Evaluation of fluorodeoxyglucose positron emission tomography in the detection of axillary lymph node metastases in patients with early-stage breast cancer.
BACKGROUND
The aim of this study was to assess the capacity of positron emission tomography (PET) with fluorodeoxyglucose (FDG) to determine axillary lymph node status in patients with breast cancer undergoing sentinel node (SN) biopsy.


METHODS
Thirty-two patients with breast cancer and clinically negative axillary nodes were recruited. All patients underwent FDG-PET before SN biopsy. After SN biopsy, all patients underwent complete axillary lymph node (ALN) dissection.


RESULTS
The SNs were identified in all patients. Fourteen patients (43.8%) had metastatic SNs (macrometastatic in seven, micrometastatic in six, and isolated tumor cells in one). The false-negative rate of SN biopsy was 6.6% (1 in 15). FDG-PET identified lymph node metastases in 3 of the 14 patients with positive SNs. The overall sensitivity, specificity, and positive and negative predictive values of FDG-PET in the diagnosis of axillary metastasis were 20%, 100%, 100%, and 58.6%, respectively. No false-positive findings were obtained with FDG-PET.


CONCLUSIONS
This study demonstrates the limitations of FDG-PET in the detection of ALN metastases in patients with early breast cancer. In contrast, FDG-PET seems to be a specific method for staging the axilla in breast cancer. SN biopsy can be avoided in patients with positive FDG-PET, in whom complete ALN dissection should be the primary procedure.
Barranger
Emmanuel
E
Department of Gynecologic and Breast Cancers, Hôpital Tenon, Paris, France. emmanuel.barranger@tnn.ap-hop-paris.fr
Grahek
Dany
D
Antoine
Martine
M
Montravers
Françoise
F
Talbot
Jean-Noel
JN
Uzan
Serge
S
D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011300:Preoperative Care; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D014055:Tomography, Emission-Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18