Japanese Journal of Clinical Oncology Advance Access originally published online on November 8, 2008
Japanese Journal of Clinical Oncology 2009 39(1):16-21; doi:10.1093/jjco/hyn120
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© The Author (2008). Published by Oxford University Press. All rights reserved
Determination of Indication for Sentinel Lymph Node Biopsy in Clinical Node-negative Breast Cancer Using Preoperative 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Fusion Imaging
1 Department of Breast and Endocrine Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama
2 Department of Breast and Endocrine Surgery
3 Department of Radiology,
4 Department of Pathology, National Hospital Organization, National Shikoku Cancer Center, Matsuyama, Ehime, Japan
For reprints and all correspondence: Naruto Taira, Department of Breast and Endocrine Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. E-mail: ntaira{at}md.okayama-u.ac.jp
Received June 30, 2008; accepted October 2, 2008
Objective: Sentinel node biopsy (SNB) is indicated for axillary lymph node metastasis-negative cases (N0), but clarification of the indication may increase treatment efficiency. Fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) may have a high positive predictive value in diagnosis of axillary lymph node metastasis.
Methods: Ninety-two breasts/axillae were analyzed retrospectively in 90 patients (median age 54.6-year old, median primary tumor 1.7 cm). FDG-PET/computed tomography was used to indicate SNB in N0 cases. Axillary lymph node dissection (ALND) was performed in cases that were axillary lymph node metastasis-positive (PET N+) on FDG-PET/CT.
Results: Seventy-four (80.4%) and 18 (19.6%) of the 92 axillae were diagnosed as metastasis-negative (PET N0) and PET N+, respectively, by FDG-PET/CT. SNB was performed in 51 of the 74 PET N0 axillae. ALND was performed in 23 PET N0 axillae (at the patients’ request) and in all 18 PET N+ axillae. Of the 74 PET N0 axillae, 14 were metastasis-positive (pN+) and 60 were pN0 pathologically, and of the 18 PET N+ axillae, 13 were pN+ and five were pN0. The sensitivity and specificity of FDG-PET/CT for diagnosis of axillary metastasis were 48.1 and 92.3%, respectively, and the positive and negative predictive values were 72.2 and 81.1%, respectively.
Conclusion: The positive detection rate on FDG-PET/CT was insufficient for determining an indication of SNB. However, use of an appropriate cut-off for SUVmax (the positive rate was 90.9% with a cut-off of 2.0) and exclusion of surgically biopsied cases may achieve a clinically applicable positive detection rate.
Key Words: breast cancer • sentinel node biopsy • FDG-PET/CT • SUV
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