Korean Journal of Clinical Oncology (대한종양외과학회지)

Korean Society of Surgical Oncology (대한종양외과학회)
권호 표지
DOI QR코드

DOI QR Code

Use of positron emission tomography-computed tomography to predict axillary metastasis in patients with triple-negative breast cancer

  • Youm, Jung Hyun (Department of Surgery, Kyung Hee University Hospital at Gangdong) ;
  • Chung, Yoona (Department of Surgery, Kyung Hee University Hospital at Gangdong) ;
  • Yang, You Jung (Department of Nuclear Medicine, Kyung Hee University Hospital at Gangdong) ;
  • Han, Sang Ah (Department of Surgery, Kyung Hee University Hospital at Gangdong) ;
  • Song, Jeong Yoon (Department of Surgery, Kyung Hee University Hospital at Gangdong)
  • Received : 2018.09.29
  • Accepted : 2018.10.22
  • Published : 2018.12.31
⟨ Previous Next ⟩

Abstract

Purpose: Axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) are important for staging of patients with node-positive breast cancer. However, these can be avoided in select micrometastatic diseases, preventing postoperative complications. The present study evaluated the ability of axillary lymph node maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET-CT) to predict axillary metastasis of breast cancer. Methods: The records of invasive breast cancer patients who underwent pretreatment (surgery and/or chemotherapy) PET-CT between January 2006 and December 2014 were reviewed. ALNs were preoperatively evaluated by PET-CT. Lymph nodes were dissected by SLNB or ALND. SUVmax was measured in both the axillary lymph node and primary tumor. Student t-test and chi-square test were used to analyze sensitivity and specificity. Receiver operating characteristic (ROC) and area under the ROC curve (AUC) analyses were performed. Results: SUV-tumor (SUV-T) and SUV-lymph node (SUV-LN) were significantly higher in the triple-negative breast cancer (TNBC) group than in other groups (SUV-T: 5.99, P<0.01; SUV-LN: 1.29, P=0.014). The sensitivity (0.881) and accuracy (0.804) for initial ALN staging were higher in fine needle aspiration+PET-CT than in other methods. For PET-CT alone, the subtype with the highest sensitivity (0.870) and negative predictive value (0.917) was TNBC. The AUC for SUV-LN was greatest in TNBC (0.797). Conclusion: The characteristics of SUV-T and SUV-LN differed according to immunohistochemistry subtype. Compared to other subtypes, the true positivity of axillary metastasis on PET-CT was highest in TNBC. These findings could help tailor management for therapeutic and diagnostic purposes.

Keywords

References

  1. Fisher B, Bauer M, Wickerham DL, Redmond CK, Fisher ER, Cruz AB, et al. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer: an NSABP update. Cancer 1983;52:1551-7. https://doi.org/10.1002/1097-0142(19831101)52:9<1551::AID-CNCR2820520902>3.0.CO;2-3
  2. Walls J, Boggis CR, Wilson M, Asbury DL, Roberts JV, Bundred NJ, et al. Treatment of the axilla in patients with screen-detected breast cancer. Br J Surg 1993;80:436-8. https://doi.org/10.1002/bjs.1800800409
  3. Weiss RB, Woolf SH, Demakos E, Holland JF, Berry DA, Falkson G, et al. Natural history of more than 20 years of node-positive primary breast carcinoma treated with cyclophosphamide, methotrexate, and fluorouracil-based adjuvant chemotherapy: a study by the Cancer and Leukemia Group B. J Clin Oncol 2003;21:1825-35. https://doi.org/10.1200/JCO.2003.09.006
  4. Arriagada R, Le MG, Dunant A, Tubiana M, Contesso G. Twenty-five years of follow-up in patients with operable breast carcinoma: correlation between clinicopathologic factors and the risk of death in each 5-year period. Cancer 2006;106:743-50. https://doi.org/10.1002/cncr.21659
  5. Moffat FL Jr, Senofsky GM, Davis K, Clark KC, Robinson DS, Ketcham AS. Axillary node dissection for early breast cancer: some is good, but all is better. J Surg Oncol 1992;51:8-13. https://doi.org/10.1002/jso.2930510105
  6. Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol 2007;25:3657-63. https://doi.org/10.1200/JCO.2006.07.4062
  7. Noguchi M, Morioka E, Ohno Y, Noguchi M, Nakano Y, Kosaka T. The changing role of axillary lymph node dissection for breast cancer. Breast Cancer 2013;20:41-6. https://doi.org/10.1007/s12282-012-0416-4
  8. Schwartz GF. Clinical practice guidelines for the use of axillary sentinel lymph node biopsy in carcinoma of the breast: current update. Breast J 2004;10:85-8. https://doi.org/10.1111/j.1075-122X.2004.21439.x
  9. Walsh R, Kornguth PJ, Soo MS, Bentley R, DeLong DM. Axillary lymph nodes: mammographic, pathologic, and clinical correlation. AJR Am J Roentgenol 1997;168:33-8. https://doi.org/10.2214/ajr.168.1.8976915
  10. Alvarez S, Anorbe E, Alcorta P, Lopez F, Alonso I, Cortes J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol 2006;186:1342-8. https://doi.org/10.2214/AJR.05.0936
  11. Fuster D, Duch J, Paredes P, Velasco M, Munoz M, Santamaria G, et al. Preoperative staging of large primary breast cancer with [18F] fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J Clin Oncol 2008;26:4746-51. https://doi.org/10.1200/JCO.2008.17.1496
  12. Eubank WB, Mankoff D, Bhattacharya M, Gralow J, Linden H, Ellis G, et al. Impact of FDG PET on defining the extent of disease and on the treatment of patients with recurrent or metastatic breast cancer. AJR Am J Roentgenol 2004;183:479-86. https://doi.org/10.2214/ajr.183.2.1830479
  13. Hatt M, Groheux D, Martineau A, Espie M, Hindie E, Giacchetti S, et al. Comparison between 18F-FDG PET image-derived indices for early prediction of response to neoadjuvant chemotherapy in breast cancer. J Nucl Med 2013;54:341-9. https://doi.org/10.2967/jnumed.112.108837
  14. Cerfolio RJ, Bryant AS. Ratio of the maximum standardized uptake value on FDG-PET of the mediastinal (N2) lymph nodes to the primary tumor may be a universal predictor of nodal malignancy in patients with nonsmall-cell lung cancer. Ann Thorac Surg 2007;83:1826-9. https://doi.org/10.1016/j.athoracsur.2006.12.034
  15. Ueda S, Kondoh N, Tsuda H, Yamamoto S, Asakawa H, Fukatsu K, et al. Expression of centromere protein F (CENP-F) associated with higher FDG uptake on PET/CT, detected by cDNA microarray, predicts high-risk patients with primary breast cancer. BMC Cancer 2008;8:384. https://doi.org/10.1186/1471-2407-8-384
  16. Specht JM, Kurland BF, Montgomery SK, Dunnwald LK, Doot RK, Gralow JR, et al. Tumor metabolism and blood flow as assessed by positron emission tomography varies by tumor subtype in locally advanced breast cancer. Clin Cancer Res 2010;16:2803-10. https://doi.org/10.1158/1078-0432.CCR-10-0026
  17. Levy L, Suissa M, Chiche JF, Teman G, Martin B. BIRADS ultrasonography. Eur J Radiol 2007;61:202-11. https://doi.org/10.1016/j.ejrad.2006.08.035
  18. Harvey JM, Clark GM, Osborne CK, Allred DC. Estrogen receptor status by immunohistochemistry is superior to the ligand-binding assay for predicting response to adjuvant endocrine therapy in breast cancer. J Clin Oncol 1999;17:1474-81. https://doi.org/10.1200/JCO.1999.17.5.1474
  19. Cheang MC, Chia SK, Voduc D, Gao D, Leung S, Snider J, et al. Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst 2009;101:736-50. https://doi.org/10.1093/jnci/djp082
  20. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;349:546-53. https://doi.org/10.1056/NEJMoa012782
  21. Jung J, Park H, Park J, Kim H. Accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration cytology for axillary staging in breast cancer. ANZ J Surg 2010;80:271-5. https://doi.org/10.1111/j.1445-2197.2009.05090.x
  22. Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ, et al. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol 2007;18:1133-44. https://doi.org/10.1093/annonc/mdm271
  23. Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ, et al. Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 2011;22:1736-47. https://doi.org/10.1093/annonc/mdr304
  24. Gianni L, Dafni U, Gelber RD, Azambuja E, Muehlbauer S, Goldhirsch A, et al. Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2-positive early breast cancer: a 4-year follow-up of a randomised controlled trial. Lancet Oncol 2011;12:236-44. https://doi.org/10.1016/S1470-2045(11)70033-X
  25. Caudle AS, Yu TK, Tucker SL, Bedrosian I, Litton JK, Gonzalez-Angulo AM, et al. Local-regional control according to surrogate markers of breast cancer subtypes and response to neoadjuvant chemotherapy in breast cancer patients undergoing breast conserving therapy. Breast Cancer Res 2012;14:R83. https://doi.org/10.1186/bcr3198
  26. Basu S, Chen W, Tchou J, Mavi A, Cermik T, Czerniecki B, et al. Comparison of triple-negative and estrogen receptor-positive/progesterone receptor-positive/HER2-negative breast carcinoma using quantitative fluorine-18 fluorodeoxyglucose/positron emission tomography imaging parameters: a potentially useful method for disease characterization. Cancer 2008;112:995-1000. https://doi.org/10.1002/cncr.23226
  27. Majid AS, de Paredes ES, Doherty RD, Sharma NR, Salvador X. Missed breast carcinoma: pitfalls and pearls. Radiographics 2003;23:881-95. https://doi.org/10.1148/rg.234025083
  28. Pamilo M, Soiva M, Lavast EM. Real-time ultrasound, axillary mammography, and clinical examination in the detection of axillary lymph node metastases in breast cancer patients. J Ultrasound Med 1989;8:115-20. https://doi.org/10.7863/jum.1989.8.3.115
  29. Lernevall A. Imaging of axillary lymph nodes. Acta Oncol 2000;39:277-81. https://doi.org/10.1080/028418600750013014
  30. Luciani A, Itti E, Rahmouni A, Meignan M, Clement O. Lymph node imaging: basic principles. Eur J Radiol 2006;58:338-44. https://doi.org/10.1016/j.ejrad.2005.12.038

Cited by

  1. The role of fluorodeoxyglucose-PET/computed tomography as a predictor of breast cancer characteristics and prognosis vol.43, pp.1, 2018, https://doi.org/10.1097/mnm.0000000000001476