucose. J Natl Cancer Inst. 1996;88:1204–9.CrossRefPubMed
16.
go back to reference Smith IC, Ogston KN, Whitford P, Smith FW, Sharp P, Norton M, et al. Staging of the axilla in breast cancer: accurate in vivo assessment using positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-d-glucose. Ann Surg. 1998;228:220–7.CrossRefPubMed Smith IC, Ogston KN, Whitford P, Smith FW, Sharp P, Norton M, et al. Staging of the axilla in breast cancer: accurate in vivo assessment using positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-d-glucose. Ann Surg. 1998;228:220–7.CrossRefPubMed
17.
go back to reference Greco M, Crippa F, Agresti R, Seregni E, Gerali A, Giovanazzi R, et al. Axillary lymph node staging in breast cancer by 2-fluoro-2-deoxy-d-glucose-positron emission tomography: clinical evaluation and alternative management. J Natl Cancer Inst. 2001;93:630–5.CrossRefPubMed Greco M, Crippa F, Agresti R, Seregni E, Gerali A, Giovanazzi R, et al. Axillary lymph node staging in breast cancer by 2-fluoro-2-deoxy-d-glucose-positron emission tomography: clinical evaluation and alternative management. J Natl Cancer Inst. 2001;93:630–5.CrossRefPubMed
18.
go back to reference Schirrmeister H, Kühn T, Guhlmann A, Santjohanser C, Hörster T, Nüssle K, et al. Fluorine-18 2-deoxy-2-fluoro-d-glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures. Eur J Nucl Med. 2001;28:351–8.CrossRefPubMed Schirrmeister H, Kühn T, Guhlmann A, Santjohanser C, Hörster T, Nüssle K, et al. Fluorine-18 2-deoxy-2-fluoro-d-glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures. Eur J Nucl Med. 2001;28:351–8.CrossRefPubMed
19.
go back to reference van der Hoeven JJ, Hoekstra OS, Comans EF, Pijpers R, Boom RP, van Geldere D, et al. Determinants of diagnostic performance of [F-18]fluorodeoxyglucose positron emission tomography for axillary staging in breast cancer. Ann Surg. 2002;236:619–24.CrossRefPubMed van der Hoeven JJ, Hoekstra OS, Comans EF, Pijpers R, Boom RP, van Geldere D, et al. Determinants of diagnostic performance of [F-18]fluorodeoxyglucose positron emission tomography for axillary staging in breast cancer. Ann Surg. 2002;236:619–24.CrossRefPubMed
20.
go back to reference Barranger E, Grahek D, Antoine M, Montravers F, Talbot JN, Uzan S. Evaluation of fluorodeoxyglucose positron emission tomography in the detection of axillary lymph node metastases in patients with early-stage breast cancer. Ann Surg Oncol. 2003;10:622–7.CrossRefPubMed Barranger E, Grahek D, Antoine M, Montravers F, Talbot JN, Uzan S. Evaluation of fluorodeoxyglucose positron emission tomography in the detection of axillary lymph node metastases in patients with early-stage breast cancer. Ann Surg Oncol. 2003;10:622–7.CrossRefPubMed
21.
go back to reference Fehr MK, Hornung R, Varga Z, Burger D, Hess T, Haller U, et al. Axillary staging using positron emission tomography in breast cancer patients qualifying for sentinel lymph node biopsy. Breast J. 2004;10:89–93.CrossRefPubMed Fehr MK, Hornung R, Varga Z, Burger D, Hess T, Haller U, et al. Axillary staging using positron emission tomography in breast cancer patients qualifying for sentinel lymph node biopsy. Breast J. 2004;10:89–93.CrossRefPubMed
22.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
23.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
24.
go back to reference Townsend DW, Carney JP, Yap JT, Hall NC. PET/CT today and tomorrow. J Nucl Med. 2004;45:4S–13S.PubMed Townsend DW, Carney JP, Yap JT, Hall NC. PET/CT today and tomorrow. J Nucl Med. 2004;45:4S–13S.PubMed
25.
go back to reference Boolbol SK, Fey JV, Borgen PI, Heerdt AS, Montgomery LL, Paglia M, et al. Intradermal isotope injection: a highly accurate method of lymphatic mapping in breast carcinoma. Ann Surg Oncol. 2001;8:20–4.CrossRefPubMed Boolbol SK, Fey JV, Borgen PI, Heerdt AS, Montgomery LL, Paglia M, et al. Intradermal isotope injection: a highly accurate method of lymphatic mapping in breast carcinoma. Ann Surg Oncol. 2001;8:20–4.CrossRefPubMed
26.
go back to reference Suga K, Yuan Y, Okada M, Matsunaga N, Tangoku A, Yamamoto S, et al. Breast sentinel lymph node mapping at CT lymphography with iopamidol: preliminary experience. Radiology. 2004;230:543–52.CrossRefPubMed Suga K, Yuan Y, Okada M, Matsunaga N, Tangoku A, Yamamoto S, et al. Breast sentinel lymph node mapping at CT lymphography with iopamidol: preliminary experience. Radiology. 2004;230:543–52.CrossRefPubMed
27.
go back to reference Verbanck J, Vandewiele I, De Winter H, Tytgat J, Van Aelst F, Tanghe W. Value of axillary ultrasonography and sonographically guided needle biopsy of axillary nodes: a prospective study in 144 consecutive patients. J Clin Ultrasound. 1997;25:53–6.CrossRefPubMed Verbanck J, Vandewiele I, De Winter H, Tytgat J, Van Aelst F, Tanghe W. Value of axillary ultrasonography and sonographically guided needle biopsy of axillary nodes: a prospective study in 144 consecutive patients. J Clin Ultrasound. 1997;25:53–6.CrossRefPubMed
28.
go back to reference Yang WT, Ahuja A, Tang A, Suen M, King W, Metreweli C. High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med. 1996;16:241–6. Yang WT, Ahuja A, Tang A, Suen M, King W, Metreweli C. High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med. 1996;16:241–6.
29.
go back to reference Miyauchi M, Yamamoto N, Imanaka N, Matsumoto M. Computed tomography for preoperative evaluation of axillary nodal status in breast cancer. Breast Cancer. 1999;6:243–8. Miyauchi M, Yamamoto N, Imanaka N, Matsumoto M. Computed tomography for preoperative evaluation of axillary nodal status in breast cancer. Breast Cancer. 1999;6:243–8.
30.
go back to reference Hodgson NC, Gulenchyn KY. Is there a role for positron emission tomography in breast cancer staging? J Clin Oncol. 2008;26:712–20.CrossRefPubMed Hodgson NC, Gulenchyn KY. Is there a role for positron emission tomography in breast cancer staging? J Clin Oncol. 2008;26:712–20.CrossRefPubMed
31.
go back to reference Lovrics PJ, Chen V, Coates G, Cornacchi SD, Goldsmith CH, Law C. A prospective evaluation of positron emission tomography scanning, sentinel lymph node biopsy, and standard axillary dissection for axillary staging in patients with early stage breast cancer. Ann Surg Oncol. 2004;11:846–53.CrossRefPubMed Lovrics PJ, Chen V, Coates G, Cornacchi SD, Goldsmith CH, Law C. A prospective evaluation of positron emission tomography scanning, sentinel lymph node biopsy, and standard axillary dissection for axillary staging in patients with early stage breast cancer. Ann Surg Oncol. 2004;11:846–53.CrossRefPubMed
32.
go back to reference Crippa F, Agresti R, Seregni E, Greco M, Pascali C, Bogni A, et al. Prospective evaluation of fluorine-18-FDG PET in presurgical staging of the axilla in breast cancer. J Nucl Med. 1998;39:4–8.PubMed Crippa F, Agresti R, Seregni E, Greco M, Pascali C, Bogni A, et al. Prospective evaluation of fluorine-18-FDG PET in presurgical staging of the axilla in breast cancer. J Nucl Med. 1998;39:4–8.PubMed
33.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
34.
go back to reference 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 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
35.
go back to reference Kitajima K, Murakami K, Yamasaki E, Domeki Y, Tsubaki M, Sunagawa M, et al. Performance of integrated FDG PET/contrast-enhanced CT in the diagnosis of recurrent colorectal cancer: comparison with integrated FDG PET/non-contrast-enhanced CT and enhanced CT. Eur J Nucl Med Mol Imaging. 2009;36:1388–96.CrossRefPubMed Kitajima K, Murakami K, Yamasaki E, Domeki Y, Tsubaki M, Sunagawa M, et al. Performance of integrated FDG PET/contrast-enhanced CT in the diagnosis of recurrent colorectal cancer: comparison with integrated FDG PET/non-contrast-enhanced CT and enhanced CT. Eur J Nucl Med Mol Imaging. 2009;36:1388–96.CrossRefPubMed
Metadata
Title
Diagnostic performance of fluorodeoxyglucose-positron emission tomography/computed tomography of breast cancer in detecting axillary lymph node metastasis: comparison with ultrasonography and contrast-enhanced CT
Authors
Shuichi Monzawa
Shuji Adachi
Kayo Suzuki
Koichi Hirokaga
Shintaro Takao
Toshiko Sakuma
Keisuke Hanioka
Publication date
01-12-2009
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 10/2009
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-009-0314-9

Other articles of this Issue 10/2009

Annals of Nuclear Medicine 10/2009 Go to the issue