| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
PET Unit, Division of Nuclear Medicine, and Divisions of Surgical Oncology "B," Surgical Oncology "C" and Pathology and Cytology, National Cancer Institute, Milan, Italy
Correspondence: For correspondence or reprints contact: Emilio Bombardieri, MD, Division of Nuclear Medicine, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian 1, 20133 Milan, Italy.
ABSTRACT
Methods: The presurgical, noninvasive staging of axillary nodes for metastases was prospectively investigated in 68 patients who were diagnosed with primary breast cancer using PET with 18F-fluorodeoxyglucose (FDG). Four patients had bilateral nodules; therefore, the total number of evaluable cases was 72. Visual analyses of attenuation-corrected PET images and standardized uptake values (SUVs) of FDG uptake in carcinomas were compared with histopathological surgical findings. The SUV distribution differences between carcinomas with and without axillary metastases were evaluated by means of statistical and receiver operating characteristics analyses. Results: PET correctly classified 64 of the 72 cases; four false-positive and four false-negative PET results were found. The overall sensitivity, specificity and accuracy of PET for axillary metastases were 85%, 91% and 89%, respectively. With respect to the clinical axillary stage of the patients (TNM, or tumor-node-metastasis, classification), we obtained the following results: N0 patients, sensitivity = 70%, specificity = 92%, accuracy = 86%; N1a patients, sensitivity = 85.5%, specificity = 100%, accuracy = 95%; and N1b-2 patients, sensitivity = 100%, specificity = 67%, accuracy = 87%. The median SUV in carcinomas with axillary metastases (4.6) was significantly higher than that in carcinomas without metastases (2.9), but there was a great SUV overlap between the two groups (interquartile ranges = 2.7–7.2 and 1.9–4.5, respectively). Analysis of the receiver operating characteristics curve showed that a high sensitivity of SUV in predicting axillary metastases was associated with a very low specificity and vice versa. With the best SUV cutoff value of 2.9, the sensitivity and specificity were 74% and 56%, respectively. Conclusion: PET showed good overall diagnostic accuracy in the detection of axillary metastases (86%). The very high accuracy (95%) in N1a patients is of particular importance. False-negative PET findings, however, can be encountered. SUVs of breast carcinoma cannot predict the spread of the disease to the axilla, even if higher values are often associated with axillary metastases. Any decision on the use of PET in the presurgical staging of breast cancer should be incorporated into a more general debate on axillary management. In selected patients with a very low probability of axillary metastases (T1a), in whom axillary surgery can already be avoided according to data from follow-up studies, 18F-FDG PET could be proposed as a noninvasive imaging modality to improve the diagnosis of axillary relapses.
Key Words: breast cancer • axillary metastasis • PET • fluorine-18-fluorodeoxyglucose
This article has been cited by other articles:
|
|
 |
|
  N. C. Hodgson and K. Y. Gulenchyn Is There a Role for Positron Emission Tomography in Breast Cancer Staging? J. Clin. Oncol., February 10, 2008; 26(5): 712 - 720. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. A. Margolis, J. M. Hoffman, R. J. Herfkens, R. B. Jeffrey, A. Quon, and S. S. Gambhir Molecular Imaging Techniques in Body Imaging Radiology, November 1, 2007; 245(2): 333 - 356. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. S. Lim, W. Yoon, T. W. Chung, J. K. Kim, J. G. Park, H. K. Kang, H. S. Bom, and J. H. Yoon FDG PET/CT for the Detection and Evaluation of Breast Diseases: Usefulness and Limitations RadioGraphics, October 1, 2007; 27(suppl_1): S197 - S213. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B Vincenzi, A Calvieri, D Santini, V Altomare, and G Tonini Occasional FDG PET recognition of in situ breast cancer Ann. Onc., September 1, 2007; 18(9): 1584 - 1585. [Full Text] [PDF]
|
|
|
|
|
|
T. M. Blodgett, C. C. Meltzer, and D. W. Townsend PET/CT: Form and Function Radiology, February 1, 2007; 242(2): 360 - 385. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Kelloff, J. M. Hoffman, B. Johnson, H. I. Scher, B. A. Siegel, E. Y. Cheng, B. D. Cheson, J. O'Shaughnessy, K. Z. Guyton, D. A. Mankoff, et al. Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development Clin. Cancer Res., April 15, 2005; 11(8): 2785 - 2808. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Quon and S. S. Gambhir FDG-PET and Beyond: Molecular Breast Cancer Imaging J. Clin. Oncol., March 10, 2005; 23(8): 1664 - 1673. [Full Text] [PDF]
|
|
|
|
|
|
R. Sasaki, R. Komaki, H. Macapinlac, J. Erasmus, P. Allen, K. Forster, J. B. Putnam, R. S. Herbst, C. A. Moran, D. A. Podoloff, et al. [18F]Fluorodeoxyglucose Uptake by Positron Emission Tomography Predicts Outcome of Non-Small-Cell Lung Cancer J. Clin. Oncol., February 20, 2005; 23(6): 1136 - 1143. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. M. Rohren, T. G. Turkington, and R. E. Coleman Clinical Applications of PET in Oncology Radiology, May 1, 2004; 231(2): 305 - 332. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Wahl, B. A. Siegel, R. E. Coleman, and C. G. Gatsonis 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., January 15, 2004; 22(2): 277 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Kostakoglu, H. Agress Jr, and S. J. Goldsmith Clinical Role of FDG PET in Evaluation of Cancer Patients RadioGraphics, March 1, 2003; 23(2): 315 - 340. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Rieber, H Schirrmeister, A Gabelmann, K Nuessle, S Reske, R Kreienberg, H J Brambs, and T Kuehn Pre-operative staging of invasive breast cancer with MR mammography and/or PET: boon or bunk? Br. J. Radiol., October 1, 2002; 75(898): 789 - 798. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Vranjesevic, J. E. Filmont, J. Meta, D. H. Silverman, M. E. Phelps, J. Rao, P. E. Valk, and J. Czernin Whole-Body 18F-FDG PET and Conventional Imaging for Predicting Outcome in Previously Treated Breast Cancer Patients J. Nucl. Med., March 1, 2002; 43(3): 325 - 329. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. S. Yap, M. A. Seltzer, C. Schiepers, S. S. Gambhir, J. Rao, M. E. Phelps, P. E. Valk, and J. Czernin Impact of Whole-Body 18F-FDG PET on Staging and Managing Patients with Breast Cancer: The Referring Physician's Perspective J. Nucl. Med., September 1, 2001; 42(9): 1334 - 1337. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. B. Eubank, D. A. Mankoff, J. Takasugi, H. Vesselle, J. F. Eary, T. J. Shanley, J. R. Gralow, A. Charlop, G. K. Ellis, K. L. Lindsley, et al. 18Fluorodeoxyglucose Positron Emission Tomography to Detect Mediastinal or Internal Mammary Metastases in Breast Cancer J. Clin. Oncol., August 1, 2001; 19(15): 3516 - 3523. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Gambhir, J. Czernin, J. Schwimmer, D. H. S. Silverman, R. E. Coleman, and M. E. Phelps A Tabulated Summary of the FDG PET Literature J. Nucl. Med., May 1, 2001; 42(90050): 1S - 93. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Greco, F. Crippa, R. Agresti, E. Seregni, A. Gerali, R. Giovanazzi, A. Micheli, S. Asero, C. Ferraris, M. Gennaro, 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, April 18, 2001; 93(8): 630 - 635. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Messa, C. Landoni, C. Pozzato, and F. Fazio Is There a Role for FDG PET in the Diagnosis of Musculoskeletal Neoplasms? J. Nucl. Med., October 1, 2000; 41(10): 1702 - 1702. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| JOURNAL OF NUCLEAR MEDICINE TECHNOLOGY | THE JOURNAL OF NUCLEAR MEDICINE |
