The new perspective of PET/CT for axillary nodal staging in early breast cancer patients according to ACOSOG Z0011 trial PET/CT axillary staging according to Z0011. Issue 12 (December 2021)

• Record Type: Journal Article
• Authors: Kong, Eunjung; Choi, Jungeun
• Is Part Of: Nuclear medicine communications. Volume 42:Issue 12(2021)
• Publication Date: 2021-12
• Subjects: axillary lymph node dissection -- axillary nodal burden -- breast cancer -- PET/CT -- sentinel lymph node biopsy -- Z0011; Nuclear medicine -- Periodicals; 616.07575
• DOI: 10.1097/MNM.0000000000001466
• Languages: English
• ISSNs: 0143-3636

Abstract

Abstract : Objective: Post Z0011 trial, axillary lymph node dissections (ALNDs) can be performed in patients with ≥3 positive axillary lymph nodes (ALNs). We investigated the diagnostic performance of 18 F-fluorodeoxyglucose PET/computed tomography (FDG PET/CT) to predict ≥3 metastasis [high nodal burden (HNB)]. Methods: We retrospectively analyzed preoperative FDG PET/CT from January 2010 to June 2012. Patients had clinical T1-2N0 primary invasive breast cancer and underwent breast-conserving surgery with sentinel lymph node biopsy ± ALND. All suspicious ALNs were counted considering FDG-avidity with morphologic changes. Images were considered positive if the axillary basin took up more FDG than the surrounding tissue. On CT, abnormal ALNs were round/ovoid or had cortical thickening with contrast enhancement. PET/CT results were compared with the histology and follow-up findings. Results: In total, 221 females with 224 axillae were enrolled; 161 had negative, 53 had 1–2 metastasis [low nodal burden (LNB)] and 10 had HNB. The sensitivity, specificity, negative predictive value and positive predictive value of PET/CT for HNB were 70, 100, 98.6 and 100%, respectively. There was a correlation between the number of suspicious ALNs on PET/CT and the metastatic nodes on final histology. There were no significant differences in age, tumor size and FDG-avidity between patients with negative or LNB and HNB. During follow-up, 25 patients had a recurrence. The three false-negative patients did not show recurrence. Conclusion: Preoperative PET/CT predicts HNB with high accuracy and is useful for evaluating clinical T1-2N0 invasive breast cancer.