title: Role of [18F]fluorodeoxyglucose positron emission tomography-computed tomography, sonography, and sonographically guided fine-needle aspiration biopsy in the diagnosis of axillary lymph nodes in patients with breast cancer: comparison of diagnostic performance.
abstract: OBJECTIVE
  The aim of this study was to compare the diagnostic performance of [(18)F]fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) with that of sonography and sonographically guided fine-needle aspiration (FNA) for determining the preoperative axillary lymph node (ALN) status and to evaluate the factors related to false-negative PET-CT, sonographic, and FNA results in ALN staging of invasive ductal carcinoma.
  
  
  METHODS
  From March 2009 to July 2012, 226 patients had a diagnosis of primary breast cancer. Among these patients, 107 constituted the study population after exclusion of transferred patients and patients with breast cancer other than invasive ductal carcinoma. The diagnostic performance of the modalities was compared with pathologic reports. Univariate and multivariate analyses were used to evaluate the relationship between clinicopathologic factors (symptoms, T stage, hormone receptors, and histologic grade), false-negative results, and true-negative results on PET-CT, sonography, and FNA.
  
  
  RESULTS
  Of the 107 patients, 45 (42.1%) had positive results on final pathologic analysis of ALNs. Sonographically guided FNA had a significantly higher specificity, positive predictive value, accuracy, and area under the receiver operating characteristic curve than sonography and PET-CT (P < .01). When sonography and PET-CT were combined, the sensitivity was significantly improved (P = .019) compared with sonography alone. When FNA and PET-CT were combined, the sensitivity and negative predictive value were significantly increased compared with each modality (P < .01).
  
  
  CONCLUSIONS
  Sonographically guided FNA was found to be an excellent diagnostic tool for preoperative evaluation of the ALN status. To obviate the step of sentinel lymph node biopsy for determining the ALN status, combined evaluation of ALNs by these modalities may be more complementary than the use of a single modality.
authors.affiliation: Departments of Radiology (Y.-M.S.) and Nuclear Medicine (I.K.H.), Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul Korea; and Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (K.H.). sonyumee@naver.com.
authors.forename: Yu-Mee
authors.initials: YM
authors.lastname: Sohn
authors.affiliation: Departments of Radiology (Y.-M.S.) and Nuclear Medicine (I.K.H.), Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul Korea; and Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (K.H.).
authors.forename: Il Ki
authors.initials: IK
authors.lastname: Hong
authors.affiliation: Departments of Radiology (Y.-M.S.) and Nuclear Medicine (I.K.H.), Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul Korea; and Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea (K.H.).
authors.forename: Kyunghwa
authors.initials: K
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005188:False Negative Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016217:Ultrasonography, Mammary / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: [18F]fluorodeoxyglucose; axillary lymph node; breast ultrasound; fine-needle aspiration biopsy; positron emission tomography–computed tomography; sonography