© 1996 by Oxford University Press
Journal of the National Cancer Institute, Vol. 88, No. 17, 1204-1209,
September 4, 1996
© 1996 Oxford University Press
Assessment of Axillary Lymph Node Involvement in Breast Cancer Patients With Positron Emission Tomography Using Radiolabeled 2-(Fluorine-18)-fluoro-2-deoxy-D-glucose
Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany
Department of Gynecology, Technische Universität München Munich, Federal Republic of Germany
Department of Pathology, Technische Universität München Munich, Federal Republic of Germany
Norbert Avril. M.D., Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaningerstr. 22, 81675 Munich, Federal Republic of Germany.
BACKGROUND:: The presence of metastatic tumor cells in the axillary lymph nodes is an important factor when deciding whether or not to treat breast cancer patients with adjuvant therapy. Positron emission tomography (PET) imaging with the radiolabeled glucose analogue 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (F-18 FDG) has been used to visualize primary breast tumors as well as bone and soft-tissue metas-tases.
PURPOSE:: This study was undertaken to evaluate before surgery the diagnostic accuracy of PET for detection of axillary lymph node metastases in patients suspected of having breast cancer.
METHODS:: Women who were scheduled to undergo surgery for newly discovered, suspected breast cancers were referred for PET imaging of the axilla region. The women were first clinically examined to determine the status of their axillary lymph nodes (i.e., presence or absence of metastases). Fifty-one women were intravenously administered F-18 FDG and were studied by PET imaging. Attenuation-corrected transaxial and coronal images were visually evaluated by two nuclear medicine physicians (blinded to the patient's medical history) for foci of increased F-18 FDG uptake in the axilla region. All patients underwent surgery for their suspected breast cancers. Axillary lymph node dissection was also performed on all patients with breast cancer, with the exception of four patients who received primary chemotherapy for locally advanced breast cancer. A single pathologist analyzed breast tumor and lymph node tissue specimens.
RESULTS:: The overall sensitivity (i.e., the ability of the test to detect disease in patients who actually have disease) and specificity (i.e., the ability of the test to rule out disease in patients who do not have disease) of this method for detection of axillary lymph node metastases in these patients were 79% and 96%, respectively. When only patients with primary breast tumors larger than 2 cm in diameter (more advanced than stage pT1; n = 23) were considered, the sensitivity of axillary PET imaging increased to 94%, and the corresponding specificity was 100%. Lymph node metastases could not be identified in four of six patients with small primary breast cancers (stage pT1), resulting in a sensitivity of only 33%. Axillary PET imaging provided additional diagnostic information in 12 (29%) of 41 breast cancer patients with regard to the extension of disease to other sites (i.e., other lymph nodes, skin, bone, and lung).
CONCLUSIONS:: PET imaging with F-18 FDG allowed accurate and noninvasive detection of axillary lymph node metastases, primarily in patients with breast cancer more advanced than stage pT1. Detection of micrometastases and small tumor-infiltrated lymph nodes is limited by the currently achievable spatial resolution of PET imaging.
IMPLICATIONS:: In clinical practice, PET imaging cannot substitute for histopathologic analysis in detecting axillary lymph node metastases in breast cancer patients. PET imaging, however, improves the preoperative staging of the disease in breast cancer patients and, therefore, might alter therapeutic regimen options. [J Natl Cancer Inst 1996;88:1204–9]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. Mahner, S. Schirrmacher, W. Brenner, L. Jenicke, C. R. Habermann, N. Avril, and J. Dose-Schwarz Comparison between positron emission tomography using 2-[fluorine-18]fluoro-2-deoxy-D-glucose, conventional imaging and computed tomography for staging of breast cancer Ann. Onc., July 1, 2008; 19(7): 1249 - 1254. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Gillies, I. Robey, and R. A. Gatenby Causes and Consequences of Increased Glucose Metabolism of Cancers J. Nucl. Med., June 1, 2008; 49(Suppl_2): 24S - 42S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Huddart, M. J. O'Doherty, A. Padhani, G. J.S. Rustin, G. M. Mead, J. K. Joffe, P. Vasey, S. J. Harland, J. Logue, G. Daugaard, et al. 18Fluorodeoxyglucose Positron Emission Tomography in the Prediction of Relapse in Patients With High-Risk, Clinical Stage I Nonseminomatous Germ Cell Tumors: Preliminary Report of MRC Trial TE22 The NCRI Testis Tumour Clinical Study Group J. Clin. Oncol., July 20, 2007; 25(21): 3090 - 3095. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U Veronesi, C De Cicco, V. Galimberti, J. Fernandez, N Rotmensz, G Viale, G Spano, A Luini, M Intra, P Veronesi, et al. A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases Ann. Onc., March 1, 2007; 18(3): 473 - 478. [Abstract] [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]
|
|
|
|
 |
|
 A. Chung, D. Liou, S. Karlan, A. Waxman, K. Fujimoto, M. Hagiike, and E. H. Phillips Preoperative FDG-PET for Axillary Metastases in Patients With Breast Cancer Arch Surg, August 1, 2006; 141(8): 783 - 789. [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]
|
|
|
|
 |
|
 U. Guller, E. Nitzsche, H. Moch, and M. Zuber Is Positron Emission Tomography an Accurate Non-invasive Alternative to Sentinel Lymph Node Biopsy in Breast Cancer Patients? J Natl Cancer Inst, July 16, 2003; 95(14): 1040 - 1043. [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 J.-H. Yang, S. J. Nam, T. S. Lee, H. K. Lee, S. H. Jung, and B. T. Kim Comparison of Intraoperative Frozen Section Analysis of Sentinel Node with Preoperative Positron Emission Tomography in the Diagnosis of Axillary Lymph Node Status in Breast Cancer Patients Jpn. J. Clin. Oncol., January 1, 2001; 31(1): 1 - 6. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. P. van Rijk and A. J. van Dongen Limited Angle, Limited Approach? J. Nucl. Med., November 1, 2000; 41(11): 1859 - 1860. [Full Text] [PDF]
|
|
|
|
|
|
N. Avril, C. A. Rose, M. Schelling, J. Dose, W. Kuhn, S. Bense, W. Weber, S. Ziegler, H. Graeff, and M. Schwaiger Breast Imaging With Positron Emission Tomography and Fluorine-18 Fluorodeoxyglucose: Use and Limitations J. Clin. Oncol., October 20, 2000; 18(20): 3495 - 3502. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G Cserni Axillary staging of breast cancer and the sentinel node J. Clin. Pathol., October 1, 2000; 53(10): 733 - 741. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schelling, N. Avril, J. Nahrig, W. Kuhn, W. Romer, D. Sattler, M. Werner, J. Dose, F. Janicke, H. Graeff, et al. Positron Emission Tomography Using [18F]Fluorodeoxyglucose for Monitoring Primary Chemotherapy in Breast Cancer J. Clin. Oncol., April 1, 2000; 18(8): 1689 - 1695. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Hathaway, D. A. Mankoff, K. R. Maravilla, M. M. Austin-Seymour, G. K. Ellis, J. R. Gralow, A. A. Cortese, C. E. Hayes, and R. E. Moe Value of Combined FDG PET and MR Imaging in the Evaluation of Suspected Recurrent Local-Regional Breast Cancer: Preliminary Experience Radiology, March 1, 1999; 210(3): 807 - 814. [Abstract] [Full Text]
|
|
|
|
 |
|
 V. J Lowe and K. S Naunheim Current role of positron emission tomography in thoracic oncology Thorax, August 1, 1998; 53(8): 703 - 712. [Full Text]
|
|