Prospective Study of 2-[<sup>18</sup>F]Fluorodeoxyglucose Positron Emission Tomography in the Assessment of Regional Nodal Spread of Disease in Patients With Breast Cancer: An Ontario Clinical Oncology Group Study

Pritchard, Kathleen I.; Julian, Jim A.; Holloway, Claire; McCready, David R.; Gulenchyn, Karen Y.; George, Ralph; Hodgson, Nicole; Lovrics, Peter; Perera, Francisco; Elavathil, Leela; O’Malley, Frances P.; Down, Nancy; Bodurtha, A.; Shelley, Wendy; Levine, Mark

doi:10.1200/jco.2011.38.1103

Cited by 89 publications

(50 citation statements)

References 23 publications

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“…Biopsy or additional imaging and follow-ups 37 96 83 74 FDG PET/CT could not be recommended as a primary diagnostic procedure Groheux et al [16] 2011 70 SLNB or US-FNA 63 91 63 91 FDG PET/CT might impact cancer management in small portions of patients Koolen et al [3] 2012 290 SLNB or US-FNA 82 92 98 53 FDG PET/CT could be recommended as a standard staging procedure Pritchard et al [18] that FDG PET/CT contributes to pretreatment staging and therapy planning, upstaging substantial proportion of patients to the high risk group, thereby potentially changing prognosis and possibly implicating postoperative irradiation.…”

Section: Discussionmentioning

confidence: 99%

“…In a more recently published Ontario Clinical Oncology Group Study with 325 patient enrollments and ALND or SLNB as the gold standard following FDG PET/CT, the sensitivity, specificity, positive predictive value and negative predictive value were 23.7%, 99.6%, 95.8% and 75.4% [18] . Using logistic regression, primary tumor size was predictive for prevalence of the nodal lesion and for PET sensitivity.…”

Section: Nodesmentioning

confidence: 99%

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Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Liu¹

2014

WJCO

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Fluorodeoxyglucose positron emission tomography/ computed tomography (FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node (IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observations suggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast cancer; Fluorodeoxyglucose positron emission tomography/computed tomography; Locoregional nodal disease; Axillary lymph node; Internal mammary lymph node; Axillary lymph node dissection; Sentinel lymph node biopsy Core tip: The presence and extent of locoregional nodal metastasis at diagnosis is the single most important prognostic factor in breast cancer. The predominant lymphatic drainage pathway from the breast cancer is toward the axilla. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity secondary to the limitation of its spatial resolution. The internal mammary node (IMN) involvement is of prognostic significance in breast cancer, and IMN metastasis has been associated with higher rate of distant metastasis and lower overall survival rates. Limited preliminary data indicated that FDG PET/CT plays a role in identification of positive IMN, and it is superior to conventional imaging modalities.

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Section: Discussionmentioning

confidence: 99%

Section: Nodesmentioning

confidence: 99%

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Liu¹

2014

WJCO

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“…Several groups have demonstrated that, in most cases, FDG-PET or PET/CT has a low sensitivity (range 24-82 %) but a high specificity (range 80-100 %) and high positive predictive value (PPV) of more than 80 % [24][25][26][27][28][29][30][31][32][33]. In a review of 472 patients examined using FDG-PET/CT, the pooled sensitivity was relatively low (60 %) but the pooled specificity was very high (97 %) [34].…”

Section: Axillary Lymph Node Stagingmentioning

confidence: 99%

Present and future role of FDG-PET/CT imaging in the management of breast cancer

Kitajima

Miyoshi

2016

Jpn J Radiol

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by malignant cells, opened a new field in clinical oncologic imaging. Recently, integrated positron emission tomography/computed tomography (PET/CT), in which a full-ringdetector clinical PET scanner and multidetector-row helical CT scanner are combined, has made it possible to acquire both metabolic and anatomic imaging data using a single device in a single diagnostic session, and provides precise anatomic localization of suspicious areas of increased FDG uptake. When used in a clinical setting, FDG-PET/CT leads to a significant improvement in diagnostic accuracy and has had a considerable impact on patient management, including diagnosis, initial staging, optimization of treatment, restaging, monitoring of the response to therapy, and prognostication of various malignant tumors. We herein review the current and future roles of FDG-PET/CT in the management of breast cancer, discussing its usefulness and limitations for imaging in these patients. DiagnosisFDG-PET imaging has poor sensitivity (<50 %) for subcentimeter breast cancers [9,10]. This is due to the limited spatial resolution of PET and, in some cases, by tumor characteristics (e.g., low FDG avidity in grade 1 cancer, ductal carcinoma in situ, or lobular carcinoma) [1,2]. Specificity can also be altered by variations of FDG uptake in certain benign conditions, such as infection, fibroadenoma, ductal adenoma, inflammatory granulomatous mastitis, and fibrocystic changes [3].In order to improve specificity, some authors would obtain a second series of PET images centered on the breast approximately 2 h after FDG injection (dual-time imaging) [4]. Indeed, FDG uptake seems to increase with time in the case of malignancy, while some inflammatory lesions show stable or decreasing uptake [4]. However, dual-time Abstract Integrated positron emission tomography/computed tomography (PET/CT) with 2-[18F]fluoro-2-deoxyd-glucose (FDG) is a useful tool for acquisition of both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session, and has opened a new field in clinical oncologic imaging. FDG-PET/CT has been used successfully for the diagnosis, initial staging, restaging, early treatment response assessment, evaluation of metastatic disease response, and prognostication of breast cancer as well as various malignant tumors. We herein review the current place and role of FDG-PET/CT in the management of breast cancer, focusing on its usefulness and limitations in the imaging of these patients.

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“…To determine whether 18 F-FDG PET is useful for evaluating axillary lymph node involvement and detecting distant metastasis in women with primary breast cancer, 325 women diagnosed with operable breast cancer were screened by Pritchard et al [27] . SLNs were found in 312 (96%) of the 325 women.…”

Section: Comparison Of 18 F-fdg Pet (Pet/ct) and Slnb For Detecting Rmentioning

confidence: 99%

Comparison between 18F-FDG PET (PET/CT) and sentinel lymph node biopsy in the detection of regional lymph node metastasis of various malignancies: review of the literature

Qiu

Chen²

2013

JBGC

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This article reviewed comparative studies of the use of 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) and sentinel lymph node biopsy (SLNB) for the detection of regional lymph node metastasis in patients with various malignancies. We sought to evaluate the diagnostic accuracy of 18 F-FDG PET (PET/CT) compared with SLNB to determine the presence or absence of regional lymph node metastasis. In this paper, we review 15 comparative studies of breast tumors and 17 comparative studies of melanomas that used these methods to detect regional lymph node metastasis. Original articles for other malignancies, including oral and oropharyngeal carcinoma, penile carcinoma, anal cancer, and cervical cancer, are relatively scarce. A consensus has been reached in the literature that SLNB is much more sensitive than 18 F-FDG PET and PET/CT for detecting small lymph node metastasis. 18 F-FDG PET and PET/CT cannot replace SLNB for the evaluation of early-stage regional lymphatic tumor dissemination in this patient population.

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Prospective Study of 2-[¹⁸F]Fluorodeoxyglucose Positron Emission Tomography in the Assessment of Regional Nodal Spread of Disease in Patients With Breast Cancer: An Ontario Clinical Oncology Group Study

Cited by 89 publications

References 23 publications

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Present and future role of FDG-PET/CT imaging in the management of breast cancer

Comparison between 18F-FDG PET (PET/CT) and sentinel lymph node biopsy in the detection of regional lymph node metastasis of various malignancies: review of the literature

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Prospective Study of 2-[18F]Fluorodeoxyglucose Positron Emission Tomography in the Assessment of Regional Nodal Spread of Disease in Patients With Breast Cancer: An Ontario Clinical Oncology Group Study

Cited by 89 publications

References 23 publications

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer

Present and future role of FDG-PET/CT imaging in the management of breast cancer

Comparison between 18F-FDG PET (PET/CT) and sentinel lymph node biopsy in the detection of regional lymph node metastasis of various malignancies: review of the literature

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Prospective Study of 2-[¹⁸F]Fluorodeoxyglucose Positron Emission Tomography in the Assessment of Regional Nodal Spread of Disease in Patients With Breast Cancer: An Ontario Clinical Oncology Group Study