Positron emission tomography (PET) for assessment of axillary lymph node status in early breast cancer: A systematic review and meta-analysis

2011 ◽  
Vol 37 (3) ◽  
pp. 187-198 ◽  
Author(s):  
K.L. Cooper ◽  
S. Harnan ◽  
Y. Meng ◽  
S.E. Ward ◽  
P. Fitzgerald ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Positron Emission Tomography ◽  
Lymph Node ◽  
Meta Analysis ◽  
Emission Tomography ◽  
Lymph Node Status ◽  
Axillary Lymph ◽  
Axillary Lymph Node Status ◽  
Positron Emission

Prospective Study of 2-[18F]Fluorodeoxyglucose Positron Emission Tomography in the Assessment of Regional Nodal Spread of Disease in Patients With Breast Cancer: An Ontario Clinical Oncology Group Study

2012 ◽  
Vol 30 (12) ◽  
pp. 1274-1279 ◽  
Author(s):  
Kathleen I. Pritchard ◽  
Jim A. Julian ◽  
Claire M.B. Holloway ◽  
David McCready ◽  
Karen Yvonne Gulenchyn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Positron Emission Tomography ◽  
Lymph Node ◽  
Positive Predictive Value ◽  
Lymph Nodes ◽  
Predictive Value ◽  
Distant Metastases ◽  
Emission Tomography ◽  
Axillary Lymph ◽  
Positron Emission

Purpose 2-[18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) is potentially useful in assessing lymph nodes and detecting distant metastases in women with primary breast cancer. Patients and Methods Women diagnosed with operable breast cancer within 3 months underwent FDG-PET at one of five Ontario study centers followed by axillary lymph node assessment (ALNA) consisting of sentinel lymph node biopsy (SLNB) alone if sentinel lymph nodes (SLNs) were negative, SLNB with axillary lymph node dissection (ALND) if SLNB or PET was positive, or ALND alone if SLNs were not identified. Results Between January 2005 and March 2007, 325 analyzable women entered this study. Sentinel nodes were found for 312 (96%) of 325 women and were positive for tumor in 90 (29%) of 312. ALND was positive in seven additional women. Using ALNA as the gold standard, sensitivity for PET was 23.7% (95% CI, 15.9% to 33.6%), specificity was 99.6% (95% CI, 97.2% to 99.9%), positive predictive value was 95.8% (95% CI, 76.9% to 99.8%), negative predictive value was 75.4% (95% CI, 70.1% to 80.1%), and prevalence was 29.8% (95% CI, 25.0% to 35.2%). Using logistic regression, tumor size was predictive for prevalence of tumor in the axilla and for PET sensitivity. PET scan was suspicious for distant metastases in 13 patients; three (0.9%) were confirmed as metastatic disease and 10 (3.0%) were false positive. Conclusion FDG-PET is not sufficiently sensitive to detect positive axillary lymph nodes, nor is it sufficiently specific to appropriately identify distant metastases. However, the very high positive predictive value (96%) suggests that PET when positive is indicative of disease in axillary nodes, which may influence surgical care.

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