Nuklearmedizin 2014; 53(03): 89-94
DOI: 10.3413/Nukmed-0605-13-06
Original article
Schattauer GmbH

Diagnostic performance of 18F-FDG PET/CT, ultrasonography and MRI

Detection of axillary lymph node metastasis in breast cancer patientsDiagnostische Aussagekraft von 18F-FDG PET/CT, Sonografie und MRTNachweis axillärer Lymphknotenmetastasen bei Brustkrebspatientinnen
Y.-S. An
1   Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
,
D. H. Lee
1   Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
,
J.-K Yoon
1   Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
,
S. J. Lee
1   Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
,
T. H. Kim
2   Department of Radiology, Ajou University School of Medicine, Suwon, Korea
,
D. K. Kang
2   Department of Radiology, Ajou University School of Medicine, Suwon, Korea
,
K. S. Kim
3   Department of Surgery, Ajou University School of Medicine, Suwon, Korea
,
Y. S. Jung
3   Department of Surgery, Ajou University School of Medicine, Suwon, Korea
,
H. Yim
4   Department of Pathology, Ajou University School of Medicine, Suwon, Korea
› Author Affiliations
Further Information

Publication History

received: 25 June 2013

accepted in revised form: 26 August 2013

Publication Date:
02 January 2018 (online)

Summary

The aim of this study was to evaluate the diagnostic abilities of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) compared with those of ultrasonography and magnetic resonance imaging (MRI) for axillary lymph node staging in breast cancer patients. Patients, methods: Pre- operative 18F-FDG PET/non-contrast CT, ultrasonography and MRI were performed in 215 women with breast cancer. Axillary lymph node dissection was performed in all patients and the diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. ROC curves were compared to evaluate the diagnostic ability of several imaging modalities (i. e., ultrasonography, MRI and 18F-FDG PET/CT). Results: In total, 132 patients (61.4%) had axillary lymph node metastasis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of axillary lymph node metastasis were 72.3%, 77.3%, 66.7%, 81.6%, 75.3% for ultrasonography, 67.5%, 78.0%, 65.9%, 79.2%, 74.0% for MRI, and 62.7%, 88.6%, 77.6%, 79.1%, 78.6% for 18F-FDG PET/CT, respectively. There was no significant difference in diagnostic ability among the imaging modalities (i.e., ultrasonography, MRI and 18F-FDG PET/CT). The diagnostic ability of 18F-FDG PET/CT was significantly improved by combination with MRI (p = 0.0002) or ultrasonography (p < 0.0001). The combination of 18F-FDG PET/CT with ultrasonography had a similar diagnostic ability to that of all three modalities combined (18F-FDG PET/CT+ultraso- nography+MRI, p = 0.05). Conclusion: The diagnostic performance of 18F-FDG PET/CT for detection of axillary node metastasis was not significantly different from that of ultrasonography or MRI in breast cancer patients. Combining 18F-FDG PET/CT with ultrasonography or MRI could improve the diagnostic performance compared to 18F-FDG PET/CT alone.

Zusammenfassung

Ziel dieser Studie war die Evaluierung der diagnostischen Bedeutung der 18F-Fluor deoxyglucose(FDG)-Positronenemissionstomo grafie/Computertomografie (PET/CT), verglichen mit Sonografie und Magnetresonanzto- mografie, im Staging axillärer Lymphknoten bei Brustkrebspatientinnen. Patientinnen, Methoden: Präoperativ wurden 215 Frauen mit Brustkrebs mittels 18F-FDG/CT (ohne Kontrastmittel), Sonografie oder MRT untersucht. Allen Patientinnen wurden axilläre Lymphknoten entnommen; die diagnostische jeder Methode wurde mit histopathologischen Ergebnissen als Referenzstandard evaluiert. Zur Beurteilung der diagnostischen Aussage wurden die ROC-Kurven der drei bildgebenden Methoden verglichen. Ergebnisse: Insgesamt wiesen 132 Patientinnen (61,4%) axilläre Lymphknotenmetastasen auf. Sensitivität, Spezifität, positiver bzw. negativer Vorhersagewert und Genauigkeit beim Nachweis axillärer Lymphknotenmetastasen lagen bei 72,3%, 77,3%, 66,7%, 81,6%, 75.3% für Sonografie, 67,5%, 78,0%, 65,9%, 79,2%, 74,0% für MRT sowie 62,7%, 88,6%, 77,6%, 79,1%, 78,6% für 18F-FDG-PET/CT. Hinsichtlich der diagnostischen Aussage bestand kein signifikanter Unterschied zwischen den drei Methoden. Die diagnostische Leistungsfähigkeit der 18F-FDG PET/CT konnte durch Kombination mit MRT (p = 0,0002) oder Sonografie (p < 0,0001) deutlich gesteigert werden. Die Kombination aus 18F-FDG-PET/CT und Sonografie war diagnostisch ähnlich aussagekräftig wie die aus den drei Methoden (18F-FDG-PET/CT + MRT + Sonografie, p = 0,05). Schlussfolgerung: Zum Nachweis axillärer Lymphknotenmetastasen bei Brustkrebspatientinnen unterschied sich die diagnostische Aussagekraft der 18F-FDG- PET/CT nicht signifikant von der der Sonogra- fie oder MRT. Kombinationen aus 18F-FDG- PET/CT und Sonografie oder MRT könnten die diagnostische Leistungsfähigkeit gegenüber der 18F-FDG-PET/CT jedoch verbessern.

 
  • References

  • 1 Ahn JH, Son EJ, Kim JA. et al. The role of ultrasonography and FDG-PET in axillary lymph node staging of breast cancer. Acta Radiol 2010; 51: 859-865.
  • 2 Alvarez S, Anorbe E, Alcorta P. et al. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol 2006; 186: 1342-1348.
  • 3 Avril N, Dose J, Janicke F. et al. Assessment of axillary lymph node involvement in breast cancer patients with positron emission tomography using radiolabeled 2-(fluorine-18)-fluoro-2-deoxy-D-glucose. J Natl Cancer Inst 1996; 88: 1204-1209
  • 4 Avril N, Rose CA, Schelling M. et al. Breast imaging with positron emission tomography and fluorine-18 fluorodeoxyglucose: use and limitations. J Clin Oncol 2000; 18: 3495-3502.
  • 5 Barranger E, Grahek D, Antoine M. et al. Evaluation of fluorodeoxyglucose positron emission tomography in the detection of axillary lymph node metastases in patients with early-stage breast cancer. Ann Surg Oncol 2003; 10: 622-627.
  • 6 Berger KL, Nicholson SA, Dehdashti F, Siegel BA. FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. AJR Am J Roentgenol 2000; 174: 1005-1008.
  • 7 Chung MH, Ye W, Giuliano AE. Role for sentinel lymph node dissection in the management of large (> or = 5 cm) invasive breast cancer. Ann Surg Oncol 2001; 8: 688-692.
  • 8 Cody HS 3rd. Sentinel lymph node mapping in breast cancer. Oncology (Williston Park) 1999; 13: 25-34.
  • 9 Cody HS 3rd. Current surgical management of breast cancer. Curr Opin Obstet Gynecol 2002; 14: 45-52.
  • 10 Crippa F, Agresti R, Seregni E. et al. Prospective evaluation of fluorine-18-FDG PET in presurgical staging of the axilla in breast cancer. J Nucl Med 1998; 39: 4-8.
  • 11 Garcia Fernandez A, Fraile M, Gimenez N. et al. Use of axillary ultrasound, ultrasound-fine needle aspiration biopsy and magnetic resonance imaging in the preoperative triage of breast cancer patients considered for sentinel node biopsy. Ultrasound Med Biol 2011; 37: 16-22.
  • 12 Greco M, Crippa F, Agresti R. et al. Axillary lymph node staging in breast cancer by 2-fluoro-2-deoxy-D-glucose-positron emission tomography: clinical evaluation and alternative management. J Natl Cancer Inst 2001; 93: 630-635.
  • 13 Heusner TA, Kuemmel S, Hahn S. et al. Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients. Eur J Nucl Med Mol Imaging 2009; 36: 1543-1550.
  • 14 Krag D, Weaver D, Ashikaga T. et al. The sentinel node in breast cancer– a multicenter validation study. N Engl J Med 1998; 339: 941-946.
  • 15 Kvistad KA, Rydland J, Smethurst HB. et al. Axillary lymph node metastases in breast cancer: preoperative detection with dynamic contrast-enhanced MRI. Eur Radiol 2000; 10: 1464-1471.
  • 16 Lee MC, Eatrides J, Chau A. et al. Consequences of axillary ultrasound in patients with T2 or greater invasive breast cancers. Ann Surg Oncol 2011; 18: 72-77.
  • 17 Lim HS, Yoon W, Chung TW. et al. FDG PET/CT for the detection and evaluation of breast diseases: usefulness and limitations. Radiographics 2007; 27 (Suppl. 01) S197-S213.
  • 18 Lovrics PJ, Chen V, Coates G. et al. 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 2004; 11: 846-853.
  • 19 Mancuso AA, Maceri D, Rice D, Hanafee W. CT of cervical lymph node cancer. AJR Am J Roentgenol 1981; 136: 381-385.
  • 20 Martin RC 2nd . Chagpar A, Scoggins CR. et al. Clinicopathologic factors associated with falsenegative sentinel lymph-node biopsy in breast cancer. Ann Surg 2005; 241: 1005-1012.
  • 21 McMasters KM, Tuttle TM, Carlson DJ. et al. Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multiinstitutional practice when optimal technique is used. J Clin Oncol 2000; 18: 2560-2566.
  • 22 Monzawa S, Adachi S, Suzuki K. et al. Diagnostic performance of fluorodeoxyglucose-positron emission tomography/computed tomography of breast cancer in detecting axillary lymph node metastasis: comparison with ultrasonography and contrast-enhanced CT. Ann Nucl Med 2009; 23: 855-861.
  • 23 Morrow M. Role of axillary dissection in breast cancer management. Ann Surg Oncol 1996; 3: 233-234.
  • 24 Nori J, Vanzi E, Bazzocchi M. et al. Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy. Am J Surg 2007; 193: 16-20.
  • 25 Park SH, Kim MJ, Park BW. et al. Impact of preoperative ultrasonography and fine-needle aspiration of axillary lymph nodes on surgical management of primary breast cancer. Ann Surg Oncol 2011; 18: 738-744.
  • 26 Riegger C, Koeninger A, Hartung V. et al. Comparison of the diagnostic value of FDG-PET/CT and axillary ultrasound for the detection of lymph node metastases in breast cancer patients. Acta Radiol 2012; 53: 1092-1098.
  • 27 Schirrmeister H, Kuhn T, Guhlmann A. et al. Fluorine-18 2-deoxy-2-fluoro-D-glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures. Eur J Nucl Med 2001; 28: 351-358.
  • 28 Smith IC, Ogston KN, Whitford P. et al. Staging of the axilla in breast cancer: accurate in vivo assessment using positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose. Ann Surg 1998; 228: 220-227.
  • 29 Som PM. Lymph nodes of the neck. Radiology 1987; 165: 593-600.
  • 30 Specht MC, Fey JV, Borgen PI, Cody HS. 3rd. Is the clinically positive axilla in breast cancer really a contraindication to sentinel lymph node biopsy?. J Am Coll Surg 2005; 200: 10-14.
  • 31 Stadnik TW, Everaert H, Makkat S. et al. Breast imaging. Preoperative breast cancer staging: comparison of USPIO-enhanced MR imaging and 18F-fluorodeoxyglucose (FDC) positron emission tomography (PET) imaging for axillary lymph node staging–initial findings. Eur Radiol 2006; 16: 2153-2160.
  • 32 Valente SA, Levine GM, Silverstein MJ. et al. Accuracy of predicting axillary lymph node positivity by physical examination, mammography, ultrasonography, and magnetic resonance imaging. Ann Surg Oncol 2012; 19: 1825-1830.
  • 33 Van der Hoeven JJ, Hoekstra OS, Comans EF. et al. Determinants of diagnostic performance of [F-18]fluorodeoxyglucose positron emission tomography for axillary staging in breast cancer. Ann Surg 2002; 236: 619-624.
  • 34 Veronesi U, Paganelli G, Viale G. et al. Sentinel lymph node biopsy and axillary dissection in breast cancer: results in a large series. J Natl Cancer Inst 1999; 91: 368-373.
  • 35 Wahl RL, Siegel BA, Coleman RE, Gatsonis CG, Group PETS. 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 2004; 22: 277-285.
  • 36 Weir L, Worsley D, Bernstein V. The value of FDG positron emission tomography in the management of patients with breast cancer. Breast J 2005; 11: 204-209.
  • 37 Yoshimura G, Sakurai T, Oura S. et al. Evaluation of Axillary Lymph Node Status in Breast Cancer with MRI. Breast Cancer 1999; 6: 249-258.