Factors affecting the accuracy of <sup>18</sup>F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer

Kutlutürk, Koray; Şimşek, Arife; Comak, Aylin; Gönültaş, Fatih; Ünal, Bülent; Kekilli, Ersoy

doi:10.4103/njcp.njcp_198_18

Cited by 11 publications

(1 citation statement)

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“…Zhang et al, suggest that, because of the higher specificity of FDG PET-CT and MRI, these methods can potentially replace sentinel lymph node biopsy in some breast cancer patients. Kutluturk et al, suggested that the accuracy of FDG PET-CT for detecting axillary lymph node metastases is higher with larger tumour sizes [31]. On the contrary, Kim et al, in their series of 262 patients, found that the sensitivity, specificity, and positive and negative predictive values of FDG PET-CT were higher in the subset of patients under the age of 75 years with a tumour size of <15 mm [32].…”

Section: Pet-ct and Lymph Node Metastasesmentioning

confidence: 99%

Current Role and Future Prospects of Positron Emission Tomography (PET)/Computed Tomography (CT) in the Management of Breast Cancer

Robson,

Thekkinkattil

2024

Medicina

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Breast cancer has become the most diagnosed cancer in women globally, with 2.3 million new diagnoses each year. Accurate early staging is essential for improving survival rates with metastatic spread from loco regional to distant metastasis, decreasing mortality rates by 50%. Current guidelines do not advice the routine use of positron emission tomography (PET)-computed tomography (CT) in the staging of early breast cancer in the absence of symptoms. However, there is a growing body of evidence to suggest that the use of PET-CT in this early stage can benefit the patient by improving staging and as a result treatment and outcomes, as well as psychological burden, without increasing costs to the health service. Ongoing research in PET radiomics and artificial intelligence is showing promising future prospects in its use in diagnosis, staging, prognostication, and assessment of responses to the treatment of breast cancer. Furthermore, ongoing research to address current limitations of PET-CT by improving techniques and tracers is encouraging. In this narrative review, we aim to evaluate the current evidence of the usefulness of PET-CT in the management of breast cancer in different settings along with its future prospects, including the use of artificial intelligence (AI), radiomics, and novel tracers.

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Section: Pet-ct and Lymph Node Metastasesmentioning

confidence: 99%

Current Role and Future Prospects of Positron Emission Tomography (PET)/Computed Tomography (CT) in the Management of Breast Cancer

Robson,

Thekkinkattil

2024

Medicina

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PET/CT and MRI for Identifying Axillary Lymph Node Metastases in Breast Cancer Patients: Systematic Review and Meta‐Analysis

Zhang

Liu

Luo

et al. 2020

Magnetic Resonance Imaging

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Background: Axillary lymph node metastases (ALNM) is one of the most important prognostic factors in breast cancer. Positron emission tomography / computed tomography (PET/CT) and magnetic resonance imaging (MRI) are increasingly used to assess ALNM noninvasively. There has been no study investigating PET/CT and MRI in direct comparative studies. Purpose: To assess the diagnostic accuracy of PET/CT and MRI for ALNM in the same population of breast cancer. Study Type: Systematic review and meta-analysis. Data Source: PubMed-MEDLINE, Web of Science, Cochrane, EMBASE, and Chinese Biomedical Literature databases were searched (September 1993-January 2020) by using concerned keywords. Studies using both MRI and PET/CT as diagnostic methods were included. Eleven studies included 1203 breast cancer patients using PET/CT and 1186 patients using MRI. Field Strength: 1.5T or 3.0T. Assessment: The Quality Assessment of Diagnostic Accuracy Studies (v. 2) was used to assess the quality of the studies. Statistical Tests: A bivariate mixed-effects binary regression model was used to obtain the diagnostic performance. Metaregression analysis was conducted to investigate study heterogeneity. Results: A total of 369 articles were screened; out of these, 11 studies were included that meet the inclusion criteria. The respective pooled sensitivity and specificity values were 0.56 (95% confidence interval [CI]: 0.47-0.63) and 0.91 (95% CI: 0.87-0.93) for PET/CT and 0.55 (95% CI: 0.48-0.62) and 0.86 (95% CI: 0.82-0.89) for MRI. There was no statistically significant difference in sensitivity (P = 0.769) or specificity (P = 0.447) between PET/CT and MRI. There was no threshold effect in either of the imaging tests. The diagnostic performance of both imaging tests was affected by study design, breast cancer subtype, tumor stage, or imaging features. Data Conclusion: In the same population, PET/CT and MRI had comparable diagnostic performance for the detection of ALNM, with low sensitivity and high specificity. Level of Evidence: 3. Technical Efficacy Stage: Stage 2.

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ESR Essentials: staging and restaging with FDG-PET/CT in oncology—practice recommendations by the European Society for Hybrid, Molecular and Translational Imaging

Ebner,

Sheikh,

Brendel

et al. 2024

Eur Radiol

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Positron emission tomography (PET) stands as the paramount clinical molecular imaging modality, especially in oncology. Unlike conventional anatomical-morphological imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), PET provides detailed visualizations of internal activity at the molecular and cellular levels. 18-fluorine-fluorodeoxyglucose ([18F]FDG)-PET combined with contrast-enhanced CT (ceCT) significantly improves the detection of various cancers. Appropriate patient selection is crucial, and physicians should carefully assess the appropriateness of [18F]FDG-PET/CT based on specific clinical criteria and evidence. Due to its high diagnostic accuracy, [18F]FDG-PET/CT is indispensable for evaluating the extent of disease, staging, and restaging known malignancies, and assessing the response to therapy. PET/CT imaging offers significant advantages in patient management, particularly by identifying occult metastases that might otherwise go undetected. This can help prevent unnecessary surgeries, allowing many patients to be redirected to systemic chemotherapy instead. However, it is important to note that the gold standard for surgical planning remains CT and/or MRI, depending on the body region. These imaging modalities, with or without associated angiography, provide superior contrast and spatial resolution, essential for detailed surgical preparation and planning. [18F]FDG-PET/CT has a central role in the precise and early diagnosis of cancer, contributing significantly to personalized treatment plans. However, it has limitations, including non-tumor-specific uptake and the potential to inaccurately capture the metabolic activity of certain tumor types due to low uptake in some well-differentiated tumor cell lines. Therefore, it should be utilized in clinical scenarios where it offers crucial diagnostic insights not readily available with other imaging modalities. Key Points Use [18F]FDG-PET/CT selectively based on clinical appropriateness criteria and existing evidence to optimize resource utilization and minimize patient exposure. Employ [18F]FDG-PET/CT in treatment planning and monitoring, particularly for assessing chemotherapy or radiotherapy response in FDG-avid lymphoma and solid tumors. When available, [18F]FDG-PET/CT can be integrated with other diagnostic tools, such as MRI, to enhance overall diagnostic accuracy.

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Factors affecting the accuracy of ¹⁸F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer

Cited by 11 publications

References 1 publication

Current Role and Future Prospects of Positron Emission Tomography (PET)/Computed Tomography (CT) in the Management of Breast Cancer

Current Role and Future Prospects of Positron Emission Tomography (PET)/Computed Tomography (CT) in the Management of Breast Cancer

PET/CT and MRI for Identifying Axillary Lymph Node Metastases in Breast Cancer Patients: Systematic Review and Meta‐Analysis

ESR Essentials: staging and restaging with FDG-PET/CT in oncology—practice recommendations by the European Society for Hybrid, Molecular and Translational Imaging

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Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer

Cited by 11 publications

References 1 publication

Current Role and Future Prospects of Positron Emission Tomography (PET)/Computed Tomography (CT) in the Management of Breast Cancer

Current Role and Future Prospects of Positron Emission Tomography (PET)/Computed Tomography (CT) in the Management of Breast Cancer

PET/CT and MRI for Identifying Axillary Lymph Node Metastases in Breast Cancer Patients: Systematic Review and Meta‐Analysis

ESR Essentials: staging and restaging with FDG-PET/CT in oncology—practice recommendations by the European Society for Hybrid, Molecular and Translational Imaging

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Factors affecting the accuracy of ¹⁸F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer