FDG-PET for axillary lymph node staging in primary breast cancer
FDG-PET for axillary lymph node staging in primary breast cancer
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DOI：
10.1007/s00259-004-1531-z
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发表时间：
2004-06-01
影响因子：
9.1
通讯作者：
Bombardieri, E
中科院分区：
文献类型：
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作者：
Crippa, F;Gerali, A;Bombardieri, E
可手术乳腺癌患者腋窝的处理仍然是临床肿瘤学中最有争议的领域之一。检查淋巴结的最佳方法仍然是标准腋窝淋巴结清扫术;然而，与此相关的发病率是众所周知的。基于这些考虑，重要的是在可手术的乳腺癌的治疗进展的策略，发现允许一个微创的方法腋窝采样，不损害患者的生活质量。前哨淋巴结（SLN）活检技术最近被提出用于此目的，具有非常重要的结果。SLN现已成为乳腺癌外科治疗的常规做法，在许多机构中，SLN活检阴性的患者免于腋窝淋巴结清扫，而SLN活检阳性的患者则接受腋窝淋巴结清扫。SLN活检的良好准确性代表了原发性乳腺癌管理的显著进步;然而，假阴性腋窝结果可能发生在不同百分比的患者中，SLN手术对检测内乳和锁骨上淋巴结转移的贡献尚不清楚。在最近开发的成像模式中，具有F-18-氟脱氧葡萄糖（FDG）的正电子发射断层扫描（PET）已特别应用于癌症患者的淋巴结转移的研究。已经进行了几项临床研究，以评估PET在可手术原发性乳腺癌腋窝分期中的准确性。这些研究有时提供了相互矛盾的结果，要么支持使用FDG-PET选择需要腋窝淋巴结清扫的患者的可能性，要么质疑FDG-PET是否可以准确评估原发性乳腺癌的腋窝状态。本文通过检查扫描仪技术的性能和假阴性结果的可能原因，讨论了FDG-PET的所有局限性和优点。根据作者的经验，在同一系列患者中比较FDG-PET与SLN活检，结果似乎表明PET的低灵敏度仅限于微转移。当然，PET的这种局限性必须与乳腺癌患者腋窝小转移的重要性进行分析。与术中前哨淋巴结检测相比，PET在乳腺癌分期中提供的附加值在于FDG-PET是一种非侵入性程序，可以在一次检查中对乳腺癌进行生物学表征并查看整个身体。
Management of the axilla in patients with operable breast cancer is still one of the most controversial areas in clinical oncology. The best procedure to examine the lymph nodes is still standard axillary lymph node dissection; nevertheless, the morbidity associated with this procedure is well known. Based on these considerations, it is important for progress in the treatment of operable breast cancer that strategies are found that permit a less invasive method of axillary sampling which does not impair the patient's quality of life. The technique of sentinel lymph node (SLN) biopsy has recently been proposed for this purpose, with very important results. SLN has now become routine practice in the surgical management of breast cancer, and in many institutions patients with a negative SLN biopsy are spared axillary dissection, while those with a positive SLN biopsy are submitted to axillary node dissection. The good accuracy of SLN biopsy represents a significant advance in the management of primary breast cancer; however, false negative axillary results can occur in a variable percentage of patients, and the contribution of the SLN procedure to the detection of metastases in the internal mammary and supraclavicular lymph nodes is not clear. Among the recently developed imaging modalities, positron emission tomography (PET) with F-18-fluorodeoxyglucose (FDG) has in particular been applied to the study of lymph node metastases in cancer patients. Several clinical studies have been carried out to evaluate the accuracy of PET in the axillary staging of operable primary breast cancer. These studies have sometimes provided conflicting results, either supporting the possibility of using FDG-PET to select patients who need axillary dissection or questioning whether FDG-PET can accurately assess the axillary status in primary breast cancer. All the limitations and the advantages of FDG-PET are discussed in this paper, by examining the performance of scanner technology and the possible causes of the false negative results. In the experience of the authors, comparing FDG-PET with SLN biopsy in the same series of patients, the results seem to indicate that the lower sensitivity of PET is restricted to micrometastases. Of course, this limitation of PET has to be analysed in relation to the importance of such small axillary metastases for the outcome of patients with breast cancer. The added value offered by PET in breast cancer staging in comparison with intraoperative detection of the sentinel node lies in the fact that FDG-PET is a non-invasive procedure that allows, within a single examination, the biological characterisation of breast cancer and viewing of the entire body.