nach oben

European Journal of Nuclear Medicine and Molecular Imaging

Erschienen in:

01.10.2010 | Original Article

Investigation of ¹⁸F-FDG PET in the selection of patients with breast cancer as candidates for sentinel node biopsy after neoadjuvant therapy

verfasst von: Laura Gilardi, Concetta De Cicco, Marco Colleoni, Anna Cardillo, Emilia Montagna, Silvia Dellapasqua, Viviana Galimberti, Vincenzo Bagnardi, Giovanni Paganelli

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 10/2010

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The main objective of this study was to determine the role of [¹⁸F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) in the selection of patients with breast cancer as candidates for sentinel node biopsy (SNB) after neoadjuvant therapy.

Methods

Forty-four patients with primary breast cancer clinically classified as cT2, cT3 or cT4_a-c cN0-N2 or cN3 M0 and with a baseline FDG PET scan positive both in the site of primary tumour and axillary lymph nodes underwent neoadjuvant therapy and then a second FDG PET scan. In the case of axillary FDG PET uptake, patients underwent axillary lymph node dissection (ALND). If the second FDG PET scan was negative for axillary involvement, SNB was performed in order to evaluate axillary lymph node status. Only in the case of SN positivity did total ALND follow.

Results

Specificity and positive predictive value of FDG PET for detection of axillary lymph node metastases after neoadjuvant therapy were as high as 83% (95% confidence interval: 51–97%) and 85% (95% confidence interval: 54–97%), respectively, whereas sensitivity, negative predictive value and diagnostic accuracy were inadequate for a correct staging (34, 32 and 48%, respectively).

Conclusion

The poor sensitivity of FDG PET in detecting axillary lymph node metastases makes SNB mandatory in cases of a negative scan. The relatively high positive predictive value seems to suggest a role of FDG PET in selecting patients who, after neoadjuvant therapy, are candidates for ALND, avoiding SNB. However, this issue requires confirmation in a larger series of patients.

Buzdar AU. Preoperative chemotherapy treatment of breast cancer—a review. Cancer 2007;110:2394–407.CrossRefPubMed

Fisher B, Brown A, Mamounas E, Wieand S, Robidoux A, Margolese RG, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 1997;15:2483–93.PubMed

Bear HD, Anderson S, Brown A, Smith R, Mamounas EP, Fisher B, et al. The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 2003;21:4165–74.CrossRefPubMed

Mamounas EP, Brown A, Anderson S, Smith R, Julian T, Miller T, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 2005;23:2694–702.CrossRefPubMed

Prati R, Minami CA, Gornbein JA, Debruhl N, Chung D, Chang HR. Accuracy of clinical evaluation of locally advanced breast cancer in patients receiving neoadjuvant chemotherapy. Cancer 2009;115:1194–202.CrossRefPubMed

De Cicco C, Cremonesi M, Luini A, Bartolomei M, Grana C, Prisco G, et al. Lymphoscintigraphy and radioguided biopsy of the sentinel axillary node in breast cancer. J Nucl Med 1998;39:2080–4.PubMed

Viale G, Bosari S, Mazzarol G, Galimberti V, Luini A, Veronesi P, et al. Intraoperative examination of axillary sentinel lymph nodes in breast carcinoma patients. Cancer 1999;85:2433–8.CrossRefPubMed

Veronesi U, Boyle P, Goldhirsch A, Orecchia R, Viale G. Breast cancer. Lancet 2005;365:1727–41.CrossRefPubMed

Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;349(6):546–53.CrossRefPubMed

10.

Luini A, Gatti G, Zurrida S, Talakhadze N, Brenelli F, Gilardi D, et al. The evolution of the conservative approach to breast cancer. Breast 2007;16:120–9.CrossRefPubMed

11.

Mathew J, Asgeirsson KS, Cheung KL, Chan S, Dahda A, Robertson JFR. Neoadjuvant chemotherapy for locally advanced breast cancer: a review of the literature and future directions. Eur J Surg Oncol 2009;35:113–22.PubMed

12.

Kaufmann M, von Minckwitz G, Bear HD, Buzdar A, McGale P, Bonnefoi H, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006. Ann Oncol 2007;18:1927–34.CrossRefPubMed

13.

Galimberti V, De Cicco C, Veronesi P, Landoni F, Baraldi S. Management training for hospital administrators: sentinel lymph-node biopsy under local anaesthetic for carcinoma of the breast—organisational and economic impact. Ecancer 2008;2:article no. 74. doi:10.3332/eCMS.2008.74.

14.

Veronesi U, De Cicco C, Galimberti E, Fernandez JR, Rotmensz N, Viale G, et al. A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol 2007;18:473–8.CrossRefPubMed

15.

Zornoza G, Garcia-Velloso MJ, Sola J, Regueira FM, Pina L, Beorlegui C. 18F-FDG PET complemented with sentinel lymph node biopsy in the detection of axillary involvement in breast cancer. Eur J Surg Oncol 2004;30:15–9.CrossRefPubMed

16.

Kumar R, Zhuang H, Schnall M, Conant E, Damia S, Weinstein S, et al. FDG PET positive lymph nodes are highly predictive of metastasis in breast cancer. Nucl Med Commun 2006;27:231–6.CrossRefPubMed

17.

Avril N, Menzel M, Dose J, Schelling M, Weber W, Jänicke F, et al. Glucose metabolism of breast cancer assessed by 18F-FDG PET: histologic and immunohistochemical tissue analysis. J Nucl Med 2001;42:9–16.PubMed

18.

Zytoon AA, Murakami K, El-Kholy MR, El-Shorbagy E, Ebied O. Breast cancer with low FDG uptake: characterization by means of dual-time point FDG-PET/CT. Eur J Radiol 2009;70(3):530–8.CrossRefPubMed

19.

Fuster D, Duch J, Paredes P, Velasco M, Muñoz M, Santamaría G, et al. Preoperative staging of large primary breast cancer with [18F]fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J Clin Oncol 2008;26:4746–51.CrossRefPubMed

20.

Cermik TF, Mavi A, Basu S, Alavi A. Impact of FDG PET on the preoperative staging of newly diagnosed breast cancer. Eur J Nucl Med Mol Imaging 2008;35:475–83.CrossRefPubMed

Titel: Investigation of 18F-FDG PET in the selection of patients with breast cancer as candidates for sentinel node biopsy after neoadjuvant therapy
verfasst von: Laura Gilardi
Concetta De Cicco
Marco Colleoni
Anna Cardillo
Emilia Montagna
Silvia Dellapasqua
Viviana Galimberti
Vincenzo Bagnardi
Giovanni Paganelli
Publikationsdatum: 01.10.2010
Verlag: Springer-Verlag
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 10/2010
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-010-1494-1

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 10/2010

Interim PET in lymphoma: a step towards standardization

Positron emission tomography in patients with aggressive fibromatosis/desmoid tumours undergoing therapy with imatinib

Seasonal variation in the effect of constant ambient temperature of 24°C in reducing FDG uptake by brown adipose tissue in children

Concordance between four European centres of PET reporting criteria designed for use in multicentre trials in Hodgkin lymphoma

Assessment of histological response of paediatric bone sarcomas using FDG PET in comparison to morphological volume measurement and standardized MRI parameters

FDG-PET/CT in infections: the imaging method of choice?