Different biological and prognostic breast cancer populations identified by FDG-PET in sentinel node-positive patients: Results and clinical implications after eight-years follow-up

Roberto Agresti, Flavio Crippa, Marco Sandri, Gabriele Martelli, Elda Tagliabue, Alessandra Alessi, Cristina Pellitteri, Marco Maccauro, Ilaria Maugeri, Padovano Barbara, Mario Rampa, Alessandra Moscaroli, Cristina Ferraris, Maria Luisa Carcangiu, Giulia Bianchi, Marco Greco, Emilio Bombardieri

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Sentinel node (SN) biopsy is the standard method to evaluate axillary node involvement in breast cancer (BC). Positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (FDG-PET) provides a non-invasive tool to evaluate regional nodes in BC in a metabolic-dependent, biomolecular-related way. In 1999, we initiated a prospective non-randomized study to compare these two methods and to test the hypothesis that FDG-PET results reflect biomolecular characteristics of the primary tumor, thereby yielding valuable prognostic information. Patients and methods: A total of 145 cT1N0 BC patients, aged 24-70 years, underwent FDG-PET and lymphoscintigraphy before surgery. SN biopsy was followed in all cases by complete axillary dissection. Pathologic evaluation in tissue sections for involvement of the SN and other non-SN nodes served as the basis of the comparison between FDG-PET imaging and SN biopsy. Results: FDG-PET and SN biopsy sensitivity was 72.6% and 88.7%, respectively, and negative predictive values were 80.5% and 92.2%, respectively. A subgroup of more aggressive tumors (ER-GIII, Her2+) was found mainly in the FDG-PET true-positive (FDG-PET+) patients, whereas LuminalA, Mib1 low-rate BCs were significantly undetected (p=0.009) in FDG-PET false-negative (FDG-PET-) patients. Kaplan-Meier survival estimates after a median follow-up of more than 8 years showed significantly worse overall survival for FDG-PET+ patients in node-positive (N+) patients (p=0.035) as compared to N+/FDG-PET- patients, which overlapped with survival curves of N- and FDG-PET+ or- patients. Conclusions: Our findings suggest that FDG-PET results reflect intrinsic biologic features of primary BC tumors and have prognostic value with respect to nodal metastases. FDG-PET false negative cases appear to identify less aggressive indolent metastases. The possibility to identify a subgroup of N+ BC patients with an outcome comparable with N- BC patients could reduce the surgical and adjuvant therapeutic intervention.

Original languageEnglish
Pages (from-to)334-340
Number of pages7
JournalBreast
Volume23
Issue number4
DOIs
Publication statusPublished - 2014

Keywords

  • Adjuvant treatment
  • Breast cancer
  • Positron emission tomography
  • Prognosis
  • Sentinel node biopsy
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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