Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients.
OBJECTIVE
The aims of this study were (1) to evaluate FDG PET/CT and CT for the detection of axillary lymph node metastases in breast cancer (BC) patients and (2) to evaluate FDG PET/CT as a pre-test for the triage to sentinel lymph node biopsy (SLNB) versus axillary lymph node dissection (ALND).


METHODS
The sensitivity, specificity, positive and negative predictive value (PPV, NPV), and accuracy of FDG PET/CT and CT for axillary lymph node metastases were determined in 61 patients (gold standard: histopathology). According to the equation "NPV = specificity (1-prevalence) / [specificity (1-prevalence) + (1-sensitivity) prevalence]" FDG PET/CT was evaluated as a triage tool for SLNB versus ALND.


RESULTS
The sensitivity, specificity, PPV, NPV and accuracy of FDG PET/CT was 58, 92, 82, 77 and 79% and of CT 46, 89, 72, 71 and 72%, respectively. Patients with an up to approximately 60% risk for axillary lymph node metastases appear to be candidates for SLNB provided that the axilla is unremarkable on FDG PET/CT.


CONCLUSIONS
FDG PET/CT cannot replace invasive approaches for axillary staging but may extend the indication for SLNB.
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany. till.heusner@uni-due.de
Till A
TA
Heusner
Sherko
S
Kuemmel
Steffen
S
Hahn
Angela
A
Koeninger
Friedrich
F
Otterbach
Monia E
ME
Hamami
Klaus R
KR
Kimmig
Michael
M
Forsting
Andreas
A
Bockisch
Gerald
G
Antoch
Alexander
A
Stahl
D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods* / Q000706:statistics & numerical data; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D014057:Tomography, X-Ray Computed
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18