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Annals of Oncology Advance Access published online on December 12, 2006
Annals of Oncology, doi:10.1093/annonc/mdl425
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© 2006 European Society for Medical Oncology

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, European Institute of Oncology, Milan, Italy
2 Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy
3 Division of Senology, European Institute of Oncology, Milan, Italy
4 Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
5 Division of Pathology, European Institute of Oncology, Milan, Italy
6 School of Medicine, University of Milan, Milan, Italy
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.

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


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