Selective Sentinel Node Plus Additional Non‐Sentinel Node Biopsy Based on an FDG‐PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience

Kim, Je-Ryong; Lee, Jinsun; Chang, Eilsung; Kim, Seong–Min; Suh, Kwang Sun; Sul, Ji Young; Song, In-Sang; Kim, Yong‐Hoon; Lee, Chuljoo

doi:10.1007/s00268-009-9955-z

Cited by 55 publications

(47 citation statements)

References 32 publications

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“…Wahl et al [10] 2004 360 ALND 61 80 62 79 FDG PET was limited in detection of micrometastasis Veronesi et al [9] 2007 236 SLNB 37 96 88 66 High specificity of FDG PET/CT indicated that patients with positive PET should have ALND directly Ueda et al [11] 2008 183 SLNB and/or ALND 58 95 85 83 Diagnostic accuracy of PET/CT was nearly equal to ultrasound Kim et al [12] 2009 137 ALND or SLNB 77 100 100 94 FDG PET/CT could help to select patients for either ALND or SLNB Heusner et al [17] 2009 61 SLNB 58 92 82 77 FDG PET/CT could not replace invasive approaches for axillary staging Choi et al [13] 2012 154…”

Section: Discussionmentioning

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%

“…Kim et al [12] tried to determine whether pre-surgical FDG PET/CT could be used as a guide for ALND or SLNB. 137 patients with biopsy-proven breast cancer underwent preoperative FDG PET/CTs, those who were positive in the axillae went to ALND directly, and those who were negative in the axillae proceeded to SLNB.…”

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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“…The sensitivity of PET or PET/CT for regional lymph node metastasis in patients with early-stage tumors is unacceptably low compared with SLNB because normal-size lymph nodes may contain micrometastases that are below the sensitivity threshold of the imaging method. Most reported sensitivity values of 18 F-FDG PET or PET/CT in the evaluation of lymphatic metastasis for breast tumors ranged from 20% to 60%, with only one value greater than 60% (i.e., 77.1% sensitivity reported by Kim [25] ). The sensitivity for melanoma is even lower, with most reported values ranging from 0% to 22%.…”

Section: Remarks and Conclusionmentioning

confidence: 99%

“…To determine whether preoperative 18 F-FDG PET/CT can be used as a guide for ALND (PET/CT N+) or SLNB (PET/CT N0) in breast cancer patients, Kim et al [25] performed 18 F-FDG PET/CT in 137 biopsy-proven breast cancer patients. Twenty-seven patients with positive 18 F-FDG PET/CT scans underwent complete ALND as a primary procedure, and 110 patients with negative 18 F-FDG PET/CT scans underwent SLNB.…”

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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“…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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Selective Sentinel Node Plus Additional Non‐Sentinel Node Biopsy Based on an FDG‐PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience

Cited by 55 publications

References 32 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

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

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

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