caa a22 4500 397562837 CHVBK 20180308164820.0 cr unu---uuuuu 161202e19960904xx s 000 0 eng 10.1093/jnci/88.17.1204 doi (NATIONALLICENCE)oxford-10.1093/jnci/88.17.1204 Assessment of Axillary Lymph Node Involvement in Breast Cancer Patients With Positron Emission Tomography Using Radiolabeled 2-(Fluorine-18)-fluoro-2-deoxy-D-glucose [Elektronische Daten] [Norbert Avril, Jörg Dose, Fritz Jänicke, Sibylle Ziegler, Wolfgang Römer, Wolfgang Weber, Michael Herz, Walter Nathrath, Henner Graeff, Markus Schwaiger] Background: The presence of metastatic tumor cells in the axillary lymph nodes is an important factor when deciding whether or not to treat breast cancer patients with adjuvant therapy. Positron emission tomography (PET) imaging with the radiolabeled glucose analogue 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (F-18 FDG) has been used to visualize primary breast tumors as well as bone and soft-tissue metas-tases. Purpose: This study was undertaken to evaluate before surgery the diagnostic accuracy of PET for detection of axillary lymph node metastases in patients suspected of having breast cancer. Methods: Women who were scheduled to undergo surgery for newly discovered, suspected breast cancers were referred for PET imaging of the axilla region. The women were first clinically examined to determine the status of their axillary lymph nodes (i.e., presence or absence of metastases). Fifty-one women were intravenously administered F-18 FDG and were studied by PET imaging. Attenuation-corrected transaxial and coronal images were visually evaluated by two nuclear medicine physicians (blinded to the patient's medical history) for foci of increased F-18 FDG uptake in the axilla region. All patients underwent surgery for their suspected breast cancers. Axillary lymph node dissection was also performed on all patients with breast cancer, with the exception of four patients who received primary chemotherapy for locally advanced breast cancer. A single pathologist analyzed breast tumor and lymph node tissue specimens. Results: The overall sensitivity (i.e., the ability of the test to detect disease in patients who actually have disease) and specificity (i.e., the ability of the test to rule out disease in patients who do not have disease) of this method for detection of axillary lymph node metastases in these patients were 79% and 96%, respectively. When only patients with primary breast tumors larger than 2 cm in diameter (more advanced than stage pT1; n = 23) were considered, the sensitivity of axillary PET imaging increased to 94%, and the corresponding specificity was 100%. Lymph node metastases could not be identified in four of six patients with small primary breast cancers (stage pT1), resulting in a sensitivity of only 33%. Axillary PET imaging provided additional diagnostic information in 12 (29%) of 41 breast cancer patients with regard to the extension of disease to other sites (i.e., other lymph nodes, skin, bone, and lung). Conclusions: PET imaging with F-18 FDG allowed accurate and noninvasive detection of axillary lymph node metastases, primarily in patients with breast cancer more advanced than stage pT1. Detection of micrometastases and small tumor-infiltrated lymph nodes is limited by the currently achievable spatial resolution of PET imaging. Implications: In clinical practice, PET imaging cannot substitute for histopathologic analysis in detecting axillary lymph node metastases in breast cancer patients. PET imaging, however, improves the preoperative staging of the disease in breast cancer patients and, therefore, might alter therapeutic regimen options. [J Natl Cancer Inst 1996;88:1204-9] © Oxford University Press ARTICLE nationallicence Avril Norbert Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut Dose Jörg Department of Gynecology, Technische Universität München Munich, Federal Republic of Germany aut Jänicke Fritz Department of Gynecology, Technische Universität München Munich, Federal Republic of Germany aut Ziegler Sibylle Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut Römer Wolfgang Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut Weber Wolfgang Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut Herz Michael Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut Nathrath Walter Department of Pathology, Technische Universität München Munich, Federal Republic of Germany aut Graeff Henner Department of Gynecology, Technische Universität München Munich, Federal Republic of Germany aut Schwaiger Markus Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut JNCI: Journal of the National Cancer Institute Oxford University Press 88/17(1996-09-04), 1204-1209 0027-8874 88:17<1204 1996 88 jnci https://doi.org/10.1093/jnci/88.17.1204 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/jnci/88.17.1204 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Avril Norbert Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut NATIONALLICENCE 700 1- Dose Jörg Department of Gynecology, Technische Universität München Munich, Federal Republic of Germany aut NATIONALLICENCE 700 1- Jänicke Fritz Department of Gynecology, Technische Universität München Munich, Federal Republic of Germany aut NATIONALLICENCE 700 1- Ziegler Sibylle Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut NATIONALLICENCE 700 1- Römer Wolfgang Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut NATIONALLICENCE 700 1- Weber Wolfgang Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut NATIONALLICENCE 700 1- Herz Michael Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut NATIONALLICENCE 700 1- Nathrath Walter Department of Pathology, Technische Universität München Munich, Federal Republic of Germany aut NATIONALLICENCE 700 1- Graeff Henner Department of Gynecology, Technische Universität München Munich, Federal Republic of Germany aut NATIONALLICENCE 700 1- Schwaiger Markus Department of Nuclear Medicine, Technische Universität München Munich, Federal Republic of Germany aut NATIONALLICENCE 773 0- JNCI: Journal of the National Cancer Institute Oxford University Press 88/17(1996-09-04), 1204-1209 0027-8874 88:17<1204 1996 88 jnci Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford