Semih GÖRGÜLÜ, Mehmet Fatih CAN, Oğuz HANCERLİOĞULLARI, Nuri ARSLAN, Erkan ÖZTÜRK, Emel ÖZTÜRK, Müjdat BALKAN, Turgut TUFAN

Can [F-18] fluorodeoxyglucose positron emission tomography replace sentinel lymph node biopsy for the detection of axillary metastases in patients with early-stage breast cancer?*

To investigate the value of fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting axillary involvement, and to compare its accuracy with sentinel lymph node biopsy (SLNB) in patients with clinically early-stage breast cancer. Materials and methods: Twenty-eight female patients with histologically-confirmed T1-2 breast cancer who were scheduled to have SLNB were included in the study. FDG-PET images were obtained 1-7 days prior to surgery with an intravenous injection of 370 MBq of FDG, while plasma glucose levels were maintained below 120 mg/dL. All the images were interpreted by 2 independent nuclear medicine specialists, who were blinded to the histological diagnoses. SLNB was performed in standard fashion with peri-tumoral injection of isosulphan blue dye. In all cases, a level I-II axillary dissection was performed following SLNB. Sentinel nodes were processed after formalin fixation; no frozen sections were used. Results: Thirteen (46%) patients were found to have axillary involvement. SLNB (an average of 2.3 LNs removed per patient) demonstrated metastases in all 13 patients. The diagnostic accuracy of FDG-PET was as follows: true-positive in 4 out of 13 patients (overall sensitivity = 31%), false-negative in 1 patient with metastasis (overall specificity = 94%), positive predictive value = 80%, negative predictive value = 63%, and accuracy = 68%. Conclusion: FDG-PET appears to be significantly less accurate than SLNB at detecting axillary metastases. In patients with an axillary-positive PET scan, however, axillary lymph node dissection may be performed without prior SLNB.

Anahtar Kelimeler:

Key words: Breast cancer, sentinel lymph node biopsy, positron emission tomography, axillary metastasis

Can [F-18] fluorodeoxyglucose positron emission tomography replace sentinel lymph node biopsy for the detection of axillary metastases in patients with early-stage breast cancer?*

Keywords:

Key words: Breast cancer, sentinel lymph node biopsy, positron emission tomography, axillary metastasis,

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Soni NK, Spillane AJ. Experience of sentinel node biopsy alone in early breast cancer without further axillary dissection in patients with negative sentinel node. ANZ J Surg 2005; 75: 292- 9.
Fisher ER, Anderson S, Redmond C, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project. Discriminants for 15-year survival. National Surgical Adjuvant Breast and Bowel Project Investigators. Cancer 1993; 71(6 Suppl): 2141-50.
Spillane AJ, Sacks NP. Role of axillary surgery in early breast cancer: review of the current evidence. Aust N Z J Surg 2000; 70: 515-24. Cady B, Stone MD, Schuler JG, Thakur R, Wanner MA, Lavin PT. The new era in breast cancer: invasion, size, and nodal involvement dramatically decreasing as a result of mammographic screening. Arch Surg 1996; 131: 301-8.
Lovrics PJ, Chen V, Coates G, Cornacchi SD, Goldsmith CH, Law C et al. A prospective evaluation of positron emission tomography scanning, sentinel lymph node biopsy, and standard axillary dissection for axillary staging in patients with early stage breast cancer. Ann Surg Oncol 2004; 11: 846-53.
Haffty BG, Ward B, Pathare P, Salem R, McKhann C, Beinfield M et al. Reappraisal of the role of axillary lymph node dissection in the conservative treatment of breast cancer. J Clin Oncol 1997; 15: 691-700.
Roumen RM, Kuijt GP, Liem IH, van Beek MW. Treatment of 100 patients with sentinel node-negative breast cancer without further axillary dissection. Br J Surg 2001; 88: 1639-43.
Schrenk P, Rieger R, Shamiyeh A, Wayand W. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer 2000; 88: 608-14.
Kumar R, Zhuang H, Schnall M, Conant E, Damia S, Weinstein S et al. FDG PET positive lymph nodes are highly predictive of metastasis in breast cancer. Nucl Med Commun 2006; 27: 231- 6.
Zavagno G, De Salvo GL, Scalco G, Boza F, Barutta L, Del Bianco P et al. A Randomized Clinical Trial on Sentinel Lymph Node Biopsy Versus Axillary Lymph Node Dissection in Breast Cancer: Results of the Sentinella/GIVOM Trial. Ann Surg 2008; 247: 207-213.
Fehr MK, Hornung R, Varga Z, Burger D, Hess T, Haller U et al. Axillary staging using positron emission tomography in breast cancer patients qualifying for sentinel lymph node biopsy. Breast J 2004; 10: 89-93.
Adler LP, Crowe JP, al-Kaisi NK, Sunshine JL. Evaluation of breast masses and axillary lymph nodes with [F-18] 2-deoxy-2- fluoro-D-glucose PET. Radiology 1993; 187: 743-50.
Pietrzyk U, Scheidhauer K, Scharl A, Schuster A, Schicha H. Presurgical visualization of primary breast carcinoma with PET emission and transmission imaging. J Nucl Med 1995; 36: 1882- 4. Scheidhauer K, Scharl A, Pietrzyk U, Wagner R, Göhring UJ, Schomäcker K et al. Qualitative [18F]FDG positron emission tomography in primary breast cancer: clinical relevance and practicability. Eur J Nucl Med 1996; 23: 618-23.
Wahl RL, Kaminski MS, Ethier SP, Hutchins GD. The potential of 2-deoxy-2[18F]fluoro-D-glucose (FDG) for the detection of tumor involvement in lymph nodes. J Nucl Med 1990; 31: 1831- 5. Greco M, Crippa F, Agresti R, Seregni E, Gerali A, Giovanazzi R et al. Axillary lymph node staging in breast cancer by 2- fluoro-2-deoxy-D-glucose-positron emission tomography: clinical evaluation and alternative management. J Natl Cancer Inst 2001; 93: 630-5.
Schirrmeister H, Kühn T, Guhlmann A, Santjohanser C, Hörster T, Nüssle K et al. Fluorine-18 2-deoxy-2-fluoro-D-glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures. Eur J Nucl Med 2001; 28: 351- 8.
Zornoza G, Garcia-Velloso MJ, Sola J, Regueira FM, Pina L, Beorlegui C. 18F-FDG PET complemented with sentinel lymph node biopsy in the detection of axillary involvement in breast cancer. Eur J Surg Oncol 2004; 30: 15-9.
Utech CI, Young CS, Winter PF. Prospective evaluation of fluorine-18 fluorodeoxyclucose positron emission tomography in breast cancer for staging of the axilla related to surgery and immunocytochemistry. Eur J Nucl Med 1996; 23: 1588-93.
Adler LP, Faulhaber PF, Schnur KC, Al-Kasi NL, Shenk RR. Axillary lymph node metastases: screening with [F-18]2-deoxy- 2-fluoro-D-glucose (FDG) PET. Radiology 1997; 203: 323-7.
Crippa F, Agresti R, Seregni E, Greco M, Pascali C, Bogni A et al. Prospective evaluation of fluorine-18-FDG PET in presurgical staging of the axilla in breast cancer. J Nucl Med 1998; 39: 4-8.
Smith IC, Ogston KN, Whitford P, Smith FW, Sharp P, Norton M et al. Staging of the axilla in breast cancer: accurate in vivo assessment using positron emission tomography with 2- (fluorine-18)-fluoro-2-deoxy-D-glucose. Ann Surg 1998; 228: 220-7.
Barranger E, Grahek D, Antoine M, Montravers F, Talbot JN, Uzan S. Evaluation of fluorodeoxyglucose positron emission tomography in the detection of axillary lymph node metastases in patients with early-stage breast cancer. Ann Surg Oncol 2003; 10: 622-7.
Wahl RL, Siegel BA, Coleman RE, Gatsonis CG; PET Study Group. Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J Clin Oncol 2004; 22: 277-85.
Guller U, Nitzsche EU, Schirp U, Viehl CT, Torhorst J, Moch H et al. Selective axillary surgery in breast cancer patients based on positron emission tomography with 18F-fluoro-2-deoxy-D- glucose: not yet Breast Cancer Res Treat 2002; 71: 171-3. Veronesi U, De Cicco C, Galimberti VE, Fernandez JR, Rotmensz N, Viale G et al. A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol 2007; 18: 473-8.