Korean J Clin Oncol.  2018 Dec;14(2):135-141. 10.14216/kjco.18023.

Use of positron emission tomography-computed tomography to predict axillary metastasis in patients with triple-negative breast cancer

• Youm JH
• Chung Y
• Yang YJ
• Han SA
• Song JY

• KMID: 2432612
• DOI: http://doi.org/10.14216/kjco.18023

Abstract

PURPOSE
Axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) are important for staging of patients with node-positive breast cancer. However, these can be avoided in select micrometastatic diseases, preventing postoperative complications. The present study evaluated the ability of axillary lymph node maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET-CT) to predict axillary metastasis of breast cancer.
METHODS
The records of invasive breast cancer patients who underwent pretreatment (surgery and/or chemotherapy) PET-CT between January 2006 and December 2014 were reviewed. ALNs were preoperatively evaluated by PET-CT. Lymph nodes were dissected by SLNB or ALND. SUVmax was measured in both the axillary lymph node and primary tumor. Student t-test and chi-square test were used to analyze sensitivity and specificity. Receiver operating characteristic (ROC) and area under the ROC curve (AUC) analyses were performed.
RESULTS
SUV-tumor (SUV-T) and SUV-lymph node (SUV-LN) were significantly higher in the triple-negative breast cancer (TNBC) group than in other groups (SUV-T: 5.99, P < 0.01; SUV-LN: 1.29, P=0.014). The sensitivity (0.881) and accuracy (0.804) for initial ALN staging were higher in fine needle aspiration+PET-CT than in other methods. For PET-CT alone, the subtype with the highest sensitivity (0.870) and negative predictive value (0.917) was TNBC. The AUC for SUV-LN was greatest in TNBC (0.797).
CONCLUSION
The characteristics of SUV-T and SUV-LN differed according to immunohistochemistry subtype. Compared to other subtypes, the true positivity of axillary metastasis on PET-CT was highest in TNBC. These findings could help tailor management for therapeutic and diagnostic purposes.

Keyword

Breast neoplasms; Triple negative breast neoplasms; Lymphatic metastasis; Positron emission tomography computed tomography; ROC curve

MeSH Terms

Area Under Curve
Breast Neoplasms
Electrons*
Humans
Immunohistochemistry
Lymph Node Excision
Lymph Nodes
Lymphatic Metastasis
Needles
Neoplasm Metastasis*
Postoperative Complications
ROC Curve
Sensitivity and Specificity
Sentinel Lymph Node Biopsy
Triple Negative Breast Neoplasms*