Preoperative Axillary Staging Using 18F-FDG PET/CT and Ultrasonography in Breast Cancer Patients

Yong Hun Kim; Jin Sun Lee; Chul Joo Lee; Je Ryong Kim; Eil Sung Chang

doi:10.4048/jbc.2009.12.3.163

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Kim, Lee, Lee, Kim, and Chang: Preoperative Axillary Staging Using 18F-FDG PET/CT and Ultrasonography in Breast Cancer Patients

Original Article

Journal of Breast Cancer

Journal of Breast Cancer 2009; 12(3): 163-169.

Published online: 28 September 2009

DOI: https://doi.org/10.4048/jbc.2009.12.3.163

Preoperative Axillary Staging Using ¹⁸F-FDG PET/CT and Ultrasonography in Breast Cancer Patients

Yong Hun Kim, Jin Sun Lee, Chul Joo Lee, Je Ryong Kim, Eil Sung Chang

Department of Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Korea.

Corresponding author (eschang@cnu.ac.kr)

Received 31 March 2009 Accepted 10 June 2009

Abstract

Purpose

The axillary lymph node status is an important prognostic factor for recurrence and survival of patients who have primary breast cancer. This study determined the accuracy of ultrasonography and ¹⁸F-FDG positron emission tomography (PET)/computed tomography (CT) in preoperative staging in axilla in patients with breast cancer.

Methods

One hundred seventy-one patients with primary breast cancer were recruited from January 2007 to August 2008. All the patients underwent axillary ultrasonography and ¹⁸F-FDG PET/CT for the axillary staging before their operation.

Results

The overall sensitivity, specificity, and the positive and negative predictive values and the accuracy of axillary ultrasonography for making the diagnosis of axillary metastasis were 73.07%, 84.87%, 67.85%, 87.82%, and 81.28%, respectively. On a visual assessment of ¹⁸F-FDG PET/CT, the diagnostic accuracy was 85.38% with 69.23% sensitivity, 92.43% specificity, a positive predictive value of 80.00%, and a negative predictive value of 87.30%. By the combined use axillary ultrasonography and ¹⁸F-FDG PET/CT to the axilla, the sensitivity, specificity, the positive and negative predictive values and the diagnostic accuracy were 82.35%, 97.91%, 93.33%, 94.00%, and 93.84%, respectively.

Conclusion

The combination of ¹⁸F-FDG PET/CT and ultrasonography improves preoperative axillary staging in breast cancer that are often not found if only one imaging modalities are applied.

Keywords: Breast neoplasms, Positron-emission tomography, Ultrasonography

Figures and Tables

Figure 1

The ultrasonographic findings of axillary lymph node. (A) The reactive lymph node has shown a oval shape, smooth contour, hyperechoic central hilum (arrows). (B) The malignant lymph node has shown a round shape, hypoechoic echogenecity and loss of hyperechoic central hilum (arrows).

Figure 2

¹⁸F-FDG PET/CT imaging of metastatic axillary lymph node. (A) Transaxial computed tomography (CT) image showing a metastatic axillary lymph node (arrow). (B) Transaxial positron emission tomography (PET) image showing a small hypermetabolic axillary lymph node (arrow). (C) PET/CT fusion image showing a metastatic lymph node in axilla (arrow).

Figure 3

Receiver operating characteristics (ROC) curve for semiquantitative SUV analysis and visual interpretation of ¹⁸F-FDG PET/CT images for axillary lymph node staging in breast cancer patients (The AUC was 0.895±0.040, p=0.000).

Table 1

Clinical characteristics (n=171)

ALN=axillary lymph node; ER=estrogen receptor; PR=progesteron receptor; SLNB=sentinel lymph node biopsy; ALND=axillary lymph node dissection.

^*Micrometastasis: 2 case.

Table 2

Preoperative staging of axillary lymph node metastasis using ¹⁸F-FDG PET/CT and ultrasonography (p=0.000)

US=ultrasound; pN+=metastasis-positive; pN-=metastasis-negative.

Table 3

Characteristics of patients with false-negative and false-positive axillary lymph node on ¹⁸F-FDG PET/CT together with ultrasonography (n=8)

ALN=axillary lymph node; SLNB=sentinel lymph node biopsy; ALND=axillary lymph node dissection; +=number of metastatic nodes; FN=false negative; FP=false positive; IDC=invasive ductal carcinoma.

Table 4

Accuracy of ultrasonography and ¹⁸F-FDG PET/CT and in predicting axillary lymph node status (p=0.000)

TP=true positive; FP=false positive; FN=false negative; TN=true negative; Sen=sensitivity; Sp=specificity; PPV=positive predictive value; NPV=negative predictive value; Acc=accuracy.

^*Combination of PET/CT and ultrasound.

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