title: The roles of18F-FDG-PET/CT and US-guided FNAC in assessment of axillary nodal metastases in breast cancer patients.
abstract: BACKGROUND
  There is a need for less invasive techniques for preoperative identification of axillary lymph node (ALN) metastases.
  
  
  METHODS
  Patients underwent ultrasonography (US) and18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT), and then US-guided fine needle aspiration cytology (FNAC) and/or sentinel lymph node (SLN) biopsy were performed based on the US findings of the ALNs. Subsequently, patients with positive FNAC as well as those with positive SLN underwent axillary lymph node dissection (ALND). Postoperatively, removed SLNs and ALNs were examined histologically.
  
  
  RESULTS
  Fifty (85 %) of 59 patients with positive18F-FDG uptake in the axilla had axillary metastases, but18F-FDG uptake results were false-positive in 9 (15 %) cases. On the other hand, 29 patients with positive FNAC underwent ALND without the need for SLN biopsy, while the remaining 20 patients with negative FNAC as well as 249 patients with negative US findings underwent SLN biopsy. Subsequently, 68 patients with positive SLN underwent ALND.
  
  
  CONCLUSIONS
  Positive FDG uptake in the axilla does not always indicate axillary metastasis. US-guided FNAC is useful to avoid unnecessary ALND in patients with positive18F-FDG uptake. However, SLN biopsy is needed in patients with negative US findings of the ALNs and those with negative FNAC.
authors.affiliation: Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Nakano
authors.affiliation: Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan. nogumasa@kanazawa-med.ac.jp.
authors.forename: Masakuni
authors.initials: M
authors.lastname: Noguchi
authors.affiliation: Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Yokoi-Noguchi
authors.affiliation: Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
authors.forename: Yukako
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Morioka
authors.affiliation: Department of Surgical Oncology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Kosaka
authors.affiliation: Department of Radiology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Minato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000473:pathology; D044963:Biopsy, Fine-Needle / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D014463:Ultrasonography / Q000379:methods
chemical_list: D019788:Fluorodeoxyglucose F18
keywords: Axillary lymph node metastasis; Breast cancer; Fine needle aspiration cytology; Positron emission tomography