Diagnostic Performance of FDG-PET/CT Scan as Compared to US-Guided FNA in Prediction of Axillary Lymph Node Involvement in Breast Cancer Patients.

Maya Charafeddine,Hazem I Assi,Ibrahim A Alameh,Ghina Berjawi,Vanessa Akiki,Maroun Bou Zerdan,Eman Sbaity,Fares Sukhon,Serine Baydoun,Jessica Khoury,Nina Shabb,Ghida I El Saheb,Mohamad B Haidar

doi:10.3389/fonc.2021.740336

Maya Charafeddine, Hazem I Assi + Show 11 more

Open Access

https://doi.org/10.3389/fonc.2021.740336

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Abstract

PurposeThe aim of this study was to evaluate the diagnostic ability of 2-deoxy-2-[fluorine-18]fluoro-d-glucose (18F-FDG) PET/non-contrast CT compared with those of ultrasound (US)-guided fine needle aspiration (FNA) for axillary lymph node (ALN) staging in breast cancer patients.Patients and MethodsPreoperative 18F-FDG PET/non-contrast CT was performed in 268 women with breast cancer, as well as ALN dissection or sentinel lymph node (SLN) biopsy. One hundred sixty-four patients underwent US-guided FNA in combination with 18F-FDG PET/CT. The diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. The receiver operating characteristic (ROC) curves were compared to evaluate the diagnostic ability of several imaging modalities.ResultsAxillary 18F-FDG uptake was positive in 180 patients, and 125 patients had axillary metastases according to the final pathology obtained by ALN dissection and/or SLN dissection. Of the patients with positive 18F-FDG uptake in the axilla, 21% had false-positive results, whereas 79% were truly positive. Eighty-eight patients had negative 18F-FDG uptake in the axilla, among which 25% were false-negative. 18F-FDG-PET/CT had a sensitivity of 86.59% and a specificity of 63.46% in the assessment of ALN metastasis; on the other hand, US-guided FNA had a sensitivity of 91.67% and a specificity of 87.50%. The mean primary cancer size (p = 0.04) and tumor grade (p = 0.04) in combination were the only factors associated with the accuracy of 18F-FDG PET/CT for detecting metastatic ALNs.ConclusionThe diagnostic performance of 18F-FDG PET/CT for the detection of axillary node metastasis in breast cancer patients was not significantly different from that of US-guided FNA. Combining 18F-FDG PET/CT with US-guided FNA or SLN biopsy could improve the diagnostic performance compared to 18F-FDG PET/CT alone.

Highlights

Breast cancer is the most common diagnosed cancer and one of the major causes of cancer-related deaths in female patients worldwide [1]
Axillary 18F-FDG uptake was positive in 180 patients, and 125 patients had axillary metastases according to the final pathology obtained by axillary lymph node (ALN) dissection and/or sentinel lymph node (SLN) dissection
Eighty-eight patients had negative 18F-FDG uptake in the axilla, among which 25% were false-negative. 18F-FDG-positron emission tomography/computed tomography (PET/CT) had a sensitivity of 86.59% and a specificity of 63.46% in the assessment of ALN metastasis; on the other hand, US-guided fine-needle aspiration (FNA) had a sensitivity of 91.67% and a specificity of 87.50%

Summary

Introduction

Breast cancer is the most common diagnosed cancer and one of the major causes of cancer-related deaths in female patients worldwide [1]. Sentinel lymph node biopsy (SLNB) is currently performed for eligible breast cancer patients with no evidence of clinical or radiological nodal enlargement. SLNB has replaced ALND and is the standard procedure to stage patients with clinically node-negative early breast cancer. The application of new accurate and noninvasive imaging modalities to preoperatively assess the axillary status is gradually increasing [5]. Such imaging modalities include ultrasound (US)-guided fine-needle aspiration (FNA) and positron emission tomography/computed tomography (PET/CT) scan, both of which have more importance in dictating further therapeutic measures

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