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Gilardi L, Airò Farulla LS, Curigliano G, Corso G, Leonardi MC, Ceci F. FDG and Non-FDG Radiopharmaceuticals for PET Imaging in Invasive Lobular Breast Carcinoma. Biomedicines 2023; 11:biomedicines11051350. [PMID: 37239021 DOI: 10.3390/biomedicines11051350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most frequent histological type of breast cancer (BC) and includes a heterogeneous spectrum of diseases with unique characteristics, especially the infiltrative growth pattern and metastatic spread. [18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is extensively used in oncology and BC patient evaluation. Its role in ILCs is considered suboptimal due to its low FDG avidity. Therefore, ILCs could benefit from molecular imaging with non-FDG tracers that target other specific pathways, contributing to precision medicine. This narrative review aims to summarize the current literature on the use of FDG-PET/CT in ILC and to discuss future opportunities given by the development of innovative non-FDG radiotracers.
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Affiliation(s)
- Laura Gilardi
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lighea Simona Airò Farulla
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Division of New Drugs and Early Drug Development, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
| | | | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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2
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Bonnin D, Ladoire S, Briot N, Bertaut A, Drouet C, Cochet A, Alberini JL. Performance of [18F]FDG-PET/CT Imaging in First Recurrence of Invasive Lobular Carcinoma. J Clin Med 2023; 12:jcm12082916. [PMID: 37109252 PMCID: PMC10144846 DOI: 10.3390/jcm12082916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Invasive lobular carcinoma accounts for 10 to 15% of all breast cancers. The first objective of this retrospective study was to assess the diagnostic performance of FDG-PET/CT scanning in women previously treated for invasive lobular carcinoma with suspected first recurrence. The secondary objectives were to evaluate the impact of PET/CT in a change in treatment and its prognostic value on specific survival. METHODS Patients in whom a PET/CT scan was performed from January 2011 to July 2019 in our Cancer Research Center were enrolled. Recurrence was suspected based on clinical symptoms, abnormal findings on conventional imaging, and/or elevated tumor markers. The diagnosis of recurrence was established by the oncologist after integration of all clinical, biological, histological, imaging, and follow-up data. Prognostic factors of recurrence as predicted by PET were determined using univariate logistic regression. KI67, mitotic index, or grade of mitosis were tested. Survival curves were compared using the log-rank test. Sixty-four patients (mean age: 60.3; SD = 12.4 years) were enrolled. The average time from initial diagnosis of the primary tumor to suspicion of recurrence was 5.2 ± 4.1 years. Forty-eight patients (75%) were judged to have recurrence by the oncologist: 7 local and 41 metastatic, with mainly bone (n = 24), lymph node (n = 14) and liver (n = 10) metastases. RESULTS Sensitivity, specificity, and positive and negative predictive values of PET/CT to predict recurrence were, respectively: 87%, 87%, 95%, and 70%. SUVmax at recurrence sites was generally high (mean: 6.4; SD = 2.9). False negative PET/CT results occurred with local (n = 2), peritoneal (n = 2), meningeal (n = 1), or bladder (n = 1) recurrences. In 40 patients with available histopathological data from suspected sites of recurrence, 30 PET/CT were true positive. In four patients, primary lung (n = 1) or gastric (n = 1) tumors or lymphomas (n = 2) were found. The detection of a recurrence resulted in a change in treatment in 44/48 patients (92%). No association between recurrence predicted by PET and biological biomarkers was found. Median specific survival appears shorter in patients with metastatic recurrence versus patients with local or no recurrence on PET/CT (p = 0.067). CONCLUSIONS FDG-PET/CT is an effective and reliable tool for the detection of invasive lobular carcinoma recurrence, although certain recurrence sites specific to this histological type can impair its diagnostic performance.
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Affiliation(s)
- David Bonnin
- Department of Nuclear Medicine, Georges Francois Leclerc Research Cancer Center, 21079 Dijon, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Georges Francois Leclerc Research Cancer Center; 21000 Dijon, France
- Research Center INSERM LNC-UMR1231, 21000 Dijon, France
| | - Nathalie Briot
- Department of Methodology and Biostatistics, Georges-Francois Leclerc Research Cancer Center, 21000 Dijon, France
| | - Aurélie Bertaut
- Department of Methodology and Biostatistics, Georges-Francois Leclerc Research Cancer Center, 21000 Dijon, France
| | - Clément Drouet
- Department of Nuclear Medicine, Georges Francois Leclerc Research Cancer Center, 21079 Dijon, France
| | - Alexandre Cochet
- Department of Nuclear Medicine, Georges Francois Leclerc Research Cancer Center, 21079 Dijon, France
- Laboratoire ICMUB, University Bourgogne, 21000 Dijon, France
| | - Jean-Louis Alberini
- Department of Nuclear Medicine, Georges Francois Leclerc Research Cancer Center, 21079 Dijon, France
- Laboratoire ICMUB, University Bourgogne, 21000 Dijon, France
- Centre Georges-Francois Leclerc, 1 rue du Pr Marion, 21079 Dijon CEDEX, France
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3
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Li Z, Gao Y, Gong H, Feng W, Ma Q, Li J, Lu X, Wang X, Lei J. Different Imaging Modalities for the Diagnosis of Axillary Lymph Node Metastases in Breast Cancer: A Systematic Review and Network Meta-Analysis of Diagnostic Test Accuracy. J Magn Reson Imaging 2022; 57:1392-1403. [PMID: 36054564 DOI: 10.1002/jmri.28399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Accurate diagnosis of axillary lymph node metastasis (ALNM) of breast cancer patients is important to guide local and systemic treatment. PURPOSE To evaluate the diagnostic performance of different imaging modalities for ALNM in patients with breast cancer. STUDY TYPE Systematic review and network meta-analysis (NMA). SUBJECTS Sixty-one original articles with 8011 participants. FIELD STRENGTH 1.5 T and 3.0 T. ASSESSMENT We used the QUADAS-2 and QUADAS-C tools to assess the risk of bias in eligible studies. The identified articles assessed ultrasonography (US), MRI, mammography, ultrasound elastography (UE), PET, CT, PET/CT, scintimammography, and PET/MRI. STATISTICAL ANALYSIS We used random-effects conventional meta-analyses and Bayesian network meta-analyses for data analyses. We used sensitivity and specificity, relative sensitivity and specificity, superiority index, and summary receiver operating characteristic curve (SROC) analysis to compare the diagnostic value of different imaging modalities. RESULTS Sixty-one studies evaluated nine imaging modalities. At patient level, sensitivities of the nine imaging modalities ranged from 0.27 to 0.84 and specificities ranged from 0.84 to 0.95. Patient-based NMA showed that UE had the highest superiority index (5.95) with the highest relative sensitivity of 1.13 (95% confidence interval [CI]: 0.93-1.29) among all imaging methods when compared to US. At lymph node level, MRI had the highest superiority index (6.91) with highest relative sensitivity of 1.13 (95% CI: 1.01-1.23) and highest relative specificity of 1.11 (95% CI: 0.95-1.23) among all imaging methods when compared to US. SROCs also showed that UE and MRI had the largest area under the curve (AUC) at patient level and lymph node level of 0.92 and 0.94, respectively. DATA CONCLUSION UE and MRI may be superior to other imaging modalities in the diagnosis of ALNM in breast cancer patients at the patient level and the lymph node level, respectively. Further studies are needed to provide high-quality evidence to validate our findings. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Zhifan Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Hengxin Gong
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Wen Feng
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Qinqin Ma
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Jinkui Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Xingru Lu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaohui Wang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Junqiang Lei
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
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4
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Wu J, Zhang X, Jia Z, Zhou X, Qi R, Ji H, Sun J, Sun C, Teng Z, Lu G, Chen X. Combined 18F-FDG and 18F-Alfatide II PET May Predict Luminal B (HER2 Negative) Subtype and Nonluminal Subtype of Invasive Breast Cancer. Mol Pharm 2022; 19:3405-3411. [PMID: 35972444 DOI: 10.1021/acs.molpharmaceut.2c00547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Noninvasive PET molecular imaging using radiopharmaceuticals is important to classify breast cancer in the clinic. The aim of this study was to investigate the combination of 18F-FDG and 18F-Alfatide II for predicting molecular subtypes of invasive breast cancer. Forty-four female patients with clinically suspected breast cancer were recruited and underwent 18F-FDG and 18F-Alfatide II PET/CT within a week. Tracer uptake in breast lesions was assessed using the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and SUVmax ratio of 18F-FDG to 18F-Alfatide II (FAR). Invasive breast cancer lesions were further classified as luminal A subtype, luminal B subtype, human epidermal growth factor receptor-2 (HER2) overexpressing subtype, and triple negative subtype according to the expression of the estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67. Among 44 patients, 35 patients were pathologically diagnosed with invasive breast cancer. The SUVmax and SUVmean of 18F-FDG were significantly higher in the ER-negative group than those in the ER-positive group, as well as in the PR-negative group than those in the PR-positive group. However, the SUVmax and SUVmean of 18F-Alfatide II were higher in the ER-positive group and the PR-positive group. By combining 18F-FDG and 18F-Alfatide II, the FAR was lower in the ER-positive group and the PR-positive group. The HER2 overexpressing subtype showed the highest SUVmax and SUVmean for 18F-FDG while the luminal B (HER2 negative) subtype revealed the lowest values. The luminal B (HER2 negative) subtype showed the highest 18F-Alfatide II SUVmax, while the triple negative subtype showed the lowest 18F-Alfatide II SUVmax. The FAR was the lowest in the luminal B (HER2 negative) subtype and much higher in the HER2 overexpressing and triple negative subtypes. FAR less than 1 predicted the luminal B (HER2 negative) subtype with high specificity (93.1%) and NPV (90%). FAR greater than 3 predicted the HER2 overexpressing subtype and triple negative subtype (namely, the nonluminal subtype) with very high specificity (100%) and PPV (100%). In summary, FAR, the combined PET parameter of 18F-FDG and 18F-Alfatide II, can be used to predict molecular subtypes of invasive breast cancer, especially for the luminal B (HER2 negative) subtype and the nonluminal subtype.
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Affiliation(s)
- Jiang Wu
- Department of Nuclear Medicine, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
| | - Xiaoyi Zhang
- Department of Nuclear Medicine, Changshu No.2 People's Hospital, Changshu 215500, China
| | - Zhijun Jia
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210008, China
| | - Xiaodie Zhou
- Department of Pathology, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
| | - Rongxin Qi
- Department of Nuclear Medicine, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
| | - Hengshan Ji
- Department of Nuclear Medicine, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
| | - Jingjing Sun
- Department of Nuclear Medicine, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
| | - Chuanjin Sun
- Department of Nuclear Medicine, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
| | - Zhaogang Teng
- Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials, Jiangsu National Synergetic Innovation Centre for Advanced Materials, Nanjing University of Posts & Telecommunications, Nanjing 210023, China
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, China
| | - Xiaoyuan Chen
- Departments of Diagnostic Radiology, and Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore.,Departments of Chemical and Biomolecular Engineering, and Biomedical Engineering, National University of Singapore, Singapore 117599, Singapore.,Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore.,Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117599, Singapore
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5
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Le-Petross HT, Slanetz PJ, Lewin AA, Bao J, Dibble EH, Golshan M, Hayward JH, Kubicky CD, Leitch AM, Newell MS, Prifti C, Sanford MF, Scheel JR, Sharpe RE, Weinstein SP, Moy L. ACR Appropriateness Criteria® Imaging of the Axilla. J Am Coll Radiol 2022; 19:S87-S113. [PMID: 35550807 DOI: 10.1016/j.jacr.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/26/2022]
Abstract
This publication reviews the current evidence supporting the imaging approach of the axilla in various scenarios with broad differential diagnosis ranging from inflammatory to malignant etiologies. Controversies on the management of axillary adenopathy results in disagreement on the appropriate axillary imaging tests. Ultrasound is often the appropriate initial imaging test in several clinical scenarios. Clinical information (such as age, physical examinations, risk factors) and concurrent complete breast evaluation with mammogram, tomosynthesis, or MRI impact the type of initial imaging test for the axilla. Several impactful clinical trials demonstrated that selected patient's population can received sentinel lymph node biopsy instead of axillary lymph node dissection with similar overall survival, and axillary lymph node dissection is a safe alternative as the nodal staging procedure for clinically node negative patients or even for some node positive patients with limited nodal tumor burden. This approach is not universally accepted, which adversely affect the type of imaging tests considered appropriate for axilla. This document is focused on the initial imaging of the axilla in various scenarios, with the understanding that concurrent or subsequent additional tests may also be performed for the breast. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Huong T Le-Petross
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Director of Breast MRI.
| | - Priscilla J Slanetz
- Panel Chair, Boston University School of Medicine, Boston, Massachusetts; Vice Chair of Academic Affairs, Department of Radiology, Boston Medical Center; Associate Program Director, Diagnostic Radiology Residency, Boston Medical Center; Program Director, Early Career Faculty Development Program, Boston University Medical Campus; Co-Director, Academic Writing Program, Boston University Medical Group; President, Massachusetts Radiological Society; Vice President, Association of University Radiologists
| | - Alana A Lewin
- Panel Vice-Chair, New York University School of Medicine, New York, New York; Associate Program Director, Breast Imaging Fellowship, NYU Langone Medical Center
| | - Jean Bao
- Stanford University Medical Center, Stanford, California; Society of Surgical Oncology
| | | | - Mehra Golshan
- Smilow Cancer Hospital, Yale Cancer Center, New Haven, Connecticut; American College of Surgeons; Deputy CMO for Surgical Services and Breast Program Director, Smilow Cancer Hospital at Yale; Executive Vice Chair for Surgery, Yale School of Medicine
| | - Jessica H Hayward
- University of California San Francisco, San Francisco, California; Co-Fellowship Direction, Breast Imaging Fellowship
| | | | - A Marilyn Leitch
- UT Southwestern Medical Center, Dallas, Texas; American Society of Clinical Oncology
| | - Mary S Newell
- Emory University Hospital, Atlanta, Georgia; Interim Director, Division of Breast Imaging at Emory; ACR: Chair of BI-RADS; Chair of PP/TS
| | - Christine Prifti
- Boston Medical Center, Boston, Massachusetts, Primary care physician
| | | | | | | | - Susan P Weinstein
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania; Associate Chief of Radiology, San Francisco VA Health Systems
| | - Linda Moy
- Specialty Chair, NYU Clinical Cancer Center, New York, New York; Chair of ACR Practice Parameter for Breast Imaging, Chair ACR NMD
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18F-Alfatide II for the evaluation of axillary lymph nodes in breast cancer patients: comparison with 18F-FDG. Eur J Nucl Med Mol Imaging 2022; 49:2869-2876. [PMID: 35138445 DOI: 10.1007/s00259-021-05333-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE 18F-Alfatide II has been translated into clinical use and been proven to have good performance in identifying breast cancer. In this study, we investigated 18F-Alfatide II for evaluation of axillary lymph nodes (ALN) in breast cancer patients and compared the performance with 18F-FDG. METHODS A total of 44 female patients with clinically suspected breast cancer were enrolled and underwent 18F-Alfatide II and 18F-FDG PET/CT within a week. Tracer uptakes in ALN were evaluated by visual analysis, semi-quantitative analysis with maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and SUVmax ratio of target/non-target (T/NT). RESULTS Among 44 patients, 37 patients were pathologically diagnosed with breast cancer with metastatic (17 cases) or non-metastatic (20 cases) ALN. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of visual analysis were 70.6%, 90%, 81.1%, 85.7%, and 78.3% for 18F-Alfatide II, 64.7%, 90%, 78.4%, 84.6%, and 75% for 18F-FDG, respectively. By combining 18F-Alfatide II and 18F-FDG, the sensitivity significantly increased to 82.4%, the specificity was 85%, the accuracy increased to 83.8%, the PPV was 82.4%, and the NPV significantly increased to 85.0%. Three cases of luminal B subtype were false negative for both 18F-Alfatide II and 18F-FDG. The other 2 false negative cases of 18F-Alfatide II were triple-negative subtype and 3 false negative cases of 18F-FDG were luminal B subtype too. The AUCs of three semi-quantitative parameters (SUVmax, SUVmean, T/NT) for 18F-Alfatide II were between 0.8 and 0.9, whereas those for 18F-FDG were more than 0.9. 18F-Alfatide II T/NT had the highest Youden index (76.5%), specificity (100%), accuracy (89.2%), and PPV (100%) among these semi-quantitative parameters. 18F-Alfatide II uptake as well as 18F-FDG uptake in metastatic axillary lymph nodes (MALN) was significantly higher than that in benign axillary lymph nodes (BALN). Both 18F-Alfatide II and 18F-FDG did not show difference in primary tumor uptake irrespective of ALN status. CONCLUSION 18F-Alfatide II can be used in breast cancer patients to detect metastatic ALN, however, like 18F-FDG, with high specificity but relatively low sensitivity. The combination of 18F-Alfatide II and 18F-FDG can significantly improve sensitivity and NPV. 18F-Alfatide II T/NT may serve as the most important semi-quantitative parameter to evaluate ALN.
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Kasem J, Wazir U, Mokbel K. Sensitivity, Specificity and the Diagnostic Accuracy of PET/CT for Axillary Staging in Patients With Stage I-III Cancer: A Systematic Review of The Literature. In Vivo 2021; 35:23-30. [PMID: 33402446 DOI: 10.21873/invivo.12228] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND/AIM Axillary lymph node (ALN) status plays a key role in the staging of breast cancer. Positron Emission Tomography/Computed Tomography (PET/CT) using 18-Fluorodeoxyglucose (18FDG) can visualise ALN metastasis. However, its utility compared to current methods is unclear. We systematically reviewed the role of 18FDG PET/CT in breast cancer staging. MATERIALS AND METHODS PubMed, Ovid and Cochrane were searched systematically up until August 2020. Included papers had true positive (TP), false positive (FP), true negative (TN) and false negative (FN) rates, sensitivity, specificity, accuracy, positive (PPV) and negative predictive value (NPV). RESULTS Nine studies (n=1486) were included, showing: i) sensitivity=52.2%, ii) specificity=91.6%, iii) PPV=77.8%, iv) NPV=77.2, and v) accuracy=77.3%. CONCLUSION 18FDG-PET/CT has a low sensitivity but high specificity for ALN disease. Therefore, ultrasound-guided biopsy could be considered in a positive CT/PET. Modest accuracy prohibits the use of 18FDG-PET/CT alone in axillary staging. Prospective research using standardised protocols and quantitative cut-off points is warranted.
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Affiliation(s)
- Judi Kasem
- London Breast Institute, Princess Grace Hospital, London, U.K
| | - Umar Wazir
- London Breast Institute, Princess Grace Hospital, London, U.K.,Department of General Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Kefah Mokbel
- London Breast Institute, Princess Grace Hospital, London, U.K.;
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8
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Zhang X, Liu Y, Luo H, Zhang J. PET
/
CT
and
MRI
for Identifying Axillary Lymph Node Metastases in Breast Cancer Patients: Systematic Review and Meta‐Analysis. J Magn Reson Imaging 2020; 52:1840-1851. [PMID: 32567090 DOI: 10.1002/jmri.27246] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Xin Zhang
- Department of Breast Surgery, Sichuan Cancer Hospital and Research Institute, Sichuan Cancer Center, School of Medicine University of Electronic Science and Technology Chengdu China
| | - Yuanyuan Liu
- Division of Radiology, Sichuan Cancer Hospital and Research Institute, Sichuan Cancer Center, School of Medicine University of Electronic Science and Technology Chengdu China
| | - Hongbing Luo
- Division of Radiology, Sichuan Cancer Hospital and Research Institute, Sichuan Cancer Center, School of Medicine University of Electronic Science and Technology Chengdu China
| | - Jianhui Zhang
- Department of Breast Surgery, Sichuan Cancer Hospital and Research Institute, Sichuan Cancer Center, School of Medicine University of Electronic Science and Technology Chengdu China
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9
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18F-fluorodeoxyglucose PET/computed tomography in locoregional staging and assessment of biological and clinical aggressiveness of breast cancer subtypes. Nucl Med Commun 2020; 40:1043-1050. [PMID: 31425343 DOI: 10.1097/mnm.0000000000001073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We aimed to evaluate the availability of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in initial axillary lymph node (ALN) staging in breast cancer. The secondary objective is to evaluate the role of FDG PET/CT as a pretest in sentinel lymph node biopsy vs. axillary lymph node dissection when predicting disease aggressiveness. METHODS The study evaluated retrospectively 194 breast cancer patients who underwent preoperative 18F-FDG. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FDG PET/CT for ALN metastases were confirmed with histopathology as the gold standard. RESULTS The value of the area under curve (AUC), sensitivity and specificity for ALN metastases were determined as 0.847, 78.8% and 92.6%, respectively. The cut-off value of the maximum standardized uptake value (SUVmax) for metastatic ALN detection was calculated as 1.79. PPV, NPV and the accuracy of 18F-FDG PET/CT were 0.933 (93.3%), 0.75 (75%) and 0.837 (83.7%), respectively. The SUVmax value of the primary lesion was significantly correlated with grade, estrogen receptor (ER) status, progesterone receptor (PR) status, SUVmax value of metastatic ALN, Her-2 status and Ki-67 level. Molecular subtypes revealed no statistically significant difference in terms of mean SUVmax value. CONCLUSION High values of AUC, sensitivity, specificity, NPV and PPV encourage utilization of PET/CT for locoregional staging of nonmetastatic breast carcinoma. The significant correlation between the primary tumor SUVmax value and grade, ER status, PR status and Ki-67 level increases the prognostic predictive value of the preoperative PET/CT.
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10
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Abstract
Molecular imaging with positron emission tomography (PET) using tumour-seeking radiopharmaceuticals has gained wide acceptance in oncology with many clinical applications. The hybrid imaging modality PET/CT (computed tomography) allows assessing molecular as well as morphologic information at the same time. Therefore, PET/CT represents an efficient tool for whole-body staging and re-staging within one imaging modality. In oncology, the glucose analogue 18-F-fluorodeoxyglucose (FDG) is the most widely used PET/CT radiopharmaceutical in clinical routine. FDG PET and FDG PET/CT have been used for staging and re-staging of tumour patients in numerous studies. This chapter will discuss the use and the main indications of FDG PET/CT in oncology with special emphasis on lung cancer, lymphoma, head and neck cancer, melanoma and breast cancer (among other tumour entities). A review of the current literature is given with respect to primary diagnosis, staging and diagnosis of recurrent disease. Besides its integral role in diagnosis, staging and re-staging of disease in oncology, there is increasing evidence that FDG PET/CT can be used for therapy response assessment (possibly influencing therapeutic management and treatment planning) by evaluating tumour control, which will also be discussed in this chapter.
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Affiliation(s)
- Juliane Becker
- Department of Nuclear Medicine, University Medicine Rostock, Gertrudenplatz 1, 18057, Rostock, Germany
| | - Sarah M Schwarzenböck
- Department of Nuclear Medicine, University Medicine Rostock, Gertrudenplatz 1, 18057, Rostock, Germany
| | - Bernd J Krause
- Department of Nuclear Medicine, University Medicine Rostock, Gertrudenplatz 1, 18057, Rostock, Germany.
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11
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The use of single-photon emission computed tomography-computed tomography in detecting multiple metastatic lymph nodes in patients with breast cancer. Nucl Med Commun 2019; 40:169-174. [PMID: 30507749 DOI: 10.1097/mnm.0000000000000954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of the present study was to determine the accuracy of single-photon emission computed tomography-computed tomography (SPECT-CT) with technetium-99m-sestamibi (Tc-MIBI) for detecting multiple (>2 nodes) axillary lymph node involvement in patients with breast cancer (BC). PATIENTS AND METHODS A total of 184 women with BC were examined. Clinically, axillary lymph nodes were classified as N0 in all cases. Patients underwent SPECT-CT breast and axillary region imaging 10-15 min after a 740 mBq intravenous injection of Tc-MIBI. SPECT-CT data were then verified by definitive histopathological examination (sentinel-node biopsy and/or axillary lymph node dissection were used as reference standard). Diagnostic values of different CT and SPECT signs of multiple (>2) lymph node involvement were evaluated. RESULTS Histological examination of excised lymph nodes showed metastatic involvement in 62 (33.7%) out of 184 patients. In fact, 25 (13.6%) patients had more than two lymph node involvements. In another 37 (20.1%) cases the metastasis was revealed in one or two sentinel lymph nodes only. The main SPECT-CT criteria of multiple (>2) lymph node involvement were as follows: the maximum size of the primary tumor (>20 mm), lymph node dimensions (>12 mm along the long axis and >10 mm along the short axis), nodal cortical thickness (>4 mm), round shape, solid structure, quantity of identified abnormal lymph nodes (>1), and intensity of tracer uptake. The developed integrated model offers the possibility to exclude multiple lymph node metastasis (>2) in BC patients with a probability of 99%. CONCLUSION This single-center study showed that in patients with BC, a combination of functional and anatomical data that were obtained by using SPECT-CT with Tc-MIBI can significantly improve detectability of multiple (>2) axillary metastases.
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