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FDG PET evaluation of early axillary lymph node response to neoadjuvant chemotherapy in stage II and III breast cancer patients

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Regional axillary lymph node status has remained the single most independent variable to predict prognosis both in terms of disease recurrence and survival. This study aimed to prospectively assess sequential [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) findings as early predictors of axillary lymph node response to neoadjuvant chemotherapy in stage II and III breast cancer patients.

Methods

Images were acquired with a PET/CT scanner in 52 patients after administration of FDG (5 MBq/kg) at baseline and after the first, second, third and sixth course of chemotherapy before surgery. Clinical examination and ultrasound (US) were used to assess the size of axillary nodes. Decrease in the standardized uptake value (SUV) with PET corrected or not for partial volume effects was compared to the pathological response.

Results

The sensitivity, specificity and accuracy of axillary node staging was higher with PET (75, 87 and 80%) than with US (50, 83 and 65%), and even more so when PET images were corrected for partial volume effects (86, 83 and 84%). While FDG uptake did not vary much in non-responders, as confirmed by histopathological analysis, it markedly decreased to baseline levels in responders (p < 10−5). Fifty per cent of baseline SUV was considered the best cutoff value to distinguish responders from non-responders. The sensitivity, specificity, negative predictive value and accuracy of FDG PET after one course of chemotherapy were, respectively, 96, 75, 95 and 84%.

Conclusion

The pathological status of regional axillary lymph nodes in stage II and III breast cancer patients could be accurately predicted after one course of neoadjuvant chemotherapy based on FDG PET images.

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Acknowledgments

The authors’ gratitude goes to the patients of the study, the nuclear medicine technologists at the René Gauducheau, N. Fleury, E. Cerato and M. Vinson. This study was supported by «Conseil Régional des Pays de Loire.»

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Nuclear Medicine Department, Comprehensive Cancer Center René Gauducheau, IRCNA, Saint Herblain, France

    Caroline Rousseau, Boumédiène Bridji & Françoise Kraeber-Bodéré

  2. Cancer Research Center CRCNA, Nantes University, INSERM UMR 892, Nantes, France

    Caroline Rousseau & Françoise Kraeber-Bodéré

  3. Nuclear Medicine Department, Eugène Marquis Cancer Center, Rennes, France

    Anne Devillers

  4. Medical Oncology Department, Comprehensive Cancer Center René Gauducheau, Saint Herblain, France

    Mario Campone

  5. Statistic Department, Comprehensive Cancer Center René Gauducheau, Saint Herblain, France

    Loïc Campion

  6. Medical Physics Department, Comprehensive Cancer Center René Gauducheau, Saint Herblain, France

    Ludovic Ferrer

  7. Pathology Department, University Hospital, Nantes, France

    Christine Sagan

  8. Radiology Department, Comprehensive Cancer Center René Gauducheau, Saint Herblain, France

    Myriam Ricaud

  9. Service de Médecine Nucléaire, Centre René Gauducheau, Boulevard Monod, 44805, Saint Herblain Cedex, France

    Caroline Rousseau

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  1. Caroline Rousseau
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Correspondence to Caroline Rousseau.

Additional information

The study has been presented at the 2006 Annual Meeting of the American Society of Clinical Oncology, Proceedings, 2–6 June, Atlanta, USA. The study has been presented at the 2006 53rd Annual Meeting of the Society of Nuclear Medicine, Oral Presentation, 3–7 June, San Diego, USA.

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Rousseau, C., Devillers, A., Campone, M. et al. FDG PET evaluation of early axillary lymph node response to neoadjuvant chemotherapy in stage II and III breast cancer patients. Eur J Nucl Med Mol Imaging 38, 1029–1036 (2011). https://doi.org/10.1007/s00259-011-1735-y

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  • DOI: https://doi.org/10.1007/s00259-011-1735-y

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