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Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer.
Niger J Clin Pract. 2019 Jan; 22(1):63-68.NJ

Abstract

Background and Aim

There are conflicting results of studies on accuracy of positron emission tomography (PET)/computed tomography (CT) for axillary staging. The aim of this study is to determine the factors affecting the efficacy of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in detecting axillary metastases in invasive breast cancer.

Materials and Methods

Data of 232 patients with invasive breast cancer who underwent 18F-FDG PET/CT examination before surgery between January 2013 and September 2017 were reviewed retrospectively. Histopathological examination of axillary lymph nodes (ALNs) was used as a reference to assess the efficacy of 18F-FDG PET/CT in detecting axillary metastases.

Results

While 134 (57.8%) patients had axillary metastases as detected in 18F-FDG PET/CT scans, histopathologically axillary metastases were detected in 164 (70.7%) patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of 18F-FDG PET/CT in detection of axillary metastasis were 72.56%, 77.94%, 88.8%, 54%, and 74.1%, respectively. The false-negative and false-positive rates were 27.4% and 22%, respectively. In univariate analysis, patients' age, estrogen receptor positivity, higher ALN SUVmax, greater tumor size, and lymph node size determined by 18F-FDG PET/CT were all significantly associated with accuracy of 18F-FDG PET/CT for axillary metastasis. In multivariate analysis, tumor size determined by 18F-FDG PET/CT and ALN SUVmax were independent variables associated with axillary metastasis. The accuracy of 18F-FDG PET/CT for axillary metastasis was higher in patients with a larger tumor (≥19.5 mm) and a higher ALN SUVmax (≥3.2).

Conclusion

18F-FDG PET/CT should not be routinely used for axillary staging, especially in patients with small tumors. It cannot eliminiate the necessity of sentinel lymph node biopsy. When it is used, both visual information and optimal cut-off value of axillary node SUVmax should be taken into consideration.

Authors+Show Affiliations

Department of General Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.Department of General Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.Department of Nuclear Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.Department of General Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.Department of General Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.Department of Nuclear Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30666022

Citation

Kutluturk, K, et al. "Factors Affecting the Accuracy of 18F-FDG PET/CT in Evaluating Axillary Metastases in Invasive Breast Cancer." Nigerian Journal of Clinical Practice, vol. 22, no. 1, 2019, pp. 63-68.
Kutluturk K, Simsek A, Comak A, et al. Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer. Niger J Clin Pract. 2019;22(1):63-68.
Kutluturk, K., Simsek, A., Comak, A., Gonultas, F., Unal, B., & Kekilli, E. (2019). Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer. Nigerian Journal of Clinical Practice, 22(1), 63-68. https://doi.org/10.4103/njcp.njcp_198_18
Kutluturk K, et al. Factors Affecting the Accuracy of 18F-FDG PET/CT in Evaluating Axillary Metastases in Invasive Breast Cancer. Niger J Clin Pract. 2019;22(1):63-68. PubMed PMID: 30666022.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer. AU - Kutluturk,K, AU - Simsek,A, AU - Comak,A, AU - Gonultas,F, AU - Unal,B, AU - Kekilli,E, PY - 2019/1/23/entrez PY - 2019/1/23/pubmed PY - 2019/1/31/medline KW - Axillary metastasis KW - breast cancer KW - positron emission tomography/computed tomography KW - sentinel lymph node KW - sentinel lymph node biopsy SP - 63 EP - 68 JF - Nigerian journal of clinical practice JO - Niger J Clin Pract VL - 22 IS - 1 N2 - Background and Aim: There are conflicting results of studies on accuracy of positron emission tomography (PET)/computed tomography (CT) for axillary staging. The aim of this study is to determine the factors affecting the efficacy of 18F-fluorodeoxyglucose (18F-FDG) PET/CT in detecting axillary metastases in invasive breast cancer. Materials and Methods: Data of 232 patients with invasive breast cancer who underwent 18F-FDG PET/CT examination before surgery between January 2013 and September 2017 were reviewed retrospectively. Histopathological examination of axillary lymph nodes (ALNs) was used as a reference to assess the efficacy of 18F-FDG PET/CT in detecting axillary metastases. Results: While 134 (57.8%) patients had axillary metastases as detected in 18F-FDG PET/CT scans, histopathologically axillary metastases were detected in 164 (70.7%) patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of 18F-FDG PET/CT in detection of axillary metastasis were 72.56%, 77.94%, 88.8%, 54%, and 74.1%, respectively. The false-negative and false-positive rates were 27.4% and 22%, respectively. In univariate analysis, patients' age, estrogen receptor positivity, higher ALN SUVmax, greater tumor size, and lymph node size determined by 18F-FDG PET/CT were all significantly associated with accuracy of 18F-FDG PET/CT for axillary metastasis. In multivariate analysis, tumor size determined by 18F-FDG PET/CT and ALN SUVmax were independent variables associated with axillary metastasis. The accuracy of 18F-FDG PET/CT for axillary metastasis was higher in patients with a larger tumor (≥19.5 mm) and a higher ALN SUVmax (≥3.2). Conclusion: 18F-FDG PET/CT should not be routinely used for axillary staging, especially in patients with small tumors. It cannot eliminiate the necessity of sentinel lymph node biopsy. When it is used, both visual information and optimal cut-off value of axillary node SUVmax should be taken into consideration. SN - 1119-3077 UR - https://www.unboundmedicine.com/medline/citation/30666022/Factors_affecting_the_accuracy_of_18F_FDG_PET/CT_in_evaluating_axillary_metastases_in_invasive_breast_cancer_ L2 - http://www.njcponline.com/article.asp?issn=1119-3077;year=2019;volume=22;issue=1;spage=63;epage=68;aulast=Kutluturk DB - PRIME DP - Unbound Medicine ER -