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Title of Journal: Breast Cancer Res Treat

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Abbravation: Breast Cancer Research and Treatment

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Springer US

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DOI

10.1007/bf01964957

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ISSN

1573-7217

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Locoregional lymph node involvement on 18FFDG PET

Authors: Bas B Koolen Renato A Valdés Olmos Paula H M Elkhuizen Wouter V Vogel MarieJeanne T F D Vrancken Peeters Sjoerd Rodenhuis Emiel J Th Rutgers
Publish Date: 2012/07/28
Volume: 135, Issue: 1, Pages: 231-240
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Abstract

The optimal method for locoregional staging in patients treated with neoadjuvant chemotherapy NAC usually ultrasound US and pre or postchemotherapy sentinel lymph node biopsy SLNB remains subject of debate The aim of this study was to assess the value of 18FFDG PET/CT for detecting locoregional lymph node metastases in primary breast cancer patients scheduled for NAC 311 breast cancer patients scheduled for NAC underwent PET/CT of the thorax in prone position with hanging breasts A panel of four experienced reviewers examined PET/CT images blinded for other diagnostic procedures FDG uptake in locoregional nodes was determined qualitatively using a 4point scale 0 = negative 1 = questionable 2 = moderately intense and 3 = very intense Results were compared with pathology obtained by USguided fine needle aspiration or SLNB prior to NAC All FDGavid extraaxillary nodes were considered metastatic based on the previously reported high positive predictive value of the technique Sensitivity specificity positive predictive value negative predictive value and accuracy of FDGavid nodes for the detection of axillary metastases score 2 or 3 were 82 92 98 53 and 84  respectively Of 28 patients with questionable axillary FDG uptake score 1 23 82  were nodepositive Occult lymph node metastases in the internal mammary chain and periclavicular area were detected in 26 8  and 32 10  patients respectively resulting in changed regional radiotherapy planning in 50 16  patients In breast cancer patients scheduled for NAC PET/CT renders prechemotherapy SLNB unnecessary in case of an FDGavid axillary node enables axillary response monitoring during or after NAC and leads to changes in radiotherapy for a substantial number of patients because of detection of occult N3disease Based on these results we recommend a PET/CT as a standard staging procedure in breast cancer patients scheduled for NAC

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