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The roles of 18F-FDG-PET/CT and US-guided FNAC in assessment of axillary nodal metastases in breast cancer patients

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Abstract

Background

There is a need for less invasive techniques for preoperative identification of axillary lymph node (ALN) metastases.

Method

Patients underwent ultrasonography (US) and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT), and then US-guided fine needle aspiration cytology (FNAC) and/or sentinel lymph node (SLN) biopsy were performed based on the US findings of the ALNs. Subsequently, patients with positive FNAC as well as those with positive SLN underwent axillary lymph node dissection (ALND). Postoperatively, removed SLNs and ALNs were examined histologically.

Results

Fifty (85 %) of 59 patients with positive 18F-FDG uptake in the axilla had axillary metastases, but 18F-FDG uptake results were false-positive in 9 (15 %) cases. On the other hand, 29 patients with positive FNAC underwent ALND without the need for SLN biopsy, while the remaining 20 patients with negative FNAC as well as 249 patients with negative US findings underwent SLN biopsy. Subsequently, 68 patients with positive SLN underwent ALND.

Conclusions

Positive FDG uptake in the axilla does not always indicate axillary metastasis. US-guided FNAC is useful to avoid unnecessary ALND in patients with positive 18F-FDG uptake. However, SLN biopsy is needed in patients with negative US findings of the ALNs and those with negative FNAC.

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Author information

Authors and Affiliations

  1. Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku-1-1, Uchinada, Kahoku, Ishikawa, 920-0293, Japan

    Yasuharu Nakano, Masakuni Noguchi, Miki Yokoi-Noguchi, Yukako Ohno & Emi Morioka

  2. Department of Surgical Oncology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan

    Takeo Kosaka

  3. Department of Radiology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan

    Tomoko Takahashi

  4. Department of Pathology, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan

    Hiroshi Minato

Authors
  1. Yasuharu Nakano
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  2. Masakuni Noguchi
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  3. Miki Yokoi-Noguchi
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  4. Yukako Ohno
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  5. Emi Morioka
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  6. Takeo Kosaka
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  7. Tomoko Takahashi
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Correspondence to Masakuni Noguchi.

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Nakano, Y., Noguchi, M., Yokoi-Noguchi, M. et al. The roles of 18F-FDG-PET/CT and US-guided FNAC in assessment of axillary nodal metastases in breast cancer patients. Breast Cancer 24, 121–127 (2017). https://doi.org/10.1007/s12282-016-0684-5

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  • DOI: https://doi.org/10.1007/s12282-016-0684-5

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