Positron emission tomography (PET) for assessment of axillary lymph node status in early breast cancer: A systematic review and meta-analysis

Cooper, Katy; Harnan, S; Meng, Yang; Ward, Sue; Fitzgerald, Patrick; Papaioannou, Diana; Wyld, Lynda; Ingram, Christine; Wilkinson, Iain D.; Lorenz, Edith

doi:10.1016/j.ejso.2011.01.003

Cited by 115 publications

(64 citation statements)

References 56 publications

(32 reference statements)

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“…The number of axillary lymph nodes suspicious for metastases is often higher on PET/CT compared to conventional imaging [8][9][10][11]. The specificity of PET/CT for axillary lymph node metastases is around 96%, compared to about 78% on US and breast MRI [16][17][18].…”

Section: Introductionmentioning

confidence: 94%

“…For determining cN-stage, number and location of suspicious lymph nodes were assessed on both modalities. A lymph node was characterized as malignant on PET if an abnormal focal FDG accumulation was present in combination with high visual uptake intensity (VUI) compared to background tissue, as recommended by the European Association of Nuclear Medicine [17,25].…”

Section: Imaging Analysis and Stagingmentioning

confidence: 99%

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Hybrid 18F–FDG PET/MRI might improve locoregional staging of breast cancer patients prior to neoadjuvant chemotherapy

Goorts

Vöö

Nijnatten

et al. 2017

Eur J Nucl Med Mol Imaging

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Purpose Our purpose in this study was to assess the added clinical value of hybrid 18 F-FDG-PET/MRI compared to conventional imaging for locoregional staging in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). Methods In this prospective study, primary invasive cT2-4 N0 or cT1-4 N+ breast cancer patients undergoing NAC were included. A PET/MRI breast protocol was performed before treatment. MR images were evaluated by a breast radiologist, blinded for PET images. PET images were evaluated by a nuclear physician. Afterwards, a combined PET/MRI report was written. PET/MRI staging was compared to conventional imaging, i.e., mammography, ultrasound and MRI. The proportion of patients with a modified treatment plan based on PET/MRI findings was analyzed.Results A total of 40 patients was included. PET/MRI was of added clinical value in 20.0% (8/40) of patients, changing the treatment plan in 10% and confirming the malignancy of suspicious lesions on MRI in another 10%. In seven (17.5%) patients radiotherapy fields were extended because of additional or affirmative PET/MRI findings being lymph node metastases (n = 5) and sternal bone metastases (n = 2). In one (2.5%) patient radiotherapy fields were reduced because of fewer lymph node metastases on PET/MRI compared to conventional imaging. Interestingly, all treatment changes were based on differences in number of lymph nodes suspicious for metastasis or number of distant metastasis, whereas differences in intramammary tumor extent were not observed. Conclusion Prior to NAC, PET/MRI shows promising results for locoregional staging compared to conventional imaging, changing the treatment plan in 10% of patients and potentially replacing PET/CT or tissue sampling in another 10% of patients.

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Section: Introductionmentioning

confidence: 94%

Section: Imaging Analysis and Stagingmentioning

confidence: 99%

Hybrid 18F–FDG PET/MRI might improve locoregional staging of breast cancer patients prior to neoadjuvant chemotherapy

Goorts

Vöö

Nijnatten

et al. 2017

Eur J Nucl Med Mol Imaging

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show abstract

“…However, management of the axilla in patients with operable breast cancer is still one of most controversial areas in clinical oncology. A recent systematic review found that the sensitivity of PET/CT systems in the detection of axillary nodal metastases ranged from 44% to 67% (29). Patients with false-negative PET results had significantly smaller and fewer tumor-positive lymph nodes than true-positive cases.…”

Section: Figure 2 Maximum Intensity Projection Of Positron-emission mentioning

confidence: 99%

PET Probe-Guided Surgery in Patients with Breast Cancer: Proposal for a Methodological Approach

Orsaria

Chiaravalloti

Fiorentini

et al. 2017

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Nuclear medicine has an essential and increasing role in the management of patients with breast cancer. Sentinel node detection has achieved reliability and, at present, it has an important place in clinical management. Even in the era of gene-expression profiling, nodal status remains one of the primary prognostic discriminants in patients with breast cancer, and is of great value as an independent predictor of distant disease development. Although several institutional case series have differed in patient selection, follow-up, type of surgery, and adjuvant therapies, they have consistently shown that the percentage of positive lymph nodes is a significant indicator of survival in women with axillary metastases on final pathology (1-5). The American Society of Clinical Oncology convened an Update Committee of experts to provide evidence-based recommendations to practicing oncologists, surgeons, and radiation therapy clinicians on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer (6). The need to perform axillary lymph node dissection (ALND) when SNB is positive and administration of contemporary adjuvant treatment including radiotherapy, chemotherapy, and hormonal therapy has been questioned in recent years. On the other hand, ongoing trials are testing whether node-positive patients can be spared chemotherapy, as qualifying indications increasingly rely on breast cancer biology for decision-making regarding adjuvant systemic treatment (7). In summary, sentinel node surgery represents the next major step in reducing the extent of surgical procedures, but despite the revolution of quality-conserving care, recent data collection and analyses of anatomical techniques suggest that exact lymphatic drainage of the breast is debatable (8). Different lymphatic patterns may help explain some important unresolved clinical problems, including different detection rates between studies and high false-negative rates of about 10% in multicenter randomized controlled trials (9). Further anatomical investigation and knowledge of the exact sentinel lymphatic channels will provide more information about patterns of breast cancer in order to improve surgical strategy, locoregional recurrence, and survival.

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“…However, the increased clinical use of breast MRI is not without limitations. Cooper et al [37] performed a study looking at the cost effectiveness of MRI and PET for the evaluation of axillary lymph nodes in early breast cancer. They created an individual patient discrete-event simulation model to estimate the lifetime costs and benefits of replacing SLNB with MRI or PET, or adding MRI or PET before SLNB.…”

Section: The Future Role Of Mnps In the Management Of The Axilla In Bmentioning

confidence: 99%

What is the future of magnetic nanoparticles in the axillary management of breast cancer?

Ahmed

Douek

2013

Breast Cancer Res Treat

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Magnetic nanoparticles (MNPs) possess unique properties, which make them highly attractive for medical applications. The use of MNPs in surgery has mainly been focused on their role in the identification of metastatic lymph node involvement. There have been developments within this field, including ongoing and newly conducted clinical trials. The current published evidence for the use of MNPs in assessing metastatic lymph node spread using sentinel lymph node biopsy and non-invasive imaging modalities is reviewed and future applications considered.

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Positron emission tomography (PET) for assessment of axillary lymph node status in early breast cancer: A systematic review and meta-analysis

Cited by 115 publications

References 56 publications

Hybrid 18F–FDG PET/MRI might improve locoregional staging of breast cancer patients prior to neoadjuvant chemotherapy

Hybrid 18F–FDG PET/MRI might improve locoregional staging of breast cancer patients prior to neoadjuvant chemotherapy

PET Probe-Guided Surgery in Patients with Breast Cancer: Proposal for a Methodological Approach

What is the future of magnetic nanoparticles in the axillary management of breast cancer?

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