A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases
A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases
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DOI：
10.1093/annonc/mdl425
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发表时间：
2007-03-01
影响因子：
50.5
通讯作者：
Paganelli, G.
中科院分区：
文献类型：
--
作者：
Veronesi, U.;De Cicco, C.;Paganelli, G.
背景：前哨淋巴结活检（SNB）已成为早期乳腺癌腋窝淋巴结分期的标准治疗方法。然而，SNB是一种侵入性手术，并且在术中分析前哨淋巴结时非常耗时。乳腺癌的特征通常是2-氟-2-脱氧-D-葡萄糖摄取增加，许多研究在检测腋窝淋巴结转移方面显示了令人鼓舞的结果。本研究的目的是比较SNB和-正电子发射断层扫描（PET）成像，以评估其价值在检测隐匿性腋窝metastasis.Patients和方法：在所有，236例乳腺癌和临床阴性腋窝入选研究。术前使用正电子发射断层扫描（PET）/计算机断层扫描仪进行18-FDG-PET。在所有患者中，通过淋巴管造影识别后进行SNB。FDG-PET阳性或SNB阳性的患者接受腋窝淋巴结清扫术（ALND）。结果：236例患者中，103例（44%）有腋窝淋巴结转移。FDG-PET扫描检测腋窝淋巴结转移的敏感性低（37%），然而，特异性和阳性预测值是可以接受的（96%和88%，分别）。结论：PET成像的高特异性表明，患者有PET阳性腋窝应该有ALND，而不是SNB腋窝分期。相比之下，FDG-PET在检测腋窝转移方面显示出较差的灵敏度，证实了在腋窝PET阴性的情况下需要SNB。
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.