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

Liu, Yiyan

doi:10.5306/wjco.v5.i5.982

Cited by 42 publications

(35 citation statements)

References 47 publications

(64 reference statements)

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“…PET/CT shows lymph node metastases in the internal mammary chain (IMC) and periclavicular area that are not detected on conventional imaging. 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%

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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%

“…Previous studies have shown fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/ computed tomography (CT) is of added value in nodal staging [8][9][10][11][12][13][14][15]. PET/CT shows lymph node metastases in the internal mammary chain (IMC) and periclavicular area that are not detected on conventional imaging.…”

Section: Introductionmentioning

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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“…The prognosis and therapeutic decisions are based primarily on precise data on the real extent of the disease, which is directly related to the metastatic involvement of locoregional lymph nodes (LNs), including ipsilateral axillary, internal mamarian (IM), supraclavicular (SC) and infraclavicular (IC) LNs [6]. Axillary LN status was accepted as the most significant and reliable predictor of survival and disease recurrence in primary BC [5,7,8]. Gold-standard methods for the assessment of axillary nodal status are still ALND or SLNB [8].…”

Section: Introductionmentioning

confidence: 99%

Initial Fludeoxyglucose (18F) Positron Emission Tomography-Computed Tomography (FDG-PET/CT) Imaging of Breast Cancer – Correlations with the Primary Tumour and Locoregional Metastases

et al. 2018

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SummaryBackroundWe aimed to evaluate initial PET/CT features of primary tumour and locoregional metastatic lymph nodes (LNs) in breast cancer and to look for potential relationships between several parameters from PET/CT.Material/MethodsTwenty-three women (mean age; 48.66±12.23 years) with a diagnosis of primary invasive ductal carcinoma were included. They underwent PET/CT imaging for the initial tumour staging and had no evidence of distant metastates. Patients were divided into two groups. The LABC (locally advanced breast cancer) group included 17 patients with ipsilateral axillary lymph node (LN) metastases. The Non-LABC group consisted of six patients without LN metastases. PET/CT parameters including tumour size, axillary LN size, SUVmax of ipsilateral axillary LNs (SUVmax-LN), SUVmax of primary tumour (SUVmax-T) and NT ratios (SUVmax-LN/SUVmax-T) were compared between the groups. Correlations between the above-mentioned PET/CT parameters in the LABC group as well as the correlation between tumour size and SUVmax-T within each group were evaluated statistically.ResultsThe mean values of the initial PET/CT parameters in the LABC group were significantly higher than those of the non-LABC group (p<0.05). The correlation between tumour size and SUVmax-T value within both LABC and non-LABC groups was statistically significant (p<0.05). In the LABC group, the correlations between the size and SUVmax-LN values of metastatic axillary LNs, between tumour size and metastatic axillary LN size, between SUVmax-T values and metastatic axillary LN size, between SUVmax-T and SUVmax-LN values, and between tumour size and SUVmax-LN values were all significant (p<0.05).ConclusionsWe found significant correlations between PET/CT parameters of the primary tumour and those of metastatic axillary LNs. Patients with LN metastases had relatively larger primary tumours and higher SUVmax values.

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“…Despite a low sensitivity, 18 F-FDG PET/CT is generally reported to have a good specificity for identifying axillary nodal disease. Some authors advocate the use of 18 F-FDG PET/CT in order to reduce the use of SNB, evaluating patients with a high axillary lymph node burden who could then move directly to ALND (27). Others suggest that 18 F-FDG PET/CT should be used to extend the use of SNB over more invasive methods, since in patients with a high risk of axillary lymph node metastases that are not considered candidates for SNB, an unremarkable 18 F-FDG PET/CT scan can still identify those who can safely undergo SNB instead of immediate ALND.…”

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

Cited by 42 publications

References 47 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

Initial Fludeoxyglucose (18F) Positron Emission Tomography-Computed Tomography (FDG-PET/CT) Imaging of Breast Cancer – Correlations with the Primary Tumour and Locoregional Metastases

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

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