title: Role of fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography in the evaluation of axillary lymph node involvement in operable breast cancer in comparison with sentinel lymph node biopsy.
abstract: OBJECTIVE
  Role of (18 [F] fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose [FDG] positron emission tomography-computed tomography [PET-CT]) in the evaluation of axillary lymph node involvement in T1T2N0 breast cancer and compare results with sentinel lymph node biopsy (SLNB).
  
  
  METHODS
  A total of 37 patients of proven T1T2N0 breast cancer were included in the study. Patients with past history of breast surgery, T3T4 disease, uncontrolled diabetes mellitus and pregnant patients were excluded from the study. Pre-operative FDG PET-CT was performed followed by sentinel lymph node (SLN) biopsy with blue dye or combined technique.
  
  
  RESULTS
  SLN was identified in 32 of 37 patients with an identification rate of 86.48% (32/37). With combined technique SLN identification rate was 100% (6/6) while with blue dye alone; it was 83.8% (26/31). Among 37 patients, 16 had axillary metastases of which 12 had macrometastases and four had micrometastases detected by immunohistochemistry (IHC). Of 12 patients with axillary macrometastases, skip metastases were present in two patients in whom SLN was negative and in two patients SLN was not identified, but axillary dissection showed metastases. PET-CT had shown sensitivity, specificity, negative predictive value and positive predictive value of 56%, 90%, 73%, and 81.8%, respectively. IHC of SLN detected four patients with micrometastases upstaging the disease by 11% (4/37).
  
  
  CONCLUSIONS
  Because FDG PET-CT has a high specificity in the evaluation of axillary lymph node involvement in T1T2N0 breast cancer patients according to the results of this study if FDG PET-CT is positive in axillary lymph nodes, axillary lymph node dissection may be considered instead of SLNB.
authors.affiliation: Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vasu Reddy
authors.initials: VR
authors.lastname: Challa
authors.forename: Anurag
authors.initials: A
authors.lastname: Srivastava
authors.forename: Anita
authors.initials: A
authors.lastname: Dhar
authors.forename: Rajinder
authors.initials: R
authors.lastname: Parshad
authors.forename: Chandrasekhar
authors.initials: C
authors.lastname: Bal
authors.forename: Rama
authors.initials: R
authors.lastname: Mohan Reddy Gona
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Datta Gupta
authors.forename: Punit
authors.initials: P
authors.lastname: Sharma
keywords: Breast cancer; fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography; immunohistochemistry; sentinel lymph node biopsy