Background
Methods
Patients
Axillary ultrasound examination
Surgery and Sentinel node biopsy procedure
18F-FDG PET/CT and quantification of 18F-FDG uptake in axilla
Determination of the optimal SUV cut-off points
Histopathological study
Statistical analysis
Results
Patient characteristics
Variables | Number 183 | % 100 | |
---|---|---|---|
Age | mean [range] | 57 [32–81] | |
<45 | 33 | 18 | |
45 ≦ | 150 | 82 | |
pT-stage | pTis | 10 | 5 |
pT1 | 91 | 50 | |
pT2 | 68 | 37 | |
pT3 | 14 | 8 | |
Histology | DCIS | 9 | 5 |
IDC | 158 | 86 | |
ILC | 9 | 5 | |
Apocrine | 2 | 1 | |
Mucinous | 2 | 1 | |
Squamoid | 1 | 1 | |
Paget | 2 | 1 | |
Nuclear grade | 1 | 59 | 32 |
2 | 51 | 28 | |
3 | 69 | 38 | |
Not graded | 4 | 2 | |
Nodal metastasis | negative | 124 | 68 |
positive | 59 | 32 | |
Estrogen receptor (ER) | 10%> | 44 | 24 |
10% ≦ | 139 | 76 | |
Progesterone receptor(PgR) | 10%> | 63 | 34 |
10% ≦ | 120 | 66 | |
c-erbB-2 (HER2) | 0 to 2+ | 152 | 83 |
3+/FISH Amp | 28 | 15 | |
unknown | 3 | 2 | |
Primary axillary approach | Ax dissection | 58 | 32 |
SNB | 125 | 68 | |
SUV of the primary tumor | mean [range] | 4.3 [0.9–17.8] | |
SUV of axillary uptake* | mean [range] | 3.0 [0.4–11.3] |
Diagnostic performance of 18F-FDG PET/CT and ultrasonography in axillary staging
18F-FDG uptake | TP | TN | FP | FN | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) | Accuracy (%) |
---|---|---|---|---|---|---|---|---|---|
Visual assessment | 34 | 118 | 6 | 25 | 57.6 | 95.2 | 85 | 82.5 | 83.1 |
SUV cutoff point | |||||||||
0.8 | 30 | 118 | 6 | 29 | 50.8 | 95.2 | 83.3 | 80.3 | 80.9 |
1.3 | 24 | 122 | 2 | 35 | 40.7 | 98.4 | 92.3 | 77.7 | 79.8 |
1.5 | 21 | 123 | 1 | 38 | 35.6 | 99.2 | 95.5 | 76.4 | 78.7 |
1.8 | 21 | 124 | 0 | 38 | 35.6 | 100 | 100 | 76.5 | 79.2 |
2 | 20 | 124 | 0 | 39 | 33.9 | 100 | 100 | 76.1 | 78.7 |
3 | 16 | 124 | 0 | 43 | 27.1 | 100 | 100 | 74.3 | 76.5 |
AUS | 32 | 123 | 1 | 27 | 54.2 | 99.2 | 97 | 82 | 84.7 |
Visual assessment of 18F-FDG uptake Combined with AUS | 38 | 117 | 7 | 21 | 64.4 | 94.4 | 84.4 | 84.8 | 84.7 |
Feasibility of SNB for patients having negative AUS
No. of patients | ||||
---|---|---|---|---|
Permanent histopathology | ||||
Intraoperative frozen Histopathology | Total | Metastasis positive | Metastasis negative | |
A. | Total (n = 124) | |||
Metastasis positive | 24 | 24 | 0 | |
Metastasis negative | 100 | 1 | 99 | |
Total | 124 | 25 | 99 | |
B. |
18F-FDG uptake positive (n = 12) | |||
Metastasis positive | 5 | 5 | 0 | |
Metastasis negative | 7 | 1 | 6 | |
Total | 12 | 6 | 6 | |
C. |
18F-FDG uptake negative (n = 112) | |||
Metastasis positive | 19 | 19 | 0 | |
Metastasis negative | 93 | 0 | 93 | |
Total | 112 | 19 | 93 |
Axillary nodal clinicopathological factors correlated with 18F-FDG uptake
Clinicopathological factors | SUV cut-off 1.8 | No. of pts | Average | SD |
p-value |
---|---|---|---|---|---|
No. of involved ALNs | Low | 38 | 3.6 | 5 | 0.15 |
High | 21 | 6.9 | 7 | ||
The maximum size (mm) | Low | 38 | 8.6 | 6.4 | 0.006 |
High | 21 | 14.6 | 7.9 | ||
SUV | No. of pts | Grade | No. ofpts |
p-value | |
Nuclear grade | Low | 38 | Grade1/2 | 27 | 0.03 |
Grade3 | 11 | ||||
High | 21 | Grade1/2 | 9 | ||
Grade3 | 12 |
Categories of 18F-FDG PET/CT combined with ultrasound for indications of ALND and PSC
Category | 1 | 2 | 3 | 4 |
---|---|---|---|---|
AUS | - | - | + | + |
18F-FDG-uptake | - | + | - | + |
No. of involved ALNs | ||||
0 | 117 (85) | 6 (50) | 1 (20) | 0 (0) |
1 | 12 (9) | 5 (42) | 2 (40) | 9 (32) |
2 ≦ Involved ALNs ≦ 5 | 6 (4) | 1 (8) | 1 (20) | 9 (32) |
6 ≦ | 3 (2) | 0 (0) | 1 (20) | 10 (36) |
The maximum size of involved ALNs | ||||
≦ 5 mm | 10(48) | 5 (83) | 0 (0) | 0 (0) |
5 mm < metastasis < 10 mm | 7(33) | 1 (17) | 2 (50) | 6 (21) |
10 mm ≦ | 4(19) | 0 (0) | 2 (50) | 22(79) |
Nuclear grade of involved ALNs | ||||
Grade 1 and 2 | 16(76) | 3 (50) | 4 (100) | 13(46) |
Grade 3 | 5(24) | 3 (50) | 0 (0) | 15(54) |
Frequency of involved ALNs | 15% | 50% | 80% | 100% |
Indications of ALND/PSC | SNB | FNAC/Bx is needed | FNAC/Bx is needed | Acceptable |
Total | 138 (100) | 12 (100) | 5 (100) | 28 (100) |
Diagnostic performance of SNB in 18F-FDG-positive and AUS-negative patients
Patients | SUV | Involved SNs/resected SNs | Involved non-SNs/resected non-SNs | Ax dissection |
---|---|---|---|---|
1 | 8.1 | 1/1 | 0/10 | Performed |
2 | 2.5 | 1/1 | 0/17 | Performed |
3 | 2.4 | 1/2 | 0/12 | Performed |
4 | 1.4 | 1/3 | 0/21 | performed |
5 | 1.3 | 4/4 | 0/12 | performed |
6 | 0.7 | 1/4 | 0/6 | performed |
7 | 1.5 | 0/1 | - | not performed |
8 | 1 | 0/4 | - | not performed |
9 | 1 | 0/1 | 0/1 | not performed |
10 | 1 | 0/4 | 0/1 | not performed |
11 | 0.9 | 0/1 | 0/2 | not performed |
12 | 0.9 | 0/4 | 0/1 | not performed |