Evaluation of the Usefulness of FDG-PET/CT for Nodal Staging of Breast Cancer

Abstract

Background/Aim: Positron emission tomography/ computed tomography (PET/CT) with 18 F-fluorodeoxyglucose (18F-FDG) has recently been used to investigate lymph node (LN) metastases and several predictive features in patients with breast cancer (BC). The aim of this study was to assess the value of this non-invasive imaging procedure for axillary staging. Patients and Methods: Fifty patients with early primary unilateral, locally advanced, or recurrent invasive operable BC were enrolled. All patients underwent preoperative 18F-FDG PET/CT, and the results were compared with the histopathology of dissected axillary LNs and their biological and immunohistochemical characteristics. The diagnostic performance of 18F-FDG PET/CT in detecting LN metastases from primary or recurrent BC was analyzed. The mean values of the initial PET/CT parameters, including the primary tumour (SUV T) and ipsilateral axillary LNs (SUV LN), were compared with the clinicopathological features of patients to determine their usefulness for predicting clinical interactions. Results: The sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT for axillary LN staging were 87%, 90%, 88%, 93%, and 82%, respectively. Bivariate analyses showed strong interactions of nuclear grade (p=0.05), progesterone receptor expression (p=0.001), Ki-67 index (0.027), and local relapse with the SUV T. A high SUV LN value was significantly correlated with a higher nuclear grade score (p=0.05), oestrogen receptor negativity (p=0.001), progesterone receptor negativity (p=0.014), a high Ki-67 index (>20%; p=0.048), LN metastasis (p<0.001), a basal tumour (p=0.04), and locoregional recurrence (p<0.001). Conclusion: PET/CT is a reproducible, non-invasive imaging modality that is useful for evaluating a primary BC mass and its relationship with metastatic axillary LNs, thereby predicting tumour behaviour and guiding clinical practice.

PET/CT and MRI for Identifying Axillary Lymph Node Metastases in Breast Cancer Patients: Systematic Review and Meta‐Analysis

“…Heterogeneity existed among the included studies, study design, breast cancer subtype, tumor stage, and imaging features affected sensitivity or specificity of PET/CT or MRI. For PET/CT, the results of our study were similar with those of previous studies [7][8][9][10] and another meta-analysis, 25 with low or moderate sensitivity and high specificity. Kutluturk et al 43 reported that the accuracy of PET/CT for ALNM was higher in patients with larger tumor sizes and a higher ALN SUV max ; thus, PET/CT should not be routinely used for patients with small tumors.…”

“…For PET/CT, the results of our study were similar with those of previous studies 7‐10 and another meta‐analysis, 25 with low or moderate sensitivity and high specificity. Kutluturk et al 43 reported that the accuracy of PET/CT for ALNM was higher in patients with larger tumor sizes and a higher ALN SUV max ; thus, PET/CT should not be routinely used for patients with small tumors.…”

“…6 The criteria for the use of PET/CT to detect ALNM include higher uptake of the lymph node than surrounding tissue as well as the maximum standardized uptake value (SUV max ). The sensitivity and specificity of PET/CT for detecting metastatic ALN have been reported to range from 50-80% and 90-100%, [7][8][9][10] respectively, but some studies have raised issues regarding whether PET/CT could able to identify the axillary status accurately and, further, underestimated the number of metastatic ALN. [11][12][13] Magnetic resonance imaging (MRI) is increasingly used for the assessment of tumors and the status of ALNs.…”

Evaluation of Concordance Between Histopathological, Radiological and Biomolecular Variables in Breast Cancer Neoadjuvant Treatment

“…Therefore, histological examination of the biopsies' sample at the end of NAC is essential before subsequent surgical treatment. In our opinion, either molecular or nuclear dedicated breast imaging could improve the sensibility and complete surgical resection of any residual tumors (39)(40)(41). Additionally, EFS and OS indices have been calculated and proven to be greater, as also reported in literature, in those patients who obtained pCR.…”

Diagnostic performance of zero-TE lung MR imaging in FDG PET/MRI for pulmonary malignancies

“…18 F-Fluorodeoxyglucose (FDG) PET/CT currently plays a major role in ensuring accurate clinical classification of disease stages and significantly influences therapeutic decisions in the oncologic setting [1,2]. In this context, PET/MRI is an emerging modality that enables simultaneous acquisition of metabolic information with PET and morphological information with high soft-tissue contrast using MRI.…”