title: Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based on an FDG-PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience.
abstract: BACKGROUND
  This study was designed to determine whether a preoperative fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) (FDG-PET/CT) could be used as a guide for axillary node dissection (AND) or sentinel lymph node biopsy (SNB) in breast cancer patients.
  
  
  METHODS
  Between February 2007 and April 2008, we performed FDG-PET/CT scans in 137 biopsy-proven breast cancer patients planning to have an SNB to select patients for either AND (PET/CT N+) or SNB (PET/CT N0). In performing SNB, we also performed additional non-SNB (ADD), which was enlarged at the lower axilla.
  
  
  RESULTS
  Twenty-seven patients with positive scans underwent complete AND as a primary procedure, and 110 patients with negative scans underwent SNB + ADD. There were 8 cases of false negative scans, and no case of false positive scan. The overall sensitivity, specificity, positive predictive value, and overall accuracy of FDG-PET/CT in predicting axillary metastasis were 77.1%, 100%, 100%, and 94.2%, respectively. In a subset of 110 patients with SNB + ADD, 104 patients had histologically negative SN, and 6 patients had positive SN in frozen section. Among 110 SNB + ADD cases, there were only 8 cases (7.3%) of positive axillary basins in permanent biopsy, including two cases of late positives that had micrometastases in the SN only. Through selective SNB + ADD based on an FDG-PET/CT, we have spared 27 unnecessary SNBs (true positive scans).
  
  
  CONCLUSIONS
  FDG-PET/CT is a specific imaging modality for predicting axillary node metastasis, and allows for a selective approach to either AND or SNB. A selective SNB + ADD based on an FDG-PET/CT reduced both unnecessary SNBs and positive axillary basins, enhancing the identification rates of SN and the accuracy of SNB.
authors.affiliation: Department of Surgery, Research Institute for Medical Science, College of Medicine, Chungnam National University, 640 Daesadong Jung-Ku, Daejeon 301-721, South Korea. kimjr@cnu.ac.kr
authors.forename: Jeryong
authors.initials: J
authors.lastname: Kim
authors.forename: Jinsun
authors.initials: J
authors.lastname: Lee
authors.forename: Eilsung
authors.initials: E
authors.lastname: Chang
authors.forename: Seongmin
authors.initials: S
authors.lastname: Kim
authors.forename: Kwangsun
authors.initials: K
authors.lastname: Suh
authors.forename: Jiyoung
authors.initials: J
authors.lastname: Sul
authors.forename: Insang
authors.initials: I
authors.lastname: Song
authors.forename: Yonghoon
authors.initials: Y
authors.lastname: Kim
authors.forename: Chuljoo
authors.initials: C
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000000981:diagnostic imaging / Q000601:surgery; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18