FDG-guided excision of peripheral non-palpable lymph nodes in the axilla with suspected malignancy

Abstract

ObjectiveTo define the feasibility of 18F-fluorodeoxyglucose (FDG) uptake tracing in the excision of potentially malignant non-palpable lymph nodes (NLN), especially in the axilla. Materials and methodsFindings of 493 peripheral lymph node (LN) excisions were examined in the study. Three hundred seventy-eight LNs were palpable and the remaining 115 LNs were non-palpable. The excised NLNs were analyzed in two groups, NLNs excised based on the anatomical descriptions of imaging methods (n=62), image-guided NLN excisions (n=53). Among the image-guided excisions, 27 NLNs were excised using real-time ultrasound (US) guidance, and 26 NLNs were excised using FDG uptake tracing. ResultsImage-guided excisions provided better diagnostic accuracy for potentially malignant NLNs compared with excisions made located based on imaging descriptions (P=0.029). In these image-guided NLN excisions, the FDG uptake-trace method combined with positron emission tomography-computed tomography (PET-CT) was more successful in detecting malignant NLNs compared with US guidance (P=0.04). NLN excisions based on FDG uptake were completed in a shorter time than both excisions with US guidance (P=0.006) and excisions made locating based on imaging definitions (P=0.001). ConclusionPotentially malignant NLN excisions can be challenging for surgeons, and can result in prolonged surgical time. It may be extrapolated from our study that anatomy and metabolism-based LN excision guidance using information obtained in PET-CT and following FDG uptake tracing may improve the accuracy of histologic examinations, and thus increase the probability of achieving a correct diagnosis.