Abstract
BackgroundAccurate evaluation of axillary lymph node (ALN) involvement is mandatory before treatment of primary breast cancer. The aim of this study is to compare preoperative diagnostic accuracy between positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (18F-FDG PET/CT) and axillary ultrasonography (AUS) for detecting ALN metastasis in patients having operable breast cancer, and to assess the clinical management of axillary 18F-FDG PET/CT for therapeutic indication of sentinel node biopsy (SNB) and preoperative systemic chemotherapy (PSC).MethodsOne hundred eighty-three patients with primary operable breast cancer were recruited. All patients underwent 18F-FDG PET/CT and AUS followed by SNB and/or ALN dissection (ALND). Using 18F-FDG PET/CT, we studied both a visual assessment of 18F-FDG uptake and standardized uptake value (SUV) for axillary staging.ResultsIn a visual assessment of 18F-FDG PET/CT, the diagnostic accuracy of ALN metastasis was 83% with 58% in sensitivity and 95% in specificity, and when cut-off point of SUV was set at 1.8, sensitivity, specificity, and accuracy were 36, 100, and 79%, respectively. On the other hand, the diagnostic accuracy of AUS was 85% with 54% in sensitivity and 99% in specificity. By the combination of 18F-FDG PET/CT and AUS to the axilla, the sensitivity, specificity, and accuracy were 64, 94, and 85%, respectively. If either 18F-FDG PET uptake or AUS was positive in allixa, the probability of axillary metastasis was high; 50% (6 of 12) in 18F-FDG PET uptake only, 80% (4 of 5) in AUS positive only, and 100% (28 of 28) in dual positive. By the combination of AUS and 18F-FDG PET/CT, candidates of SNB were more appropriately selected. The axillary 18F-FDG uptake was correlated with the maximum size and nuclear grade of metastatic foci (p = 0.006 and p = 0.03).ConclusionThe diagnostic accuracy of 18F-FDG PET/CT was shown to be nearly equal to ultrasound, and considering their limited sensitivities, the high radiation exposure by 18F-FDG PET/CT and also costs of the examination, it is likely that AUS will be more cost-effective in detecting massive axillary tumor burden. However, when we cannot judge the axillary staging using AUS alone, metabolic approach of 18F-FDG PET/CT for axillary staging would enable us a much more confident diagnosis.
Highlights
Accurate evaluation of axillary lymph node (ALN) involvement is mandatory before treatment of primary breast cancer
The diagnostic accuracy of 18F-FDG positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (PET/CT) was shown to be nearly equal to ultrasound, and considering their limited sensitivities, the high radiation exposure by 18F-FDG PET/ CT and costs of the examination, it is likely that axillary ultrasonography (AUS) will be more cost-effective in detecting massive axillary tumor burden
Accurate evaluation of ALN involvement is mandatory before treatment of primary breast cancer by following reasons; (1) ALN status is related to staging of disease and patients prognosis
Summary
Accurate evaluation of axillary lymph node (ALN) involvement is mandatory before treatment of primary breast cancer. Accurate evaluation of ALN involvement is mandatory before treatment of primary breast cancer by following reasons; (1) ALN status is related to staging of disease and patients prognosis. (2) SNB can be beneficial for the patients to whom the presence of ALN involvement is not preoperatively detectable They can avoid ALN dissection (ALND) when metastatic foci in sentinel nodes (SNs) are absent. Axillary ultrasonography (AUS) has been the most easy-applicable imaging tool for clinical staging of ALN status in patients having primary breast cancer [3,4]
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