A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases

Umberto Veronesi, C. De Cicco, V. E. Galimberti, J. R. Fernandez, N. Rotmensz, G. Viale, G. Spano, A. Luini, M. Intra, P. Veronesi, A. Berrettini, G. Paganelli

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Sentinel node biopsy (SNB) has become a standard treatment in staging axillary lymph nodes in early breast cancer. SNB, however, is an invasive procedure and is time-consuming when the sentinel node is analysed intra-operatively. Breast cancer is frequently characterised by increased 2-fluoro-2-deoxy- D -glucose uptake and many studies have shown encouraging results in detecting axillary lymph node metastases. The aim of this study was to compare SNB and -positron emission tomography (-PET) imaging, to assess their values in detecting occult axillary metastases. Patients and Methods: In all, 236 patients with breast cancer and clinically negative axilla were enrolled in the study. 18-FDG-PET was carried out before surgery, using a positron emission tomography (PET)/computed tomography scanner. In all patients, SNB was carried out after identification through lymphoscintigraphy. Patients underwent axillary lymph nodes dissection (ALND) in cases of positive FDG-PET or positive SNB. The results of PET scan were compared with histopathology of SNB and ALND. Results: In all, 103 out of the 236 patients (44%) had metastases in axillary nodes. Sensitivity of FDG-PET scan for detection of axillary lymph node metastases in this series was low (37%); however, specificity and positive predictive values were acceptable (96% and 88%, respectively). Conclusions: The high specificity of PET imaging indicates that patients who have a PET-positive axilla should have an ALND rather than an SNB for axillary staging. In contrast, FDG-PET showed poor sensitivity in the detection of axillary metastases, confirming the need for SNB in cases where PET is negative in the axilla.

Original languageEnglish
Pages (from-to)473-478
Number of pages6
JournalAnnals of Oncology
Volume18
Issue number3
DOIs
Publication statusPublished - Mar 2007

Keywords

  • Occult axillary metastases
  • Positron emission tomography (PET)
  • Sentinel node biopsy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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