Axillary Lymph Node to Primary Breast Tumor Standardized Uptake Value Ratio from FDG-PET/CT Imaging for Predicting the Necessity for Nodal Dissection in Primary Breast Tumors
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Purpose: Accurate preoperative detection by radiologic assessment is necessary to specifically identify patients with at least three positive nodes, who can directly undergo axillary lymph node (ALN) dissection, and avoid unnecessary surgical procedures. We evaluated the usefulness of the standardized uptake value (SUV) ratio of ALN in primary breast tumor, using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) and magnetic resonance imaging (MRI) to predict the necessity of ALN dissection during breast cancer surgery. Methods: In this retrospective study we enrolled 316 consecutive patients with invasive breast cancer. The SUV ratio of ALN to primary breast tumor uptake was calculated. Optimal cutoff values were determined by receiver operating characteristic curve analysis for predicting the presence of ≥3 ALN metastases. Diagnostic performance of FDG-PET and MRI features for the prediction of ≥3 ALN metastases were determined by sensitivity, specificity, and diagnostic odds ratio (DOR). A subgroup analysis for FDG-avid tumors was also performed. Results: Of the 316 patients, 36 (11.4%) showed involvement of ≥3 ALNs, with 101 (32%) having at least one metastatic lymph node. Axillary 18F-FDG uptake was positive in 75 patients (23.7%), and the optimal ratio of maximum SUV of axillary lymph node and primary tumor for determining ALN dissection was 0.3. MRI scans revealed suspicious ALN involvement in 147 patients (46.6%). The sensitivity and specificity of MRI detection were 88.9% and 56.2%, respectively, while for SUVLN/T ratio, they were 69.4% and 86.8%, respectively. DOR values for MRI and SUVLN/T ratio were 10.37 and 9.7, respectively. The area under the curve (AUC) was improved to 0.896 (95% confidence interval [CI], 0.817–0.975) for the SUVLN/T ratio in patients with FDG-avid primary tumors (FDG ≥3.9, n=108), but the MRI AUC was worsened (0.681; 95% CI, 0.569–0.793). The DOR, sensitivity, and specificity for the SUVLN/T ratio of FDG-avid cancers were 25.68, 89.0% and 86.0%, respectively. Conclusion: SUVLN/T ratio outperformed MRI features in predicting the need for ALN dissection in FDG-avid primary breast cancer. PET/CT may be a potential noninvasive diagnostic technique for identifying the presence of ≥3 ALN metastases.
Abstract
Purpose: Accurate preoperative detection by radiologic assessment is necessary to specifically identify patients with at least three positive nodes, who can directly undergo axillary lymph node (ALN) dissection, and avoid unnecessary surgical procedures. We evaluated the usefulness of the standardized uptake value (SUV) ratio of ALN in primary breast tumor, using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) and magnetic resonance imaging (MRI) to predict the necessity of ALN dissection during breast cancer surgery. Methods: In this retrospective study we enrolled 316 consecutive patients with invasive breast cancer. The SUV ratio of ALN to primary breast tumor uptake was calculated. Optimal cutoff values were determined by receiver operating characteristic curve analysis for predicting the presence of ≥3 ALN metastases. Diagnostic performance of FDG-PET and MRI features for the prediction of ≥3 ALN metastases were determined by sensitivity, specificity, and diagnostic odds ratio (DOR). A subgroup analysis for FDG-avid tumors was also performed. Results: Of the 316 patients, 36 (11.4%) showed involvement of ≥3 ALNs, with 101 (32%) having at least one metastatic lymph node. Axillary 18F-FDG uptake was positive in 75 patients (23.7%), and the optimal ratio of maximum SUV of axillary lymph node and primary tumor for determining ALN dissection was 0.3. MRI scans revealed suspicious ALN involvement in 147 patients (46.6%). The sensitivity and specificity of MRI detection were 88.9% and 56.2%, respectively, while for SUVLN/T ratio, they were 69.4% and 86.8%, respectively. DOR values for MRI and SUVLN/T ratio were 10.37 and 9.7, respectively. The area under the curve (AUC) was improved to 0.896 (95% confidence interval [CI], 0.817–0.975) for the SUVLN/T ratio in patients with FDG-avid primary tumors (FDG ≥3.9, n=108), but the MRI AUC was worsened (0.681; 95% CI, 0.569–0.793). The DOR, sensitivity, and specificity for the SUVLN/T ratio of FDG-avid cancers were 25.68, 89.0% and 86.0%, respectively. Conclusion: SUVLN/T ratio outperformed MRI features in predicting the need for ALN dissection in FDG-avid primary breast cancer. PET/CT may be a potential noninvasive diagnostic technique for identifying the presence of ≥3 ALN metastases.
참고문헌 (19)
- Giuliano AE, "Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial", JAMA, 305, pp.569~575 (2011)
- Chao C, "Utility of intraoperative frozen section analysis of sentinel lymph nodes in breast cancer", Am J Surg, 182, pp.609~615 (2001)
- Caretta-Weyer H, "Impact of axillary ultrasound and core needle biopsy on the utility of intraoperative frozen section analysis and treatment decision making in women with invasive breast cancer", Am J Surg, 204, pp.308~314 (2012)
- Luciani A, "Lymph node imaging: basic principles", Eur J Radiol, 58, pp.338~344 (2006)
- Sang Kyu Yang, "The Role of PET", CT for Evaluating Breast Cancer, 2007, pp.8(5), 429~437[DOI]
- Liu Y, "Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer", World J Clin Oncol, 5, pp.982~989 (2014)
- Machida Y, "Diagnostic performance of fluorodeoxyglucose-positron emission tomography", computed tomography combined with ultrasonography-guided fine needle aspiration cytology for identifying axillary lymph node status in patients with breast cancer, 2013, pp.39, 26~30
- Chae BJ, "Positron emission tomography-computed tomography in the detection of axillary lymph node metastasis in patients with early stage breast cancer", Jpn J Clin Oncol, 39, pp.284~289 (2009)
- Kim BS, "Usefulness of 18F-FDG uptake with clinicopathologic and immunohistochemical prognostic factors in breast cancer", Ann Nucl Med, 26, pp.175~183 (2012)
- Choi WH, "The value of dual-time-point 18F-FDG PET", CT for identifying axillary lymph node metastasis in breast cancer patients, 2011, pp.84, 593~599
- 안수경, "Can We Skip Intraoperative Evaluation of Sentinel Lymph Nodes? Nomogram Predicting Involvement of Three or More Axillary Lymph Nodes before Breast Cancer Surgery", Cancer Research and Treatment, 49(4), pp.1088~1096 (2017), 대한암학회
- Liang X, "MRI and FDG-PET", CT based assessment of axillary lymph node metastasis in early breast cancer: a meta-analysis, 2017, pp.72, 295~301
- Soret M, "Partial-volume effect in PET tumor imaging", J Nucl Med, 48, pp.932~945 (2007)
- Lim HS, "FDG PET", CT for the detection and evaluation of breast diseases: usefulness and limitations, 2007, pp.27(1), S197~S213
- Park J, "Lymph node to primary tumor SUV ratio by 18F-FDG PET", CT and the prediction of axillary lymph node metastases in breast cancer, 2014, pp.39, e249~e253
- Lovrics PJ, "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, 11, pp.846~853 (2004)
- Ahn JH, "The role of ultrasonography and FDG-PET in axillary lymph node staging of breast cancer", Acta Radiol, 51, pp.859~865 (2010)
- Peterson LM, "Factors influencing the uptake of 18F-fluoroestradiol in patients with estrogen receptor positive breast cancer", Nucl Med Biol, 38, pp.969~978 (2011)
- Gemignani ML, "Feasibility and predictability of perioperative PET and estrogen receptor ligand in patients with invasive breast cancer", J Nucl Med, 54, pp.1697~1702 (2013)