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Annals of Oncology Advance Access originally published online on December 12, 2006
Annals of Oncology 2007 18(3):473-478; doi:10.1093/annonc/mdl425
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© 2006 European Society for Medical Oncology

breast cancer

A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases

U Veronesi1,3,*, C De Cicco2, VE Galimberti3, JR Fernandez3, N Rotmensz4, G Viale5,6, G Spano7, A Luini3,6, M Intra3, P Veronesi3,6, A Berrettini3 and G Paganelli2

1 Scientific Director
2 Division of Nuclear Medicine
3 Division of Senology
4 Division of Epidemiology and Biostatistics
5 Division of Pathology, European Institute of Oncology, Milan
6 School of Medicine, University of Milan, Milan
7 Division of Anesthesiology, European Institute of Oncology, Milan, Italy

* Correspondence to: Dr U. Veronesi, Scientific Director, Istituto Europeo di Oncologia, Via G. Ripamonti 435, 20141 Milan, Italy. Tel: + 39 02 57489 224; Fax: + 39 02 57489 210; E-mail: umberto.veronesi{at}ieo.it

Background: Sentinel node biopsy (SNB) has become a standard treatment in staging axillary lymph nodes in early breast cancer. SNB, however, is an invasive procedure and is time-consuming when the sentinel node is analysed intra-operatively. Breast cancer is frequently characterised by increased 2-fluoro-2-deoxy-D-glucose uptake and many studies have shown encouraging results in detecting axillary lymph node metastases. The aim of this study was to compare SNB and -positron emission tomography (-PET) imaging, to assess their values in detecting occult axillary metastases.

Patients and Methods: In all, 236 patients with breast cancer and clinically negative axilla were enrolled in the study. 18-FDG-PET was carried out before surgery, using a positron emission tomography (PET)/computed tomography scanner. In all patients, SNB was carried out after identification through lymphoscintigraphy. Patients underwent axillary lymph nodes dissection (ALND) in cases of positive FDG-PET or positive SNB. The results of PET scan were compared with histopathology of SNB and ALND.

Results: In all, 103 out of the 236 patients (44%) had metastases in axillary nodes. Sensitivity of FDG-PET scan for detection of axillary lymph node metastases in this series was low (37%); however, specificity and positive predictive values were acceptable (96% and 88%, respectively).

Conclusions: The high specificity of PET imaging indicates that patients who have a PET-positive axilla should have an ALND rather than an SNB for axillary staging. In contrast, FDG-PET showed poor sensitivity in the detection of axillary metastases, confirming the need for SNB in cases where PET is negative in the axilla.

Key words: occult axillary metastases, positron emission tomography (PET), sentinel node biopsy

Received for publication June 16, 2006. Revision received October 6, 2006. Accepted for publication October 16, 2006.


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