Utility of 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in combination with ultrasonography for axillary staging in primary breast cancer

Ueda, Shigeto; Tsuda, Hitoshi; Asakawa, Hideki; Omata, Jiro; Fukatsu, Kazuhiko; Kondo, Nobuo; Kondo, Tadaharu; Hama, Yukihiro; Tamura, Katsumi; Ishida, Jiro; Abe, Yoshiyuki; Mochizuki, Hidetaka

doi:10.1186/1471-2407-8-165

Cited by 110 publications

(86 citation statements)

References 18 publications

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“…It is common clinical practice in patients with breast cancer to carry out ultrasound of the axilla together with fine needle aspiration cytology of any suspicious axillary nodes that are identified (or palpable) prior to patients undergoing SNB [10]. Similarly MRI [11,32], CT [33,34], mammography [7,11] and other non-PET radionuclides (MIBI) [25] have all been suggested as useful in the staging of the axilla.…”

Section: Introductionmentioning

confidence: 99%

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

Peare

Staff

Heys

2010

Breast Cancer Res Treat

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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

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Section: Introductionmentioning

confidence: 99%

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

Peare

Staff

Heys

2010

Breast Cancer Res Treat

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“…Surgical biopsy remains the gold-standard for the diagnostic evaluation of axillary lymph node metastasis (9). Traditional imaging paradigms (computed tomography, positron emission tomography, ultrasound, mammography) and physical examination have not proven to be accurate in the identification of axillary nodal metastasis (10,11). The development of noninvasive diagnostic modalities for accurate axillary staging would represent an important advance in the management of breast cancer patients.…”

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confidence: 99%

Magnetic resonance imaging for axillary staging in patients with breast cancer

Mortellaro

Marshall

Singer

et al. 2009

Magnetic Resonance Imaging

106

103

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Purpose:To determine the utility of MRI for assessing axillary lymph node status in patients with breast cancer. Materials and Methods:A consecutive series of patients who underwent breast MR before surgical management of breast cancer with axillary sampling between 2005 and 2007 were identified. MRs were evaluated for the number of nodes, contrast kinetics, nodal area, and number of nodes with no fatty hilum. Data were analyzed in the context of final breast pathology, sentinel lymph node status, and axillary nodal status. Correlations were analyzed using Kendall's -b test. Reported P values are one-sided.Results: Fifty-six females (median ϭ 58 years) were studied. Sentinel lymph nodes (SLN) were positive in 15/56 patients (27%). All SLN ϩ patients (n ϭ 15) had completion axillary dissection. Extent of nodal disease was 1 (n ϭ 3), 2 (n ϭ 4), Ͼ2 (n ϭ 8). Presence of any axillary lymph node with no fatty hilum and the number of nodes with no fatty hilum on MR significantly correlated with pathologic node positivity (P ϭ 0.04); while kinetics, node number, and node size did not correlate. Conclusion:Breast MR may be useful in the assessment of axillary nodes in patients with breast cancer.

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“…18 F-FDG PET was poor at providing effective evaluation of axillary lymph nodes, but future hardware and software improvements might improve the spatial resolution for detecting locoregional disease, allowing for a selective approach to diagnose metastases in axillary nodes and SLN. As suggested by previous reports, these false-negative results may be due to the small size of the axillary node, stromal-rich cancer, positive lymphovascular invasion, multifocal tumors, and high tumor staging (43,44). Consequently, the true incidence of 18 F-FDG PET-detectable disease in various stages of primary breast cancer needs to be determined and systematically measured.…”

Section: Resultsmentioning

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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Utility of 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in combination with ultrasonography for axillary staging in primary breast cancer

Cited by 110 publications

References 18 publications

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

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

Magnetic resonance imaging for axillary staging in patients with breast cancer

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

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