The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature

Abstract

International audienceAxillary lymph node status is the most powerful prognostic indicator in patients with breast cancer. FDG-PET has been suggested as a non-invasive method of staging the axilla. The aim of this study was to review and aggregate all studies that measured the performance of FDG-PET in patients with breast cancer, using surgically obtained axillary histology as a reference, in a meta-analysis. A systematic review of the literature was performed and data extracted from all eligible studies. These were then analysed using meta-analysis software and summary receiver operating characteristic (SROC) curves were plotted for the aggregate data. The data was then tested to determine which parameters impacted on the sensitivity and specificity of the studies. Sensitivities ranging from 20 to 100% and specificities ranging from 65 to 100% have been reported. An aggregated ROC analysis found an area under the curve of 0.95 (95% CI 0.91–0.97) and a * value of 0.89 (95% CI 0.85–0.92) in a total of 25 studies involving 2,460 patients. The AUC and * values indicated little difference between the compared study characteristics. The performance of the technique currently remains below, which is required to replace assessment of axillary node status by surgical biopsy and histological assessment. However, sensitivity and specificity are high and FDG-PET may have a role to play under particular circumstances. Moreover, the additional benefit of an assessment of distal metastatic spread provided by FDG-PET requires further investigation

Diagnostic and prognostic correlates of preoperative FDG PET for breast cancer

“…the ability to detect disease, of FDG PET in breast cancer have been investigated in many studies. The consensus from several reviews is that due to its limited spatial resolution PET lacks sensitivity for the diagnostic assessment of the axilla in patients with early breast cancer [1][2][3][4][5]. Most guidelines tend to recommend PET for breast cancer only in particular circumstances (in advanced disease, for recurrences, for treatment monitoring and possibly to evaluate the efficacy of neoadjuvant therapy) [6][7][8][9][10][11][12].…”

Initial Results of a Prospective Clinical Trial of 18F-Fluciclovine PET/CT in Newly Diagnosed Invasive Ductal and Invasive Lobular Breast Cancers

“…PETwi th 18 F-FDG has made important advances in the care of patients with breast cancer (1); however, 18 F-FDG PET has multiple limitations, including the inability to differentiate malignant from benign breast lesions (2), limited contribution to local staging of the breast and axillary nodes (3)(4)(5), and variable sensitivity for breast cancer depending on tumor and patient factors (6)(7)(8). Invasive lobular carcinoma (ILC), a subtype of breast cancer, is difficult to visualize by all known imaging modalities (9,10), including 18 F-FDG PET (11)(12)(13)(14)(15)(16).…”

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

“…On the contrary, non-radionuclide techniques such as CT and MRI have excellent spatial resolution (\1 mm). Torres Martin de Rosales et al [34][35][36] demonstrated that dual-modality imaging agents based on the conjugation of radiolabelled bisphosphonates (BP) directly to the surface of SPIO, provided excellent stability and allowed for in vivo co-localization of lymph nodes in a murine model. The application of these dual-imaging agents to future human studies provides exciting prospects to improve the sensitivity and specificity of pre-operative axillary staging.…”