Additional value of F-18 FDG PET/CT for initial staging in breast cancer with clinically negative axillary nodes

Abstract

The aim of this study was to evaluate the clinical impact of the preoperative ¹⁸F-FDG PET/CT in the initial workup of breast cancer with clinically negative axillary nodes. Whether the status of the clinical axillary nodal involvement can be considered a parameter for making a decision to omit the preoperative ¹⁸F-FDG PET/CT in the situation reported herein was also determined. A total of 178 patients who had newly diagnosed breast cancer and for whom the conventional diagnostic modalities showed no sign of axillary node metastasis were retrospectively enrolled in this study. All the patients underwent preoperative ¹⁸F-FDG PET/CT. The images and histologic results that were obtained were analyzed. ¹⁸F-FDG PET/CT detected primary lesions in 156 of the 178 patients, with an overall sensitivity of 87.6 %, and false negative results were obtained for 22 patients (12.4 %). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ¹⁸F-FDG PET/CT in the detection of axillary nodes were 20.8, 86.9, 37.0, 74.8, and 69.1 %, respectively. Extra-axillary node metastasis was identified in two patients (1.1 %) who had internal mammary nodes. There was no distant metastasis, but coexisting primary tumor was detected in five patients (2.8 %). In total, the therapeutic plan was changed based on ¹⁸F-FDG PET/CT in seven (3.9 %) of the 178 patients, but considering only the cases confined to breast cancer, the change occurred in only two patients (1.1 %). ¹⁸F-FDG PET/CT almost did not affect the initial staging and treatment plan in breast cancer with clinically negative axillary node. If the axillary node is clinically negative in the preoperative workup of breast cancer, then ¹⁸F-FDG PET/CT can be omitted.

18F-FDG PET/CT in breast cancer: Evidence-based recommendations in initial staging

“…Evidence level II, strong recommendation. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] For more information, see Tables 3-5. 3a. 18F-FDG PET/CT should be used in high-risk patients, such as those with inflammatory BC.…”

“…The low prevalence of distant metastases and the risk of false-positive findings retract from the usefulness of 18F-FDG PET/CT for distant staging in these patients. [11][12][13] By contrast, in patients with positive axilla, especially those with locally advanced BC, 18F-FDG PET/CT can be • • Inclusion criteria: T1 (early BC).…”

“…31 Nevertheless, the therapeutic impact of 18F-FDG PET/CT in early-stage BC is controversial. Jeong et al 13 reported that the impact of 18F-FDG PET/CT on the initial staging and treatment in patients with early BC with clinically negative axillary nodes was practically null. By contrast, Bernsdorf et al 41 found a substantial impact on initial staging and on clinical management in patients with early-stage BC and tumors ≥2 cm.…”

18F-FDG PET/CT for Staging and Restaging of Breast Cancer

“…These patients receive breast surgery with sentinel node biopsy (2). PET/CT cannot be used as a substitute for sentinel node biopsy because the spatial resolution of PET instruments precludes the detection of very small nodal metastases (1)(2)(3)(4)(5). The probability that 18 18 F-FDG PET (without the CT component) suggested distant metastases in 13 patients; metastatic disease was confirmed in 3 patients (0.9%), and the findings were false-positive in 10 patients (3.0%) (4).…”

Prognostic Value of SUVmax of <sup>18</sup>F-FDG PET/CT in Early Stage Breast Cancer with No LN Metastasis

“…However, the value of PET/CT for detecting distant disease in patients with early-stage breast cancers has been questioned. In a recent study including 178 newly diagnosed breast cancer patients with no clinical evidence of LN metastasis, PET/CT resulted in a change of the treatment plan in only 3.9% of the patients, and only 2 patients (1.1%) had extra-axillary metastasis [19]. Garami In this study we excluded two breast cancers (2.7%) with no focal FDG accumulation on PET/CT.…”