Detection of isolated ipsilateral regional lymph node recurrences by F18-fluorodeoxyglucose positron emission tomography–CT in follow-up of postoperative breast cancer patients

Abstract

Imaging diagnostic methods except for mammograms are not recommended for follow-up of postoperative breast cancer patients in order to detect small recurrences because of the poor survival improvement in earlier randomized trials. However, the use of new imaging modalities may improve survival by detection of small isolated regional lymph node recurrences which are potentially curable. Between April 2006 and December 2008, we used PET-CT to find small recurrences in follow-up of 1,907 postoperative breast cancer patients. A total of 3,280 PET-CT imagings were performed. The median age at PET-CT imaging was 58 years, with a median 48-month interval from definitive surgery to the PET-CT imaging. Twenty-two patients were found to have isolated ipsilateral regional recurrences only by PET-CT (axillary node recurrences in 6, infraclavicular node recurrences in 5, supraclavicular node recurrences in 6, and parasternal node recurrences in 5). All of those recurrences were missed by palpation or were nonpalpable. The pathological lymph node status at the definitive surgery for the primary breast cancer of 22 patients with the isolated ipsilateral regional lymph node recurrences was positive in 17 patients. If patients are limited to those who had pathologically positive node(s) at definitive surgery, the incidence of patients with isolated regional lymph node recurrences found only by PET-CT would be 2.6% (17/663 patients). Seventeen other asymptomatic cancers including contralateral breast cancers were found only by PET-CT. Early detection of isolated loco-regional recurrences of breast cancer is suggested to result in improved survival. Therefore, the use of PET-CT in follow-up of postoperative node-positive breast cancer patients may improve their survival because of early detection of isolated regional lymph node recurrences which are still potentially curable, and screening of other asymptomatic cancers.

Implementation of a Systematic Literature Search Strategy in a National Breast Cancer Guideline: The Relevance of Systemic Therapy in Lymph Node Recurrent Disease

“…Both Lanitis et al [9] and Chang et al [10] analyzed axillary metastatic disease or synchronous ipsilateral supraclavicular lymph node metastases as primary diagnosis rather than recurrence after the primary diagnosis of breast cancer. Ohsumi et al [11] described the detection of ipsilateral regional lymph node recurrence using positron emission tomography-computed tomography. Moossdorff et al [12] reviewed the literature to determine the prognosis after contralateral lymph node recurrence in breast cancer.…”

Value of F-18 FDG PET/CT in detection and prognostication of isolated extra-axillary lymph node recurrences in postoperative breast cancer

“…Ohsumi S et al [12] reported the incidence of isolated extra-axillary node recurrences to be 1.2%. However, the incidence demonstrated in the present study was approximately 3%, which is 2.5 times higher than that reported in the aforementioned study.…”

“…F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), on the other hand, is a useful diagnostic modality that can detect small lymph node recurrences including extra-axillary node metastases [10][11][12].…”

Internal mammary lymph node metastasis in breast cancer patients based on anatomical imaging and functional imaging

“…Based on FDG-PET/CTpositive loco-regional LN metastases (defined as the ALNs, supraclavicular LNs, and IMLNs), the rates of LNs in the IMC region were 3.7% for patients with primary M0 cancer and 9.5% for patients with primary M1 cancer, while the rates increased to 9.4% for patients with recurrent M0 cancer and 11.8% for recurrent M1 cancer [42]. Regardless of the imaging modality, follow-up results have indicated that the overall rate of clinically detectable IMLN recurrences remains < 1.5% after primary systemic breast cancer treatment, even when the regional IMLNs were not irradiated [12,[67][68][69][70][71] (Table 2). In addition, the IMLN recurrence rate was reduced to 0.2% for patient who had undergone IMLN radiotherapy (IMLN RT) [12].…”