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Prospective study of 2-[¹⁸F]fluorodeoxyglucose positron emission tomography in the assessment of regional nodal spread of disease in patients with breast cancer: an Ontario clinical oncology group study.
J Clin Oncol. 2012 Apr 20; 30(12):1274-9.JC

Abstract

PURPOSE

2-[(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) is potentially useful in assessing lymph nodes and detecting distant metastases in women with primary breast cancer.

PATIENTS AND METHODS

Women diagnosed with operable breast cancer within 3 months underwent FDG-PET at one of five Ontario study centers followed by axillary lymph node assessment (ALNA) consisting of sentinel lymph node biopsy (SLNB) alone if sentinel lymph nodes (SLNs) were negative, SLNB with axillary lymph node dissection (ALND) if SLNB or PET was positive, or ALND alone if SLNs were not identified.

RESULTS

Between January 2005 and March 2007, 325 analyzable women entered this study. Sentinel nodes were found for 312 (96%) of 325 women and were positive for tumor in 90 (29%) of 312. ALND was positive in seven additional women. Using ALNA as the gold standard, sensitivity for PET was 23.7% (95% CI, 15.9% to 33.6%), specificity was 99.6% (95% CI, 97.2% to 99.9%), positive predictive value was 95.8% (95% CI, 76.9% to 99.8%), negative predictive value was 75.4% (95% CI, 70.1% to 80.1%), and prevalence was 29.8% (95% CI, 25.0% to 35.2%). Using logistic regression, tumor size was predictive for prevalence of tumor in the axilla and for PET sensitivity. PET scan was suspicious for distant metastases in 13 patients; three (0.9%) were confirmed as metastatic disease and 10 (3.0%) were false positive.

CONCLUSION

FDG-PET is not sufficiently sensitive to detect positive axillary lymph nodes, nor is it sufficiently specific to appropriately identify distant metastases. However, the very high positive predictive value (96%) suggests that PET when positive is indicative of disease in axillary nodes, which may influence surgical care.

Authors+Show Affiliations

Ontario Clinical Oncology Group, McMaster University, Hamilton, Canada. Kathy.pritchard@sunnybrook.caNo 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 availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22393089

Citation

Pritchard, Kathleen I., et al. "Prospective Study of 2-[¹⁸F]fluorodeoxyglucose Positron Emission Tomography in the Assessment of Regional Nodal Spread of Disease in Patients With Breast Cancer: an Ontario Clinical Oncology Group Study." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 30, no. 12, 2012, pp. 1274-9.
Pritchard KI, Julian JA, Holloway CM, et al. Prospective study of 2-[¹⁸F]fluorodeoxyglucose positron emission tomography in the assessment of regional nodal spread of disease in patients with breast cancer: an Ontario clinical oncology group study. J Clin Oncol. 2012;30(12):1274-9.
Pritchard, K. I., Julian, J. A., Holloway, C. M., McCready, D., Gulenchyn, K. Y., George, R., Hodgson, N., Lovrics, P., Perera, F., Elavathil, L., O'Malley, F. P., Down, N., Bodurtha, A., Shelley, W., & Levine, M. N. (2012). Prospective study of 2-[¹⁸F]fluorodeoxyglucose positron emission tomography in the assessment of regional nodal spread of disease in patients with breast cancer: an Ontario clinical oncology group study. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 30(12), 1274-9. https://doi.org/10.1200/JCO.2011.38.1103
Pritchard KI, et al. Prospective Study of 2-[¹⁸F]fluorodeoxyglucose Positron Emission Tomography in the Assessment of Regional Nodal Spread of Disease in Patients With Breast Cancer: an Ontario Clinical Oncology Group Study. J Clin Oncol. 2012 Apr 20;30(12):1274-9. PubMed PMID: 22393089.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective study of 2-[¹⁸F]fluorodeoxyglucose positron emission tomography in the assessment of regional nodal spread of disease in patients with breast cancer: an Ontario clinical oncology group study. AU - Pritchard,Kathleen I, AU - Julian,Jim A, AU - Holloway,Claire M B, AU - McCready,David, AU - Gulenchyn,Karen Yvonne, AU - George,Ralph, AU - Hodgson,Nicole, AU - Lovrics,Peter, AU - Perera,Francisco, AU - Elavathil,Leela, AU - O'Malley,Frances P, AU - Down,Nancy, AU - Bodurtha,Audley, AU - Shelley,Wendy, AU - Levine,Mark N, Y1 - 2012/03/05/ PY - 2012/3/7/entrez PY - 2012/3/7/pubmed PY - 2012/6/15/medline SP - 1274 EP - 9 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 30 IS - 12 N2 - PURPOSE: 2-[(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) is potentially useful in assessing lymph nodes and detecting distant metastases in women with primary breast cancer. PATIENTS AND METHODS: Women diagnosed with operable breast cancer within 3 months underwent FDG-PET at one of five Ontario study centers followed by axillary lymph node assessment (ALNA) consisting of sentinel lymph node biopsy (SLNB) alone if sentinel lymph nodes (SLNs) were negative, SLNB with axillary lymph node dissection (ALND) if SLNB or PET was positive, or ALND alone if SLNs were not identified. RESULTS: Between January 2005 and March 2007, 325 analyzable women entered this study. Sentinel nodes were found for 312 (96%) of 325 women and were positive for tumor in 90 (29%) of 312. ALND was positive in seven additional women. Using ALNA as the gold standard, sensitivity for PET was 23.7% (95% CI, 15.9% to 33.6%), specificity was 99.6% (95% CI, 97.2% to 99.9%), positive predictive value was 95.8% (95% CI, 76.9% to 99.8%), negative predictive value was 75.4% (95% CI, 70.1% to 80.1%), and prevalence was 29.8% (95% CI, 25.0% to 35.2%). Using logistic regression, tumor size was predictive for prevalence of tumor in the axilla and for PET sensitivity. PET scan was suspicious for distant metastases in 13 patients; three (0.9%) were confirmed as metastatic disease and 10 (3.0%) were false positive. CONCLUSION: FDG-PET is not sufficiently sensitive to detect positive axillary lymph nodes, nor is it sufficiently specific to appropriately identify distant metastases. However, the very high positive predictive value (96%) suggests that PET when positive is indicative of disease in axillary nodes, which may influence surgical care. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/22393089/Prospective_study_of_2_[¹⁸F]fluorodeoxyglucose_positron_emission_tomography_in_the_assessment_of_regional_nodal_spread_of_disease_in_patients_with_breast_cancer:_an_Ontario_clinical_oncology_group_study_ L2 - https://ascopubs.org/doi/10.1200/JCO.2011.38.1103?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -