Clinical Significance of Peritumoral Adipose Tissue PET/CT Imaging Features for Predicting Axillary Lymph Node Metastasis in Patients with Breast Cancer.

Jeong Won Lee,Sang Mi Lee,In Young Jo,Jong Eun Lee,Sung Yong Kim,Sung Hoon Hong,Sun Wook Han

doi:10.3390/jpm11101029

Abstract

We investigated whether textural parameters of peritumoral breast adipose tissue (AT) based on F-18 fluorodeoxyglucose (FDG) PET/CT could predict axillary lymph node metastasis in patients with breast cancer. A total of 326 breast cancer patients with preoperative FDG PET/CT were retrospectively enrolled. PET/CT images were visually assessed and the maximum FDG uptake of axillary lymph nodes (LN SUVmax) was measured. From peritumoral breast AT, 38 textural features of PET imaging were extracted. The diagnostic ability of PET based on visual analysis, LN SUVmax, and textural features of peritumoral breast AT for predicting axillary lymph node metastasis were assessed using the area under the receiver operating characteristic curve (AUC) values. Among the 38 peritumoral breast AT textural features, grey-level co-occurrence matrix (GLCM) entropy showed the highest AUC value (0.830) for predicting axillary lymph node metastasis. The value of GLCM entropy was higher than that of visual analysis (0.739; p < 0.05) and the AUC value was comparable to that of LN SUVmax (0.793; p > 0.05). In the subgroup analysis of patients with negative findings on visual analysis, GLCM entropy still showed a high diagnostic ability (AUC: 0.759) in predicting lymph node metastasis. The findings suggest a potential diagnostic role of PET/CT imaging features of peritumoral breast AT in predicting axillary lymph node metastasis in patients with breast cancer.

Highlights

Breast cancer is the primary cause of the incidence of and death from female cancer globally [1]
Of the 393 patients, we excluded 67 patients (1) who were diagnosed with carcinoma in situ, (2) who had bilateral breast cancer lesions, (3) who had distant metastatic lesions based on staging workup, (4) who had a previous history of breast surgery or other malignant diseases, (5) who had a negative result of staging axillary lymph node biopsy and received neoadjuvant treatment before surgical resection which prevented histopathological confirmation of axillary lymph nodes, (6) who had insufficient peritumoral breast adipose tissue (AT) volume, and (7) who had diffuse infiltrative breast cancer
Measurable axillary lymph nodes were observed in the positron emission tomography/computed tomography (PET/CT) images of 278 patients (85.3%), and LN SUVmax was measured in all these patients

Summary

Introduction

Breast cancer is the primary cause of the incidence of and death from female cancer globally [1]. In patients with breast cancer, axillary lymph node metastasis is one of the most significant clinical factors dictating the treatment strategy and predicting survival [2,3]. Sentinel lymph node biopsy showed a 9.8% false-negative rate in a previous clinical trial and, despite a lower morbidity than that of axillary lymph node dissection, surgical complications such as lymphedema were reported in 3.7–6.9% of patients undergoing sentinel lymph node sampling [5,6,7]. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is notable for its exquisite diagnostic ability for detecting metastasis in various malignant diseases; it is one of the imaging examinations investigated for axillary lymph node staging [4,8,9,10]. A number of studies have attempted to develop diverse methods to improve the diagnostic accuracy of FDG PET/CT [4,11]

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Discussion

Conclusion