Skip to main content
SpringerLink
Log in

Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based on an FDG-PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

This study was designed to determine whether a preoperative fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) (FDG-PET/CT) could be used as a guide for axillary node dissection (AND) or sentinel lymph node biopsy (SNB) in breast cancer patients.

Methods

Between February 2007 and April 2008, we performed FDG-PET/CT scans in 137 biopsy-proven breast cancer patients planning to have an SNB to select patients for either AND (PET/CT N+) or SNB (PET/CT N0). In performing SNB, we also performed additional non-SNB (ADD), which was enlarged at the lower axilla.

Results

Twenty-seven patients with positive scans underwent complete AND as a primary procedure, and 110 patients with negative scans underwent SNB + ADD. There were 8 cases of false negative scans, and no case of false positive scan. The overall sensitivity, specificity, positive predictive value, and overall accuracy of FDG-PET/CT in predicting axillary metastasis were 77.1%, 100%, 100%, and 94.2%, respectively. In a subset of 110 patients with SNB + ADD, 104 patients had histologically negative SN, and 6 patients had positive SN in frozen section. Among 110 SNB + ADD cases, there were only 8 cases (7.3%) of positive axillary basins in permanent biopsy, including two cases of late positives that had micrometastases in the SN only. Through selective SNB + ADD based on an FDG-PET/CT, we have spared 27 unnecessary SNBs (true positive scans).

Conclusions

FDG-PET/CT is a specific imaging modality for predicting axillary node metastasis, and allows for a selective approach to either AND or SNB. A selective SNB + ADD based on an FDG-PET/CT reduced both unnecessary SNBs and positive axillary basins, enhancing the identification rates of SN and the accuracy of SNB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Carmichael AR (2008) A randomized controlled clinical trial on sentinel node lymph node dissection versus axillary lymph node dissection: a matter of technique or patient selection? Ann Surg 248:895–896

    Article  PubMed  Google Scholar 

  2. Krag D, Weaver D, Ashikaga T et al (1998) The sentinel node in breast cancer: a multicenter validation study. N Engl J Med 339:941–946

    Article  PubMed  CAS  Google Scholar 

  3. 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 

  4. Kumar R, Jana S, Heiba SI et al (2003) Retrospective analysis of sentinel lymph node localization in multicentric palpable and non-palpable breast cancer. J Nucl Med 44:7–10

    PubMed  Google Scholar 

  5. Wong SL, Edwards MJ, Chao C et al (2002) The effect of lymphatic tumor burden on sentinel lymph node biopsy results. Breast J 8:192–198

    Article  PubMed  Google Scholar 

  6. Vargas HI, Vargas MP, Venegas R et al (2003) Lymphatic tumor burden negatively impacts the ability to detect the sentinel lymph node in breast cancer. Am Surg 69:886–890

    PubMed  Google Scholar 

  7. Keskek M, Balas S, Gokoz A et al (2006) Re-evaluation of axillary skip metastases in the era of sentinel lymph node biopsy in breast cancer. Surg Today 36:1047–1052

    Article  PubMed  Google Scholar 

  8. Shivers S, Cox C, Leight G et al (2002) Final results of the department of defense multicenter breast lymphatic mapping trial. Ann Surg Oncol 9:248–255

    Article  PubMed  Google Scholar 

  9. Reske SN, Kotzerke J (2001) FDG-PET for clinical use: results of the 3rd German Interdisciplinary Consensus Conference. “Onko-PET III”, 21 July and 19 September 2000. Eur J Nucl Med 28:1707–1723

    Article  PubMed  CAS  Google Scholar 

  10. Kao CH, Hsieh JF, Tsai SC et al (2000) Comparison and discrepancy of 18F–2-deoxyglucose positron emission tomography and Tc-99 m MDP bone scan to detect bone metastasis. Anticancer Res 20:2189–2192

    PubMed  CAS  Google Scholar 

  11. Kostakoglu L, Goldsmith SJ (2003) 18F-FDG PET evaluation of the response to therapy for lymphoma and for breast, lung, and colorectal carcinoma. J Nucl Med 44:224–239

    PubMed  Google Scholar 

  12. Eubank WB, Mankoff DA, Vesselle HJ et al (2002) Detection of locoregional and distant recurrences in breast cancer patients by using FDG PET. Radiographics 22:5–17

    Article  PubMed  Google Scholar 

  13. Bockisch A, Brandt-Mainz K, Gorges R et al (2003) Diagnosis in medullary thyroid cancer with [18F]FDG-PET and improvement using a combined PET/CT scanner. Acta Med Austriaca 30:22–25

    Article  PubMed  CAS  Google Scholar 

  14. 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 

  15. De Kanter AY, Van Eijck CHJ, Van Geel AN et al (1999) Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer. Br J Surg 86:1459–1462

    Article  PubMed  Google Scholar 

  16. Sapino A, Cassoni P, Zanon E et al (2003) Ultrasonographically guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Br J Cancer 88:702–706

    Article  PubMed  CAS  Google Scholar 

  17. Motomura K, Inaji H, Komoike Y et al (2001) Gamma probe and ultrasonographically-guided fine-needle aspiration biopsy of sentinel lymph nodes in breast cancer patients. Eur J Surg Oncol 27:141–145

    Article  PubMed  CAS  Google Scholar 

  18. Kuenen-Boumeester V, Menke-Pluymers M, De Kanter AY et al (2003) Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients. A preoperative staging procedure. Eur J Cancer 39:170–174

    CAS  Google Scholar 

  19. Guller U, Nitzsche EU, Schipr 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 

  20. Yang JH, Nam SJ, Lee TS et al (2001) Comparison of intraoperative frozen section analysis of sentinel node with preoperative positron emission tomography in the diagnosis of axillary lymph node status in breast cancer patients. Jpn J Clin Oncol 31:1–6

    Article  PubMed  CAS  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. 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 

  23. 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 

  24. Avril N, Rose CA, Schelling M et al (2000) Breast imaging with positron emission tomography and fluorine-18 fluorodeoxyglucose: use and limitations. J Clin Oncol 18:3495–3502

    PubMed  CAS  Google Scholar 

  25. Fournier K, Schiller A, Perry RR et al (2004) Micrometastasis in the sentinel lymph node of breast cancer does not mandate completion axillary dissection. Ann Surg 239:859–863

    Article  PubMed  Google Scholar 

  26. Langer I, Marti WR, Guller U et al (2005) Axillary recurrence rate in breast cancer patients with negative sentinel lymph node (SLN) or SLN micrometastases: prospective analysis of 150 patients after SLN biopsy. Ann Surg 241:152–158

    PubMed  Google Scholar 

  27. Barranger E, Grahek D, Antoine M et al (2003) Evaluation of fluorodeoxyglucose positron emission tomography in the detection of axillary lymph node metastases in patients with early-stage breast cancer. Ann Surg Oncol 10:622–627

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Research Institute for Medical Science, College of Medicine, Chungnam National University, 640, Daesadong Jung-Ku, Daejeon, 301-721, South Korea

    Jeryong Kim, Jinsun Lee, Eilsung Chang, Jiyoung Sul, Insang Song, Yonghoon Kim & Chuljoo Lee

  2. Department of Nuclear Medicine, Research Institute for Medical Science, College of Medicine, Chungnam National University, Daejeon, South Korea

    Seongmin Kim

  3. Department of Pathology, Research Institute for Medical Science, College of Medicine, Chungnam National University, Daejeon, South Korea

    Kwangsun Suh

Authors
  1. Jeryong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jinsun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eilsung Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seongmin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kwangsun Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jiyoung Sul
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Insang Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yonghoon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chuljoo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeryong Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kim, J., Lee, J., Chang, E. et al. Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based on an FDG-PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience. World J Surg 33, 943–949 (2009). https://doi.org/10.1007/s00268-009-9955-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-9955-z

Keywords

Search

Navigation