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Determinants of diagnostic performance of [F-18]fluorodeoxyglucose positron emission tomography for axillary staging in breast cancer.
Ann Surg. 2002 Nov; 236(5):619-24.AnnS

Abstract

OBJECTIVE

To prospectively investigate determinants of the accuracy of staging axillary lymph nodes in breast cancer using [F-18]fluorodeoxyglucose positron emission tomography (FDG PET).

METHODS

Patients with primary operable breast cancer underwent FDG PET of the chest followed by sentinel node biopsy (SNB, n = 47) and/or complete axillary lymph node dissection (ALND, n = 23). PET scans were independently interpreted by three observers in a blinded fashion with respect to the FDG avidity of the primary tumor and the axillary status. The results were compared to histopathological analyses of the axillary lymph nodes. Clinicians were blinded to the PET results.

RESULTS

Axillary lymph node specimens and FDG PET scans were evaluated in 70 patients (59% cT1). Overall, 32 (46%) had lymph node metastases as established by SNB (18/47) or ALND (14/23), 20 of which were confined to a single node. The overall sensitivity of FDG PET was 25%, with a specificity of 97%. PET results were false-negative in all 18 positive SNBs and true-positive in 8/14 in the ALND group. The performance of FDG PET depended on the axillary tumor load and the FDG avidity of the primary tumor. Intense uptake in the primary tumor was found in only 57% of the patients, and this was independent of the size. There was excellent interobserver agreement of visual assessment of FDG uptake in primary tumor and axillary lymph nodes.

CONCLUSIONS

The sensitivity of FDG PET to detect occult axillary metastases in operable breast cancer was low, and it was a function of axillary tumor load and FDG avidity of the primary tumor. Even though the clinical relevance of occult disease detected by SNB needs to be confirmed, it is suggested that FDG PET in these patients should be focused on exploiting its nearly perfect specificity and the potential prognostic relevance of variable FDG uptake.

Authors+Show Affiliations

Departments of Internal Medicine and Surgery, Ziekenhuis Amstelveen, Amstelveen, The Netherlands. jjho@zha.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12409668

Citation

van der Hoeven, Jacobus J M., et al. "Determinants of Diagnostic Performance of [F-18]fluorodeoxyglucose Positron Emission Tomography for Axillary Staging in Breast Cancer." Annals of Surgery, vol. 236, no. 5, 2002, pp. 619-24.
van der Hoeven JJ, Hoekstra OS, Comans EF, et al. Determinants of diagnostic performance of [F-18]fluorodeoxyglucose positron emission tomography for axillary staging in breast cancer. Ann Surg. 2002;236(5):619-24.
van der Hoeven, J. J., Hoekstra, O. S., Comans, E. F., Pijpers, R., Boom, R. P., van Geldere, D., Meijer, S., Lammertsma, A. A., & Teule, G. J. (2002). Determinants of diagnostic performance of [F-18]fluorodeoxyglucose positron emission tomography for axillary staging in breast cancer. Annals of Surgery, 236(5), 619-24.
van der Hoeven JJ, et al. Determinants of Diagnostic Performance of [F-18]fluorodeoxyglucose Positron Emission Tomography for Axillary Staging in Breast Cancer. Ann Surg. 2002;236(5):619-24. PubMed PMID: 12409668.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Determinants of diagnostic performance of [F-18]fluorodeoxyglucose positron emission tomography for axillary staging in breast cancer. AU - van der Hoeven,Jacobus J M, AU - Hoekstra,Otto S, AU - Comans,Emile F I, AU - Pijpers,Rik, AU - Boom,Robert P A, AU - van Geldere,Dick, AU - Meijer,Sybren, AU - Lammertsma,Adriaan A, AU - Teule,Gerrit J J, PY - 2002/11/1/pubmed PY - 2002/11/30/medline PY - 2002/11/1/entrez SP - 619 EP - 24 JF - Annals of surgery JO - Ann Surg VL - 236 IS - 5 N2 - OBJECTIVE: To prospectively investigate determinants of the accuracy of staging axillary lymph nodes in breast cancer using [F-18]fluorodeoxyglucose positron emission tomography (FDG PET). METHODS: Patients with primary operable breast cancer underwent FDG PET of the chest followed by sentinel node biopsy (SNB, n = 47) and/or complete axillary lymph node dissection (ALND, n = 23). PET scans were independently interpreted by three observers in a blinded fashion with respect to the FDG avidity of the primary tumor and the axillary status. The results were compared to histopathological analyses of the axillary lymph nodes. Clinicians were blinded to the PET results. RESULTS: Axillary lymph node specimens and FDG PET scans were evaluated in 70 patients (59% cT1). Overall, 32 (46%) had lymph node metastases as established by SNB (18/47) or ALND (14/23), 20 of which were confined to a single node. The overall sensitivity of FDG PET was 25%, with a specificity of 97%. PET results were false-negative in all 18 positive SNBs and true-positive in 8/14 in the ALND group. The performance of FDG PET depended on the axillary tumor load and the FDG avidity of the primary tumor. Intense uptake in the primary tumor was found in only 57% of the patients, and this was independent of the size. There was excellent interobserver agreement of visual assessment of FDG uptake in primary tumor and axillary lymph nodes. CONCLUSIONS: The sensitivity of FDG PET to detect occult axillary metastases in operable breast cancer was low, and it was a function of axillary tumor load and FDG avidity of the primary tumor. Even though the clinical relevance of occult disease detected by SNB needs to be confirmed, it is suggested that FDG PET in these patients should be focused on exploiting its nearly perfect specificity and the potential prognostic relevance of variable FDG uptake. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/12409668/Determinants_of_diagnostic_performance_of_[F_18]fluorodeoxyglucose_positron_emission_tomography_for_axillary_staging_in_breast_cancer_ L2 - https://journals.lww.com/12409668.pmid DB - PRIME DP - Unbound Medicine ER -