Detection of extra-axillary lymph node involvement with FDG PET/CT in patients with stage II–III breast cancer

• Published in: European journal of cancer (1990) Vol. 46; no. 18; pp. 3205 - 3210
• Main Authors: Aukema, Tjeerd S, Straver, Marieke E, Peeters, Marie-Jeanne T.F.D. Vrancken, Russell, Nicola S, Gilhuijs, Kenneth G.A, Vogel, Wouter V, Rutgers, Emiel J.T, Olmos, Renato A. Valdés
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.12.2010; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Biopsy, Fine-Needle; Breast neoplasms; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Breast Neoplasms - therapy; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - secondary; Carcinoma, Ductal, Breast - therapy; Carcinoma, Lobular - diagnostic imaging; Carcinoma, Lobular - secondary; Carcinoma, Lobular - therapy; Chemotherapy, Adjuvant; Extra-axillary lymph nodes; Female; Fluorodeoxyglucose F18; Hematology, Oncology and Palliative Medicine; Humans; Lymphatic Metastasis - diagnostic imaging; Medical sciences; Middle Aged; Neoplasm staging; Pharmacology. Drug treatments; Positron emission tomography; Positron-Emission Tomography - methods; Prospective Studies; Radiopharmaceuticals; Tumors; Breast neoplasms; Neoplasm staging; Positron emission tomography; Extra-axillary lymph nodes; Radionuclide study; 2-deoxy-2-fluoroglucose; Breast disease; Staging; Breast tumor; Early stage; Cancerology; Diagnosis; Human; Radiodiagnosis; Lymph node; Stage classification; Breast cancer; Malignant tumor; Mammary gland diseases; Axillary ganglion; Adenopathy; Medical imagery; Computerized axial tomography; Locally advanced stage; Cancer; Emission tomography
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2010.07.034

Abstract Purpose The aim of this prospective study was to assess the incidence of extra-axillary lymph node involvement on baseline FDG PET/CT in patients with stage II–III breast cancer scheduled for neo-adjuvant chemotherapy. Methods Patients with invasive breast cancer of >3 cm and/or proven axillary lymph node metastasis were included for before neo-adjuvant chemotherapy. Baseline ultrasound of the infra- and supraclavicular regions was performed with fine-needle biopsy as needed. Subsequently FDG PET/CT was performed. All visually FDG-positive nodes were regarded as metastatic based on the previously reported high specificity of the technique. Results Sixty patients were included. In 17 patients (28%) extra-axillary lymph nodes were detected by FDG PET/CT, localised in an intra-mammary node (1 lymph node in 1 patient), mediastinal (2 lymph nodes in 2 patients), internal mammary chain (9 lymph nodes in 8 patients), intra- and interpectoral (6 lymph nodes in 4 patients), infraclavicular (5 lymph nodes in 4 patients) and in the contralateral axilla (3 lymph nodes in 2 patients). Ultrasound-guided cytology had detected extra-axillary lymph node involvement in seven of these patients, but was unable to detect extra-axillary nodes in the other 10 patients with positive extra-axillary lymph nodes on FDG PET/CT. Radiotherapy treatment was altered in 7 patients with extra-axillary involvement (12% of the total group). Conclusions FDG PET/CT detected extra-axillary lymph node involvement in almost one-third of the patients with stage II–III breast cancer, including regions not evaluable with ultrasound. FDG PET/CT may be useful as an additional imaging tool to assess extra-axillary lymph node metastasis, with an impact on the adjuvant radiotherapy management.