title: Prospective study of 2-[¹⁸F]fluorodeoxyglucose positron emission tomography in the assessment of regional nodal spread of disease in patients with breast cancer: an Ontario clinical oncology group study.
abstract: OBJECTIVE
  2-[(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) is potentially useful in assessing lymph nodes and detecting distant metastases in women with primary breast cancer.
  
  
  METHODS
  Women diagnosed with operable breast cancer within 3 months underwent FDG-PET at one of five Ontario study centers followed by axillary lymph node assessment (ALNA) consisting of sentinel lymph node biopsy (SLNB) alone if sentinel lymph nodes (SLNs) were negative, SLNB with axillary lymph node dissection (ALND) if SLNB or PET was positive, or ALND alone if SLNs were not identified.
  
  
  RESULTS
  Between January 2005 and March 2007, 325 analyzable women entered this study. Sentinel nodes were found for 312 (96%) of 325 women and were positive for tumor in 90 (29%) of 312. ALND was positive in seven additional women. Using ALNA as the gold standard, sensitivity for PET was 23.7% (95% CI, 15.9% to 33.6%), specificity was 99.6% (95% CI, 97.2% to 99.9%), positive predictive value was 95.8% (95% CI, 76.9% to 99.8%), negative predictive value was 75.4% (95% CI, 70.1% to 80.1%), and prevalence was 29.8% (95% CI, 25.0% to 35.2%). Using logistic regression, tumor size was predictive for prevalence of tumor in the axilla and for PET sensitivity. PET scan was suspicious for distant metastases in 13 patients; three (0.9%) were confirmed as metastatic disease and 10 (3.0%) were false positive.
  
  
  CONCLUSIONS
  FDG-PET is not sufficiently sensitive to detect positive axillary lymph nodes, nor is it sufficiently specific to appropriately identify distant metastases. However, the very high positive predictive value (96%) suggests that PET when positive is indicative of disease in axillary nodes, which may influence surgical care.
authors.affiliation: Ontario Clinical Oncology Group, McMaster University, Hamilton, Canada. Kathy.pritchard@sunnybrook.ca
authors.forename: Kathleen I
authors.initials: KI
authors.lastname: Pritchard
authors.forename: Jim A
authors.initials: JA
authors.lastname: Julian
authors.forename: Claire M B
authors.initials: CM
authors.lastname: Holloway
authors.forename: David
authors.initials: D
authors.lastname: McCready
authors.forename: Karen Yvonne
authors.initials: KY
authors.lastname: Gulenchyn
authors.forename: Ralph
authors.initials: R
authors.lastname: George
authors.forename: Nicole
authors.initials: N
authors.lastname: Hodgson
authors.forename: Peter
authors.initials: P
authors.lastname: Lovrics
authors.forename: Francisco
authors.initials: F
authors.lastname: Perera
authors.forename: Leela
authors.initials: L
authors.lastname: Elavathil
authors.forename: Frances P
authors.initials: FP
authors.lastname: O'Malley
authors.forename: Nancy
authors.initials: N
authors.lastname: Down
authors.forename: Audley
authors.initials: A
authors.lastname: Bodurtha
authors.forename: Wendy
authors.initials: W
authors.lastname: Shelley
authors.forename: Mark N
authors.initials: MN
authors.lastname: Levine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D016001:Confidence Intervals; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009367:Neoplasm Staging; D009864:Ontario; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D019788:Fluorodeoxyglucose F18