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Investigation of 18F-FDG PET in the selection of patients with breast cancer as candidates for sentinel node biopsy after neoadjuvant therapy

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

Abstract

Purpose

The main objective of this study was to determine the role of [18F]-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) in the selection of patients with breast cancer as candidates for sentinel node biopsy (SNB) after neoadjuvant therapy.

Methods

Forty-four patients with primary breast cancer clinically classified as cT2, cT3 or cT4a-c cN0-N2 or cN3 M0 and with a baseline FDG PET scan positive both in the site of primary tumour and axillary lymph nodes underwent neoadjuvant therapy and then a second FDG PET scan. In the case of axillary FDG PET uptake, patients underwent axillary lymph node dissection (ALND). If the second FDG PET scan was negative for axillary involvement, SNB was performed in order to evaluate axillary lymph node status. Only in the case of SN positivity did total ALND follow.

Results

Specificity and positive predictive value of FDG PET for detection of axillary lymph node metastases after neoadjuvant therapy were as high as 83% (95% confidence interval: 51–97%) and 85% (95% confidence interval: 54–97%), respectively, whereas sensitivity, negative predictive value and diagnostic accuracy were inadequate for a correct staging (34, 32 and 48%, respectively).

Conclusion

The poor sensitivity of FDG PET in detecting axillary lymph node metastases makes SNB mandatory in cases of a negative scan. The relatively high positive predictive value seems to suggest a role of FDG PET in selecting patients who, after neoadjuvant therapy, are candidates for ALND, avoiding SNB. However, this issue requires confirmation in a larger series of patients.

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Acknowledgements

This study was supported by grants of the Italian Association for Cancer Research (AIRC).

The authors thank Deborah Console for editing the manuscript.

Conflicts of interest

None.

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Authors and Affiliations

  1. Division of Nuclear Medicine, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    Laura Gilardi, Concetta De Cicco & Giovanni Paganelli

  2. Research Unit in Medical Senology, Department of Medicine, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    Marco Colleoni, Anna Cardillo, Emilia Montagna & Silvia Dellapasqua

  3. Division of Senology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    Viviana Galimberti

  4. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    Vincenzo Bagnardi

Authors
  1. Laura Gilardi
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  2. Concetta De Cicco
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  3. Marco Colleoni
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  4. Anna Cardillo
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  5. Emilia Montagna
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  6. Silvia Dellapasqua
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  7. Viviana Galimberti
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  8. Vincenzo Bagnardi
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  9. Giovanni Paganelli
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Corresponding author

Correspondence to Giovanni Paganelli.

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Gilardi, L., De Cicco, C., Colleoni, M. et al. Investigation of 18F-FDG PET in the selection of patients with breast cancer as candidates for sentinel node biopsy after neoadjuvant therapy. Eur J Nucl Med Mol Imaging 37, 1834–1841 (2010). https://doi.org/10.1007/s00259-010-1494-1

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  • DOI: https://doi.org/10.1007/s00259-010-1494-1

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