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Detection of internal mammary lymph node metastasis with 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with stage III breast cancer

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

Abstract

Purpose

The present study assessed the positive predictive value (PPV) of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the detection of internal mammary node (IMN) metastasis in patients with clinical stage III breast cancer.

Methods

Patients who were diagnosed with clinical stage III breast cancer and underwent pretreatment 18F-FDG PET/CT were retrospectively analyzed. The 18F-FDG PET/CT scans were prospectively reviewed by two board-certified nuclear medicine physicians in a blinded manner. The intensities of IMNs were graded into four categories (no activity and lower, similar, and higher activities than that of the mediastinal blood pool). IMNs were measured from the combined CT (largest diameter of the short axis). Histologic data of the IMNs were obtained by ultrasonography-guided fine-needle aspiration biopsy or surgical excision. The PPV was calculated for pathologically confirmed IMNs. Visual grade, maximum standardized uptake values (SUVmax), and sizes were analyzed according to the pathology results.

Results

There were 249 clinical stage III breast cancer patients (age 48.0 ± 10.1 years, range 26–79 years) who had undergone initial 18F-FDG PET/CT prior to treatment. Excluding 33 cases of stage IV breast cancer, 62 of 216 patients had visible IMNs on 18F-FDG PET/CT, and histologic confirmation was obtained in 31 patients. There were 27 metastatic and four nonmetastatic nodes (PPV 87.1 %). Metastatic nodes mostly presented with visual grade 3 (83.9 %), and SUVmax and size were 3.5 ± 4.3 and 5.6 ± 2.0 mm, respectively.

Conclusion

18F-FDG PET/CT has a high PPV for IMN metastasis in clinical stage III breast cancer, indicating the possibility of metastasis in IMNs with FDG uptake similar to/lower than that of the blood pool or small-sized nodes.

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Acknowledgments

This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health, Welfare and Family Affairs, Republic of Korea (no. A062254) and by the Real Time Molecular Imaging Research Program (no. 2010–002040) of the Korean Science and Engineering Foundation, which is funded by the Ministry of Education, Science and Technology, Republic of Korea.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea

    Min Jung Seo, Jong Jin Lee, Hye Ok Kim, Sun-Young Chae, Jin-Sook Ryu & Dae Hyuk Moon

  2. Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Sei Hyun Ahn, Jong Won Lee & Byung Ho Son

  3. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Gyung-Yub Gong

  4. Department of Nuclear Medicine, Ulsan University Hospital, Ulsan, Korea

    Seol Hoon Park

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  1. Min Jung Seo
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Correspondence to Jong Jin Lee.

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Seo, M.J., Lee, J.J., Kim, H.O. et al. Detection of internal mammary lymph node metastasis with 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with stage III breast cancer. Eur J Nucl Med Mol Imaging 41, 438–445 (2014). https://doi.org/10.1007/s00259-013-2600-y

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  • DOI: https://doi.org/10.1007/s00259-013-2600-y

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