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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.
World J Surg. 2009 May; 33(5):943-9.WJ

Abstract

BACKGROUND

This study was designed to determine whether a preoperative fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) (FDG-PET/CT) could be used as a guide for axillary node dissection (AND) or sentinel lymph node biopsy (SNB) in breast cancer patients.

METHODS

Between February 2007 and April 2008, we performed FDG-PET/CT scans in 137 biopsy-proven breast cancer patients planning to have an SNB to select patients for either AND (PET/CT N+) or SNB (PET/CT N0). In performing SNB, we also performed additional non-SNB (ADD), which was enlarged at the lower axilla.

RESULTS

Twenty-seven patients with positive scans underwent complete AND as a primary procedure, and 110 patients with negative scans underwent SNB + ADD. There were 8 cases of false negative scans, and no case of false positive scan. The overall sensitivity, specificity, positive predictive value, and overall accuracy of FDG-PET/CT in predicting axillary metastasis were 77.1%, 100%, 100%, and 94.2%, respectively. In a subset of 110 patients with SNB + ADD, 104 patients had histologically negative SN, and 6 patients had positive SN in frozen section. Among 110 SNB + ADD cases, there were only 8 cases (7.3%) of positive axillary basins in permanent biopsy, including two cases of late positives that had micrometastases in the SN only. Through selective SNB + ADD based on an FDG-PET/CT, we have spared 27 unnecessary SNBs (true positive scans).

CONCLUSIONS

FDG-PET/CT is a specific imaging modality for predicting axillary node metastasis, and allows for a selective approach to either AND or SNB. A selective SNB + ADD based on an FDG-PET/CT reduced both unnecessary SNBs and positive axillary basins, enhancing the identification rates of SN and the accuracy of SNB.

Authors+Show Affiliations

Department of Surgery, Research Institute for Medical Science, College of Medicine, Chungnam National University, 640 Daesadong Jung-Ku, Daejeon 301-721, South Korea. kimjr@cnu.ac.krNo 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)

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

Language

eng

PubMed ID

19259728

Citation

Kim, Jeryong, et al. "Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based On an FDG-PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience." World Journal of Surgery, vol. 33, no. 5, 2009, pp. 943-9.
Kim J, Lee J, Chang E, et al. Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based on an FDG-PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience. World J Surg. 2009;33(5):943-9.
Kim, J., Lee, J., Chang, E., Kim, S., Suh, K., Sul, J., Song, I., Kim, Y., & Lee, C. (2009). Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based on an FDG-PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience. World Journal of Surgery, 33(5), 943-9. https://doi.org/10.1007/s00268-009-9955-z
Kim J, et al. Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based On an FDG-PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience. World J Surg. 2009;33(5):943-9. PubMed PMID: 19259728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based on an FDG-PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience. AU - Kim,Jeryong, AU - Lee,Jinsun, AU - Chang,Eilsung, AU - Kim,Seongmin, AU - Suh,Kwangsun, AU - Sul,Jiyoung, AU - Song,Insang, AU - Kim,Yonghoon, AU - Lee,Chuljoo, PY - 2009/3/5/entrez PY - 2009/3/5/pubmed PY - 2009/6/26/medline SP - 943 EP - 9 JF - World journal of surgery JO - World J Surg VL - 33 IS - 5 N2 - BACKGROUND: This study was designed to determine whether a preoperative fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) (FDG-PET/CT) could be used as a guide for axillary node dissection (AND) or sentinel lymph node biopsy (SNB) in breast cancer patients. METHODS: Between February 2007 and April 2008, we performed FDG-PET/CT scans in 137 biopsy-proven breast cancer patients planning to have an SNB to select patients for either AND (PET/CT N+) or SNB (PET/CT N0). In performing SNB, we also performed additional non-SNB (ADD), which was enlarged at the lower axilla. RESULTS: Twenty-seven patients with positive scans underwent complete AND as a primary procedure, and 110 patients with negative scans underwent SNB + ADD. There were 8 cases of false negative scans, and no case of false positive scan. The overall sensitivity, specificity, positive predictive value, and overall accuracy of FDG-PET/CT in predicting axillary metastasis were 77.1%, 100%, 100%, and 94.2%, respectively. In a subset of 110 patients with SNB + ADD, 104 patients had histologically negative SN, and 6 patients had positive SN in frozen section. Among 110 SNB + ADD cases, there were only 8 cases (7.3%) of positive axillary basins in permanent biopsy, including two cases of late positives that had micrometastases in the SN only. Through selective SNB + ADD based on an FDG-PET/CT, we have spared 27 unnecessary SNBs (true positive scans). CONCLUSIONS: FDG-PET/CT is a specific imaging modality for predicting axillary node metastasis, and allows for a selective approach to either AND or SNB. A selective SNB + ADD based on an FDG-PET/CT reduced both unnecessary SNBs and positive axillary basins, enhancing the identification rates of SN and the accuracy of SNB. SN - 0364-2313 UR - https://www.unboundmedicine.com/medline/citation/19259728/Selective_Sentinel_Node_Plus_Additional_Non_Sentinel_Node_Biopsy_Based_on_an_FDG_PET/CT_Scan_in_Early_Breast_Cancer_Patients:_Single_Institutional_Experience_ L2 - https://dx.doi.org/10.1007/s00268-009-9955-z DB - PRIME DP - Unbound Medicine ER -