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A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases.
Ann Oncol. 2007 Mar; 18(3):473-8.AO

Abstract

BACKGROUND

Sentinel node biopsy (SNB) has become a standard treatment in staging axillary lymph nodes in early breast cancer. SNB, however, is an invasive procedure and is time-consuming when the sentinel node is analysed intra-operatively. Breast cancer is frequently characterised by increased 2-fluoro-2-deoxy-D-glucose uptake and many studies have shown encouraging results in detecting axillary lymph node metastases. The aim of this study was to compare SNB and -positron emission tomography (-PET) imaging, to assess their values in detecting occult axillary metastases.

PATIENTS AND METHODS

In all, 236 patients with breast cancer and clinically negative axilla were enrolled in the study. 18-FDG-PET was carried out before surgery, using a positron emission tomography (PET)/computed tomography scanner. In all patients, SNB was carried out after identification through lymphoscintigraphy. Patients underwent axillary lymph nodes dissection (ALND) in cases of positive FDG-PET or positive SNB. The results of PET scan were compared with histopathology of SNB and ALND.

RESULTS

In all, 103 out of the 236 patients (44%) had metastases in axillary nodes. Sensitivity of FDG-PET scan for detection of axillary lymph node metastases in this series was low (37%); however, specificity and positive predictive values were acceptable (96% and 88%, respectively).

CONCLUSIONS

The high specificity of PET imaging indicates that patients who have a PET-positive axilla should have an ALND rather than an SNB for axillary staging. In contrast, FDG-PET showed poor sensitivity in the detection of axillary metastases, confirming the need for SNB in cases where PET is negative in the axilla.

Authors+Show Affiliations

Division of Senology, European Institute of Oncology, Milan, Italy. umberto.veronesi@ieo.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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)

Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17164229

Citation

Veronesi, U, et al. "A Comparative Study On the Value of FDG-PET and Sentinel Node Biopsy to Identify Occult Axillary Metastases." Annals of Oncology : Official Journal of the European Society for Medical Oncology, vol. 18, no. 3, 2007, pp. 473-8.
Veronesi U, De Cicco C, Galimberti VE, et al. A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol. 2007;18(3):473-8.
Veronesi, U., De Cicco, C., Galimberti, V. E., Fernandez, J. R., Rotmensz, N., Viale, G., Spano, G., Luini, A., Intra, M., Veronesi, P., Berrettini, A., & Paganelli, G. (2007). A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Annals of Oncology : Official Journal of the European Society for Medical Oncology, 18(3), 473-8.
Veronesi U, et al. A Comparative Study On the Value of FDG-PET and Sentinel Node Biopsy to Identify Occult Axillary Metastases. Ann Oncol. 2007;18(3):473-8. PubMed PMID: 17164229.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. AU - Veronesi,U, AU - De Cicco,C, AU - Galimberti,V E, AU - Fernandez,J R, AU - Rotmensz,N, AU - Viale,G, AU - Spano,G, AU - Luini,A, AU - Intra,M, AU - Veronesi,P, AU - Berrettini,A, AU - Paganelli,G, Y1 - 2006/12/12/ PY - 2006/12/14/pubmed PY - 2007/8/11/medline PY - 2006/12/14/entrez SP - 473 EP - 8 JF - Annals of oncology : official journal of the European Society for Medical Oncology JO - Ann Oncol VL - 18 IS - 3 N2 - BACKGROUND: Sentinel node biopsy (SNB) has become a standard treatment in staging axillary lymph nodes in early breast cancer. SNB, however, is an invasive procedure and is time-consuming when the sentinel node is analysed intra-operatively. Breast cancer is frequently characterised by increased 2-fluoro-2-deoxy-D-glucose uptake and many studies have shown encouraging results in detecting axillary lymph node metastases. The aim of this study was to compare SNB and -positron emission tomography (-PET) imaging, to assess their values in detecting occult axillary metastases. PATIENTS AND METHODS: In all, 236 patients with breast cancer and clinically negative axilla were enrolled in the study. 18-FDG-PET was carried out before surgery, using a positron emission tomography (PET)/computed tomography scanner. In all patients, SNB was carried out after identification through lymphoscintigraphy. Patients underwent axillary lymph nodes dissection (ALND) in cases of positive FDG-PET or positive SNB. The results of PET scan were compared with histopathology of SNB and ALND. RESULTS: In all, 103 out of the 236 patients (44%) had metastases in axillary nodes. Sensitivity of FDG-PET scan for detection of axillary lymph node metastases in this series was low (37%); however, specificity and positive predictive values were acceptable (96% and 88%, respectively). CONCLUSIONS: The high specificity of PET imaging indicates that patients who have a PET-positive axilla should have an ALND rather than an SNB for axillary staging. In contrast, FDG-PET showed poor sensitivity in the detection of axillary metastases, confirming the need for SNB in cases where PET is negative in the axilla. SN - 0923-7534 UR - https://www.unboundmedicine.com/medline/citation/17164229/A_comparative_study_on_the_value_of_FDG_PET_and_sentinel_node_biopsy_to_identify_occult_axillary_metastases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0923-7534(19)37830-5 DB - PRIME DP - Unbound Medicine ER -