title: Preoperative FDG-PET for axillary metastases in patients with breast cancer.
abstract: OBJECTIVE
  Fludeoxyglucose F 18 (FDG) positron emission tomography (PET) can be used to predict axillary node metastases.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Comprehensive breast care center.
  
  
  METHODS
  Fifty-one women with 54 biopsy-proven invasive breast cancers.
  
  
  METHODS
  Whole-body FDG-PET performed before axillary surgery and interpreted blindly.
  
  
  METHODS
  Axillary FDG activity, quantified by standardized uptake value (SUV); axillary metastases, quantified histologically; and tumor characteristics.
  
  
  RESULTS
  There was PET activity in 32 axillae (59%). The SUVs ranged from 0.7 to 11.0. Twenty tumors had an SUV of 2.3 or greater, and 34 had an SUV of less than 2.3. There were no significant differences between these 2 groups except in axillary metastasis size (SUV </=2.2 vs SUV >/=2.3): mean age, 53 vs 58 years (P = .90); mean modified Bloom-Richardson score, 7.7 vs 7.6 (P = .20); lymphovascular invasion present, 25% vs 36% (P = .40); mean Ki-67 level, 25% vs 32% (P = .20); mean tumor size, 2.9 vs 3.2 cm (P = .05); and axillary metastasis size, 0.9 vs 1.7 (P = .001). By adopting an SUV threshold of 2.3, FDG-PET had a sensitivity of 60%, a specificity of 100%, and a positive predictive value of 100%.
  
  
  CONCLUSIONS
  Patients with an SUV greater than 2.3 had axillary metastases. This finding obviates the need for sentinel lymph node biopsy or needle biopsy to diagnose axillary involvement. Surgeons can proceed to axillary node dissection to assess the number of nodes involved, eliminate axillary disease, or perhaps provide a survival benefit if preoperative FDG-PET has an SUV greater than 2.3.
authors.affiliation: Saul and Joyce Brandman Breast Center, Cedars-Sinai Medical Center, Los Angeles, Calif, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Chung
authors.forename: Doug
authors.initials: D
authors.lastname: Liou
authors.forename: Scott
authors.initials: S
authors.lastname: Karlan
authors.forename: Alan
authors.initials: A
authors.lastname: Waxman
authors.forename: Kayo
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hagiike
authors.forename: Edward H
authors.initials: EH
authors.lastname: Phillips
mesh_terms: D001365:Axilla; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18