J Breast Cancer.  2009 Sep;12(3):163-169. 10.4048/jbc.2009.12.3.163.

Preoperative Axillary Staging Using 18F-FDG PET/CT and Ultrasonography in Breast Cancer Patients

• Kim YH
• Lee JS
• Lee CJ
• Kim JR
• Chang ES

• KMID: 2242007
• DOI: http://doi.org/10.4048/jbc.2009.12.3.163

Abstract

PURPOSE
The axillary lymph node status is an important prognostic factor for recurrence and survival of patients who have primary breast cancer. This study determined the accuracy of ultrasonography and 18F-FDG positron emission tomography (PET)/computed tomography (CT) in preoperative staging in axilla in patients with breast cancer.
METHODS
One hundred seventy-one patients with primary breast cancer were recruited from January 2007 to August 2008. All the patients underwent axillary ultrasonography and 18F-FDG PET/CT for the axillary staging before their operation. RESULTS: The overall sensitivity, specificity, and the positive and negative predictive values and the accuracy of axillary ultrasonography for making the diagnosis of axillary metastasis were 73.07%, 84.87%, 67.85%, 87.82%, and 81.28%, respectively. On a visual assessment of 18F-FDG PET/CT, the diagnostic accuracy was 85.38% with 69.23% sensitivity, 92.43% specificity, a positive predictive value of 80.00%, and a negative predictive value of 87.30%. By the combined use axillary ultrasonography and 18F-FDG PET/CT to the axilla, the sensitivity, specificity, the positive and negative predictive values and the diagnostic accuracy were 82.35%, 97.91%, 93.33%, 94.00%, and 93.84%, respectively.
CONCLUSION
The combination of 18F-FDG PET/CT and ultrasonography improves preoperative axillary staging in breast cancer that are often not found if only one imaging modalities are applied.

Keyword

Breast neoplasms; Positron-emission tomography; Ultrasonography

MeSH Terms

Axilla
Breast
Breast Neoplasms
Fluorodeoxyglucose F18
Humans
Lymph Nodes
Neoplasm Metastasis
Positron-Emission Tomography
Recurrence
Sensitivity and Specificity
Fluorodeoxyglucose F18

Figure

• 

  Figure 1 The ultrasonographic findings of axillary lymph node. (A) The reactive lymph node has shown a oval shape, smooth contour, hyperechoic central hilum (arrows). (B) The malignant lymph node has shown a round shape, hypoechoic echogenecity and loss of hyperechoic central hilum (arrows).

• 

  Figure 2 18F-FDG PET/CT imaging of metastatic axillary lymph node. (A) Transaxial computed tomography (CT) image showing a metastatic axillary lymph node (arrow). (B) Transaxial positron emission tomography (PET) image showing a small hypermetabolic axillary lymph node (arrow). (C) PET/CT fusion image showing a metastatic lymph node in axilla (arrow).

• 

  Figure 3 Receiver operating characteristics (ROC) curve for semiquantitative SUV analysis and visual interpretation of 18F-FDG PET/CT images for axillary lymph node staging in breast cancer patients (The AUC was 0.895±0.040, p=0.000).

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