title: Comparisons of Positron Emission Tomography/Computed Tomography and Ultrasound Imaging for Detection of Internal Mammary Lymph Node Metastases in Patients With Breast Cancer and Pathologic Correlation by Ultrasound-Guided Biopsy Procedures.
abstract: OBJECTIVE
  To compare the diagnostic performance of [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and ultrasound imaging (US) with pathologic results obtained by US-guided biopsy and to evaluate the role of US in detecting internal mammary lymph node (LN) metastases in patients with breast cancer.
  
  
  METHODS
  Between January 2008 and December 2012, 37 patients with breast cancer (median age, 51.4 years; range, 40-79 years) underwent US-guided biopsy for suspected internal mammary LN metastases. Medical records, radiologic images, and reports were reviewed and correlated with pathologic results.
  
  
  RESULTS
  The positive internal mammary LN metastasis rate was 78.4%. All biopsies were performed safely without major complications. Only 8.1% of obtained samples were unsatisfactory. There were statistically significant differences in lesion size (P = .0002), standardized uptake value on PET/CT (P = .0015), biopsy methods (P = .002), and specimen adequacy (P = .007) between metastatic and benign groups. Of the clinical factorsreviewed, only concurrent distant metastasis was correlated with internal mammary LN metastasis (P< .0001). Sensitivities for detecting internal mammary LN metastases were 76.7%, 96.7%, and 92.9% for initial US examinations, initial US combined with second-look US for initially missed cases, and PET/CT, respectively (P= .017). In a subgroup analysis, the only significant difference found was in sensitivities between initial and combined US (P = .019). In a receiver operating characteristic curve analysis, the area under the curve for PET/CT using standardized uptake criteria (0.87) was higher than that for US using size criteria (0.83); however, this difference was not significant.
  
  
  CONCLUSIONS
  Although PET/CT is the best noninvasive method for evaluating internal mammary LN metastases, US is also useful if internal mammary LN evaluation is routine during standard US surveillance of patients with breast cancer. Additionally, US-guided biopsies could be performed immediately on any suspected metastases and yield a high positive rate without serious complications.
authors.affiliation: Department of Radiology, St Vincent's Hospital, Catholic University of Korea, Seoul, Korea (Y.Y.A.); and Departments of Radiology (S.H.K., B.J.K.) and Hospital Pathology (A.W.L.), Seoul St Mary's Hospital, Catholic University of Korea, Seoul, Korea.
authors.forename: Yeong Yi
authors.initials: YY
authors.lastname: An
authors.affiliation: Department of Radiology, St Vincent's Hospital, Catholic University of Korea, Seoul, Korea (Y.Y.A.); and Departments of Radiology (S.H.K., B.J.K.) and Hospital Pathology (A.W.L.), Seoul St Mary's Hospital, Catholic University of Korea, Seoul, Korea.
authors.forename: Sung Hun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Radiology, St Vincent's Hospital, Catholic University of Korea, Seoul, Korea (Y.Y.A.); and Departments of Radiology (S.H.K., B.J.K.) and Hospital Pathology (A.W.L.), Seoul St Mary's Hospital, Catholic University of Korea, Seoul, Korea. lionmain@catholic.ac.kr.
authors.forename: Bong Joo
authors.initials: BJ
authors.lastname: Kang
authors.affiliation: Department of Radiology, St Vincent's Hospital, Catholic University of Korea, Seoul, Korea (Y.Y.A.); and Departments of Radiology (S.H.K., B.J.K.) and Hospital Pathology (A.W.L.), Seoul St Mary's Hospital, Catholic University of Korea, Seoul, Korea.
authors.forename: Ah Won
authors.initials: AW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: biopsy; breast cancer; breast ultrasound; internal mammary nodes; positron emission tomography/computed tomography; ultrasound