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The roles of 18F-FDG-PET/CT and US-guided FNAC in assessment of axillary nodal metastases in breast cancer patients.
Breast Cancer. 2017 Jan; 24(1):121-127.BC

Abstract

BACKGROUND

There is a need for less invasive techniques for preoperative identification of axillary lymph node (ALN) metastases.

METHOD

Patients underwent ultrasonography (US) and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT), and then US-guided fine needle aspiration cytology (FNAC) and/or sentinel lymph node (SLN) biopsy were performed based on the US findings of the ALNs. Subsequently, patients with positive FNAC as well as those with positive SLN underwent axillary lymph node dissection (ALND). Postoperatively, removed SLNs and ALNs were examined histologically.

RESULTS

Fifty (85 %) of 59 patients with positive 18F-FDG uptake in the axilla had axillary metastases, but 18F-FDG uptake results were false-positive in 9 (15 %) cases. On the other hand, 29 patients with positive FNAC underwent ALND without the need for SLN biopsy, while the remaining 20 patients with negative FNAC as well as 249 patients with negative US findings underwent SLN biopsy. Subsequently, 68 patients with positive SLN underwent ALND.

CONCLUSIONS

Positive FDG uptake in the axilla does not always indicate axillary metastasis. US-guided FNAC is useful to avoid unnecessary ALND in patients with positive 18F-FDG uptake. However, SLN biopsy is needed in patients with negative US findings of the ALNs and those with negative FNAC.

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Authors+Show Affiliations

Nakano Y
Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
Noguchi M
Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan. nogumasa@kanazawa-med.ac.jp.
Yokoi-Noguchi M
Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
Ohno Y
Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
Morioka E
Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
Kosaka T
Department of Surgical Oncology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
Takahashi T
Department of Radiology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
Minato H
Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.

MeSH

AdultAgedAged, 80 and overAxillaBiopsy, Fine-NeedleBreast NeoplasmsFemaleFluorodeoxyglucose F18HumansImage-Guided BiopsyLymph Node ExcisionLymphatic MetastasisMiddle AgedPositron Emission Tomography Computed TomographySentinel Lymph Node BiopsyUltrasonography

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

27015862

Citation

Nakano, Yasuharu, et al. "The Roles of 18F-FDG-PET/CT and US-guided FNAC in Assessment of Axillary Nodal Metastases in Breast Cancer Patients." Breast Cancer (Tokyo, Japan), vol. 24, no. 1, 2017, pp. 121-127.
Nakano Y, Noguchi M, Yokoi-Noguchi M, et al. The roles of 18F-FDG-PET/CT and US-guided FNAC in assessment of axillary nodal metastases in breast cancer patients. Breast Cancer. 2017;24(1):121-127.
Nakano, Y., Noguchi, M., Yokoi-Noguchi, M., Ohno, Y., Morioka, E., Kosaka, T., Takahashi, T., & Minato, H. (2017). The roles of 18F-FDG-PET/CT and US-guided FNAC in assessment of axillary nodal metastases in breast cancer patients. Breast Cancer (Tokyo, Japan), 24(1), 121-127. https://doi.org/10.1007/s12282-016-0684-5
Nakano Y, et al. The Roles of 18F-FDG-PET/CT and US-guided FNAC in Assessment of Axillary Nodal Metastases in Breast Cancer Patients. Breast Cancer. 2017;24(1):121-127. PubMed PMID: 27015862.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The roles of 18F-FDG-PET/CT and US-guided FNAC in assessment of axillary nodal metastases in breast cancer patients. AU - Nakano,Yasuharu, AU - Noguchi,Masakuni, AU - Yokoi-Noguchi,Miki, AU - Ohno,Yukako, AU - Morioka,Emi, AU - Kosaka,Takeo, AU - Takahashi,Tomoko, AU - Minato,Hiroshi, Y1 - 2016/03/25/ PY - 2015/12/06/received PY - 2016/03/01/accepted PY - 2016/3/27/pubmed PY - 2017/2/6/medline PY - 2016/3/27/entrez KW - Axillary lymph node metastasis KW - Breast cancer KW - Fine needle aspiration cytology KW - Positron emission tomography SP - 121 EP - 127 JF - Breast cancer (Tokyo, Japan) JO - Breast Cancer VL - 24 IS - 1 N2 - BACKGROUND: There is a need for less invasive techniques for preoperative identification of axillary lymph node (ALN) metastases. METHOD: Patients underwent ultrasonography (US) and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT), and then US-guided fine needle aspiration cytology (FNAC) and/or sentinel lymph node (SLN) biopsy were performed based on the US findings of the ALNs. Subsequently, patients with positive FNAC as well as those with positive SLN underwent axillary lymph node dissection (ALND). Postoperatively, removed SLNs and ALNs were examined histologically. RESULTS: Fifty (85 %) of 59 patients with positive 18F-FDG uptake in the axilla had axillary metastases, but 18F-FDG uptake results were false-positive in 9 (15 %) cases. On the other hand, 29 patients with positive FNAC underwent ALND without the need for SLN biopsy, while the remaining 20 patients with negative FNAC as well as 249 patients with negative US findings underwent SLN biopsy. Subsequently, 68 patients with positive SLN underwent ALND. CONCLUSIONS: Positive FDG uptake in the axilla does not always indicate axillary metastasis. US-guided FNAC is useful to avoid unnecessary ALND in patients with positive 18F-FDG uptake. However, SLN biopsy is needed in patients with negative US findings of the ALNs and those with negative FNAC. SN - 1880-4233 UR - https://www.unboundmedicine.com/medline/citation/27015862/The_roles_of_18F_FDG_PET/CT_and_US_guided_FNAC_in_assessment_of_axillary_nodal_metastases_in_breast_cancer_patients_ L2 - https://dx.doi.org/10.1007/s12282-016-0684-5 DB - PRIME DP - Unbound Medicine ER -
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