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The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature

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Abstract

Axillary lymph node status is the most powerful prognostic indicator in patients with breast cancer. FDG-PET has been suggested as a non-invasive method of staging the axilla. The aim of this study was to review and aggregate all studies that measured the performance of FDG-PET in patients with breast cancer, using surgically obtained axillary histology as a reference, in a meta-analysis. A systematic review of the literature was performed and data extracted from all eligible studies. These were then analysed using meta-analysis software and summary receiver operating characteristic (SROC) curves were plotted for the aggregate data. The data was then tested to determine which parameters impacted on the sensitivity and specificity of the studies. Sensitivities ranging from 20 to 100% and specificities ranging from 65 to 100% have been reported. An aggregated ROC analysis found an area under the curve of 0.95 (95% CI 0.91–0.97) and a Q* value of 0.89 (95% CI 0.85–0.92) in a total of 25 studies involving 2,460 patients. The AUC and Q* values indicated little difference between the compared study characteristics. The performance of the technique currently remains below, which is required to replace assessment of axillary node status by surgical biopsy and histological assessment. However, sensitivity and specificity are high and FDG-PET may have a role to play under particular circumstances. Moreover, the additional benefit of an assessment of distal metastatic spread provided by FDG-PET requires further investigation.

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References

  1. Carter CL, Allen C, Henson DE (1989) Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 63:181–187

    Article  CAS  PubMed  Google Scholar 

  2. Shek LLM, Godolphin W (1988) Model for breast cancer survival: relative prognostic roles of axillary nodal status, TNM stage, estrogen receptor concentration, and tumor necrosis. Cancer Res 48:5565–5569

    CAS  PubMed  Google Scholar 

  3. Ververs JM, Roumen RM, Vingerhoets AJ et al (2001) Risk, severity and predictors of physical and psychological morbidity after axillary lymph node dissection for breast cancer. Eur J Cancer 37:991–999

    Article  CAS  PubMed  Google Scholar 

  4. Purushotham AD, Upponi S, Klevesath MB et al (2005) Morbidity after sentinel lymph node biopsy in primary breast cancer: results from a randomized controlled trial. J Clin Oncol 23:4312–4321

    Article  PubMed  Google Scholar 

  5. Jakub JW, Pendas S, Reintgen DS (2003) Current status of sentinel lymph node mapping and biopsy: facts and controversies. Oncologist 8:59–68

    Article  PubMed  Google Scholar 

  6. Martin RC II, Chagpar A, Scoggins CR et al (2005) Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer. Ann Surg 241:1005–1012

    Article  PubMed  Google Scholar 

  7. Chae BJ, Bae JS, Kang BJ et al (2009) Positron emission tomography-computed tomography in the detection of axillary lymph node metastasis in patients with early stage breast cancer. Jpn J Clin Oncol 39:284–289

    Article  PubMed  Google Scholar 

  8. Taira N, Ohsumi S, Takabatake D et al (2009) Determination of indication for sentinel lymph node biopsy in clinical node-negative breast cancer using preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging. Jpn J Clin Oncol 39:16–21

    Article  PubMed  Google Scholar 

  9. Fuster D, Duch J, Paredes P et al (2008) Preoperative staging of large primary breast cancer with [18F]Fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J Clin Oncol 26(29):4746–4751

    Article  PubMed  Google Scholar 

  10. Ueda S, Tsuda H, Asakawa H et al (2008) Utility of 18F-fluoro-deoxyglucose emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in combination with ultrasonography for axillary staging in primary breast cancer. BMC Cancer 8:165

    Article  PubMed  Google Scholar 

  11. Yang WT, Le-Petross HT, Macapinlac H et al (2008) Inflammatory breast cancer: PET/CT, MRI, mammography, and sonography findings. Breast Cancer Res Treat 109:417–426

    Article  CAS  PubMed  Google Scholar 

  12. Veronesi U, De Cicco C, Galimberti VE et al (2007) A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol 18:473–478

    Article  CAS  PubMed  Google Scholar 

  13. Chung A, Liou D, Karlan S et al (2006) Preoperative FDG-PET for axillary metastases in patients with breast cancer. Arch Surg 141:783–788

    Article  PubMed  Google Scholar 

  14. Gil-Rendo A, Zornoza G, Garcia-Velloso MJ et al (2006) Fluorodeoxyglucose positron emission tomography with sentinel lymph node biopsy for evaluation of axillary involvement in breast cancer. Br J Surg 93:707–712

    Article  CAS  PubMed  Google Scholar 

  15. Kumar R, Zhuang H, Schnall M et al (2006) FDG PET positive lymph nodes are highly predictive of metastasis in breast cancer. Nucl Med Commun 27:231–236

    Article  PubMed  Google Scholar 

  16. Fehr MK, Hornung R, Varga Z et al (2004) Axillary staging using positron emission tomography in breast cancer patients qualifying for sentinel lymph node biopsy. Breast J 10:89–93

    Article  PubMed  Google Scholar 

  17. Lovrics PJ, Chen V, Coates G et al (2004) A prospective evaluation of positron emission tomography scanning, sentinel lymph node biopsy, and standard axillary dissection for axillary staging in patients with early stage breast cancer. Ann Surg Oncol 11:846–853

    Article  PubMed  Google Scholar 

  18. Wahl RL, Siegel BA, Coleman RE et al (2004) Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J Clin Oncol 22:277–285

    Article  PubMed  Google Scholar 

  19. Zornoza G, Garcia-Velloso MJ, Sola J et al (2004) 18F-FDG PET complemented with sentinel lymph node biopsy in the detection of axillary involvement in breast cancer. Eur J Surg Oncol 30:15–19

    Article  CAS  PubMed  Google Scholar 

  20. Guller U, Nitzsche EU, Schirp U et al (2002) Selective axillary surgery in breast cancer patients based on positron emission tomography with 18F-fluoro-2-deoxy-D-glucose: not yet!. Breast Cancer Res Treat 71:171–173

    Article  PubMed  Google Scholar 

  21. van der Hoeven JJ, Hoekstra OS, Comans EF et al (2002) Determinants of diagnostic performance of [F-18]fluorodeoxyglucose positron emission tomography for axillary staging in breast cancer. Ann Surg 236:619–624

    Article  PubMed  Google Scholar 

  22. Greco M, Crippa F, Agresti R et al (2001) Axillary lymph node staging in breast cancer by 2-fluoro-2-deoxy-D-glucose-positron emission tomography: clinical evaluation and alternative management. J Natl Cancer Inst 93:630–635

    Article  CAS  PubMed  Google Scholar 

  23. Schirrmeister H, Kuhn T, Guhlmann A et al (2001) Fluorine-18 2-deoxy-2-fluoro-D-glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures. Eur J Nucl Med 28:351–358

    Article  CAS  PubMed  Google Scholar 

  24. Ohta M, Tokuda Y, Saitoh Y et al (2000) Comparative efficacy of positron emission tomography and ultrasonography in preoperative evaluation of axillary lymph node metastases in breast cancer. Breast Cancer 7:99–103

    Article  CAS  PubMed  Google Scholar 

  25. Yutani K, Shiba E, Kusuoka H et al (2000) Comparison of FDG-PET with MIBI-SPECT in the detection of breast cancer and axillary lymph node metastasis. J Comput Assist Tomogr 24:274–280

    Article  CAS  PubMed  Google Scholar 

  26. Yutani K, Tatsumi M, Shiba E et al (1999) Comparison of dual-head coincidence gamma camera FDG imaging with FDG PET in detection of breast cancer and axillary lymph node metastasis. J Nucl Med 40:1003–1008

    CAS  PubMed  Google Scholar 

  27. Smith IC, Ogston KN, Whitford P et al (1998) Staging of the axilla in breast cancer: accurate in vivo assessment using positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose. Ann Surg 228:220–227

    Article  CAS  PubMed  Google Scholar 

  28. Adler LP, Faulhaber PF, Schnur KC et al (1997) Axillary lymph node metastases: screening with [F-18]2-deoxy-2-fluoro-D-glucose (FDG) PET. Radiology 203:323–327

    CAS  PubMed  Google Scholar 

  29. Avril N, Dose J, Janicke F et al (1996) Assessment of axillary lymph node involvement in breast cancer patients with positron emission tomography using radiolabeled 2-(fluorine-18)-fluoro-2-deoxy-D-glucose. J Natl Cancer Inst 88:1204–1209

    Article  CAS  PubMed  Google Scholar 

  30. Utech CI, Young CS, Winter PF (1996) Prospective evaluation of fluorine-18 fluorodeoxyclucose positron emission tomography in breast cancer for staging of the axilla related to surgery and immunocytochemistry. Eur J Nucl Med 23:1588–1593

    Article  CAS  PubMed  Google Scholar 

  31. Crowe JP Jr, Adler LP, Shenk RR et al (1994) Positron emission tomography and breast masses: comparison with clinical, mammographic, and pathological findings. Ann Surg Oncol 1:132–140

    Article  PubMed  Google Scholar 

  32. Murray AD, Staff RT, Redpath TW et al (2002) Dynamic contrast enhanced MRI of the axilla in women with breast cancer: comparison with pathology of excised nodes. Br J Radiol 75:220–228

    CAS  PubMed  Google Scholar 

  33. Uematsu T, Sano M, Homma K (2001) In vitro high-resolution helical CT of small axillary lymph nodes in patients with breast cancer: correlation of CT and histology. Am J Roentgenol 176:1069–1074

    CAS  Google Scholar 

  34. March DE, Wechsler RJ, Kurtz AB et al (1991) CT-pathologic correlation of axillary lymph nodes in breast carcinoma. J Comput Assist Tomogr 15:440–444

    Article  CAS  PubMed  Google Scholar 

  35. Chappell FM, Raab GM, Wardlaw JM (2009) When are summary ROC curves appropriate for diagnostic meta-analyses? Stat Med 28:2653–2668

    Article  CAS  PubMed  Google Scholar 

  36. Heusner TA, Kuemmel S, Umutlu L et al (2008) Breast cancer staging in a single session: whole-body PET/CT mammography. J Nucl Med 49:1215–1222

    Article  PubMed  Google Scholar 

  37. Crippa F, Agresti R, Donne VD et al (1997) The contribution of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in the preoperative detection of axillary metastases of breast cancer: the experience of the National Cancer Institute of Milan. Tumori 83:542–543

    CAS  PubMed  Google Scholar 

  38. DeGrado TR, Turkington TG, Williams JJ et al (1994) Performance characteristics of a whole-body PET scanner. J Nucl Med 35:1398–1406

    CAS  PubMed  Google Scholar 

  39. Mawlawi O, Podoloff DA, Kohlmyer S et al (2004) Performance characteristics of a newly developed PET/CT scanner using NEMA standards in 2D and 3D modes. J Nucl Med 45:1734–1742

    PubMed  Google Scholar 

  40. Surti S, Karp JS (2004) Imaging characteristics of a 3-dimensional GSO whole-body PET camera. J Nucl Med 45:1040–1049

    CAS  PubMed  Google Scholar 

  41. Zamora J, Abraira V, Muriel A et al (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 6:31

    Article  PubMed  Google Scholar 

  42. Walter S (2002) Properties of the summary receiver operating characteristic (SROC) curve for diagnostic test data. Stat Med 21:1237–1256

    Article  CAS  PubMed  Google Scholar 

  43. Scheidhauer K, Scharl A, Pietrzyk U et al (1996) Qualitative [18F]FDG positron emission tomography in primary breast cancer: clinical relevance and practicability. Eur J Nucl Med 23:618–623

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, Aberdeen Royal, Infirmary, Aberdeen, AB25 2ZD, UK

    Rebecca Peare & R. T. Staff

  2. University of Aberdeen, Aberdeen, UK

    S. D. Heys

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  1. Rebecca Peare
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  2. R. T. Staff
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  3. S. D. Heys
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Correspondence to Rebecca Peare.

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Peare, R., Staff, R.T. & Heys, S.D. The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature. Breast Cancer Res Treat 123, 281–290 (2010). https://doi.org/10.1007/s10549-010-0771-9

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  • DOI: https://doi.org/10.1007/s10549-010-0771-9

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