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Sae-Lim C, Wu WP, Chang MC, Lai HW, Chen ST, Chou CT, Liao CY, Huang HI, Chen ST, Chen DR, Hung CL. Reliability of predicting low-burden (≤ 2) positive axillary lymph nodes indicating sentinel lymph node biopsy in primary operable breast cancer - a retrospective comparative study with PET/CT and breast MRI. World J Surg Oncol 2024; 22:12. [PMID: 38183069 PMCID: PMC10770957 DOI: 10.1186/s12957-023-03297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in early breast cancer patients with low-burden axillary metastasis (≤ 2 positive nodes). This study aimed to determine the diagnostic performances of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and breast magnetic resonance imaging in detecting axillary lymph node (ALN) metastases and the reliability to predict ALN burden. METHODS A total of 275 patients with primary operable breast cancer receiving preoperative PET/CT and upfront surgery from January 2001 to December 2022 in a single institution were enrolled. A total of 244 (88.7%) of them also received breast MRI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT and breast MRI were assessed. The predictive values to determine ALN burden were evaluated using radio-histopathological concordance. RESULTS PET/CT demonstrated a sensitivity of 53.4%, specificity of 82.1%, PPV of 65.5%, NPV of 73.5%, and accuracy of 70.9% for detecting ALN metastasis, and the corresponding values for MRI were 71.8%, 67.8%, 56%, 80.8%, and 69.2%, respectively. Combining PET/CT and MRI showed a significantly higher PPV than MRI (72.7% vs 56% for MRI alone, p = 0.037) and a significantly higher NPV than PET/CT (84% vs 73.5% for PET/CT alone, p = 0.041). For predicting low-burden axillary metastasis (1-2 positive nodes), the PPVs were 35.9% for PET/CT, 36.7% for MRI, and 55% for combined PET/CT and MRI. Regarding patients with 0-2 positive ALNs in imaging, who were indicated for SLNB, the predictive correctness was 96.1% for combined PET/CT and MRI, 95.7% for MRI alone, and 88.6% for PET/CT alone. CONCLUSIONS PET/CT and breast MRI exhibit high predictive values for identifying low-burden axillary metastasis in patients with operable breast cancer with ≦ 2 positive ALNs on imaging.
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Affiliation(s)
- Chayanee Sae-Lim
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wen-Pei Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Che Chang
- Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Wen Lai
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.
- Minimally Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan.
- Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan.
- Kaohsiung Medical University, Kaohsiung, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- Department of Surgery, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Shu-Tian Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
| | - Chen-Te Chou
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
- Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chiung-Ying Liao
- Department of Radiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsin-I Huang
- Department of Information Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Shou-Tung Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Dar-Ren Chen
- Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Che-Lun Hung
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
- Department of Computer Science and Communication Engineering, Providence University, Taichung, Taiwan
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Groheux D. Breast Cancer Systemic Staging (Comparison of Computed Tomography, Bone Scan, and 18F-Fluorodeoxyglucose PET/Computed Tomography). PET Clin 2023; 18:503-515. [PMID: 37268506 DOI: 10.1016/j.cpet.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
After an overview of the principles of bone scintigraphy, contrast-enhanced computed tomography (CE-CT) and 18F-fluorodeoxyglucose (FDG)-PET/CT, the advantages and limits of these modalities in the staging of breast cancer are discussed in this paper. CT and PET/CT are not optimal for delineating primary tumor volume, and PET is less efficient than the sentinel node biopsy to depict small axillary lymph node metastases. In large breast cancer tumor, FDG PET/CT is useful to show extra-axillary lymph nodes. FDG PET/CT is superior to bone scan and CE-CT in detecting distant metastases, and it results in a change of treatment plan in nearly 15% of patients.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM U976, HIPI, Paris, France; Centre d'Imagerie Radio-isotopique, La Rochelle, France.
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Lee HJ, Nguyen AT, Song MW, Lee JE, Park SB, Jeong WG, Park MH, Lee JS, Park I, Lim HS. Prediction of Residual Axillary Nodal Metastasis Following Neoadjuvant Chemotherapy for Breast Cancer: Radiomics Analysis Based on Chest Computed Tomography. Korean J Radiol 2023; 24:498-511. [PMID: 37271204 DOI: 10.3348/kjr.2022.0731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/30/2023] [Accepted: 04/30/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of chest computed tomography (CT)-based qualitative and radiomics models for predicting residual axillary nodal metastasis after neoadjuvant chemotherapy (NAC) for patients with clinically node-positive breast cancer. MATERIALS AND METHODS This retrospective study included 226 women (mean age, 51.4 years) with clinically node-positive breast cancer treated with NAC followed by surgery between January 2015 and July 2021. Patients were randomly divided into the training and test sets (4:1 ratio). The following predictive models were built: a qualitative CT feature model using logistic regression based on qualitative imaging features of axillary nodes from the pooled data obtained using the visual interpretations of three radiologists; three radiomics models using radiomics features from three (intranodal, perinodal, and combined) different regions of interest (ROIs) delineated on pre-NAC CT and post-NAC CT using a gradient-boosting classifier; and fusion models integrating clinicopathologic factors with the qualitative CT feature model (referred to as clinical-qualitative CT feature models) or with the combined ROI radiomics model (referred to as clinical-radiomics models). The area under the curve (AUC) was used to assess and compare the model performance. RESULTS Clinical N stage, biological subtype, and primary tumor response indicated by imaging were associated with residual nodal metastasis during the multivariable analysis (all P < 0.05). The AUCs of the qualitative CT feature model and radiomics models (intranodal, perinodal, and combined ROI models) according to post-NAC CT were 0.642, 0.812, 0.762, and 0.832, respectively. The AUCs of the clinical-qualitative CT feature model and clinical-radiomics model according to post-NAC CT were 0.740 and 0.866, respectively. CONCLUSION CT-based predictive models showed good diagnostic performance for predicting residual nodal metastasis after NAC. Quantitative radiomics analysis may provide a higher level of performance than qualitative CT features models. Larger multicenter studies should be conducted to confirm their performance.
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Affiliation(s)
- Hyo-Jae Lee
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Anh-Tien Nguyen
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Myung Won Song
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seol Bin Park
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Won Gi Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ji Shin Lee
- Department of Pathology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Ilwoo Park
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju, Korea
- Department of Data Science, Chonnam National University, Gwangju, Korea
| | - Hyo Soon Lim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
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Ozcan C, Dag A, Arslan B, Ozcan PP, Ustun RO, Turkegun M. Axillary Lymph Nodes in Breast Cancer Patients After COVID-19 Vaccine. Indian J Surg 2023:1-6. [PMID: 37361395 PMCID: PMC10181920 DOI: 10.1007/s12262-023-03804-1] [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: 11/08/2022] [Accepted: 05/01/2023] [Indexed: 06/28/2023] Open
Abstract
One of the side effects of vaccines used to end the COVID-19 epidemic is non-specifically enlarged axillary lymph nodes. Such lymphadenopathy detected during clinical examination of breast cancer patients may require additional imaging or interventional procedures that should not normally be performed. This study has been designed to estimate the incidence of palpable enlarged axillary lymph node in breast cancer patients who had received COVID-19 vaccination in the past 3 months in the same arm as compared to those without vaccination. Breast cancer patients admitted to M.U. Medical Faculty Breast polyclinic between January 2021 and March 2022 were screened, and clinical staging was performed after thorough clinical examination. Among these patients with suspected enlarged axillary lymph node and those undergoing sentinel lymph node biopsy (SLNB), they were divided into two groups as vaccinated and unvaccinated. Age, menopausal status, tumor size, tumor location, surgery, pathology results, hormonal receptor status, and SLNB results were statistically compared with groups. There was no significant difference between groups in terms of age, menopause, tumor size, tumor location, surgery, pathological results, and hormone receptor status. The SLNB being reported as reactive only was 89.1% in the vaccinated group and 73.2% in the non-vaccinated group which was statistically significant different. Reactive lymph nodes were commonly found with an excess of 16% in patients who had received COVID-19 vaccination in the past 3 months. This required caution and additional examination of the axillary lymph nodes in this period.
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Affiliation(s)
- Cumhur Ozcan
- Department of General Surgery, Medical Faculty of Mersin University, Mersin, Turkey
| | - Ahmet Dag
- Department of General Surgery, Medical Faculty of Mersin University, Mersin, Turkey
| | - Bilal Arslan
- Department of General Surgery, Medical Faculty of Mersin University, Mersin, Turkey
| | - Pınar Pelin Ozcan
- Department of Nuclear Medicine, Medical Faculty of Mersin University, Mersin, Turkey
| | - Recep Okan Ustun
- Departman of Plastic Reconstructive and Aesthetic Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Merve Turkegun
- Department of Biostatistics and Medical Informatics, Medical Faculty of Mersin University, Mersin, Turkey
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The Value of 320-Slice Spiral Computed Tomography Perfusion Imaging in Staging and Long-Term Dynamic Evaluation of Breast Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7442123. [PMID: 35912154 PMCID: PMC9334064 DOI: 10.1155/2022/7442123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
The value of 320-slice spiral computed tomography (CT) perfusion imaging in staging and long-term dynamic evaluation of breast cancer was explored. 120 breast cancer patients who underwent preoperative CT examination and were confirmed by surgery and pathology were selected. All patients underwent preoperative TNM staging of breast cancer, with 120 cases in each stage. According to the results of 320-slice spiral CT, the postoperative pathology and surgical methods were compared and analyzed. CT diagnosis of breast cancer showed that T1 sensitivity was 71% and accuracy was 61%, T2 sensitivity was 74% and accuracy was 64%, T3 sensitivity was 94% and the accuracy was 84%, and the T4 sensitivity was 100% and the accuracy was 91%. The sensitivity of N1 stage was 71%, and the accuracy was 61%; and the sensitivity of N2 ~ N3 stage was 81%, and the accuracy was 76%. There were 7 cases of M1 with distant metastasis, the sensitivity was 71%, and the accuracy was 71%. At T1 stage, blood flow (BF) was 39.2 ± 16.7 mL/min/100 g, blood volume (BV) was 2.66 ± 1.4 mL/100 g, mean transit time (MTT) was 8.16 ± 2.7 s, and permeability surface (PS) was 16.6 ± 9.7 mL/min/100 g. 320-slice spiral CT perfusion imaging technology provided a new diagnostic mode for everyone, which can quantitatively identify breast cancer with multiple parameters, which was of great significance for clinical auxiliary diagnosis.
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de Mooij CM, Samiei S, Mitea C, Lobbes MBI, Kooreman LFS, Heuts EM, Beets-Tan RGH, van Nijnatten TJA, Smidt ML. Axillary lymph node response to neoadjuvant systemic therapy with dedicated axillary hybrid 18F-FDG PET/MRI in clinically node-positive breast cancer patients: a pilot study. Clin Radiol 2022; 77:e732-e740. [PMID: 35850866 DOI: 10.1016/j.crad.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
AIM To investigate the diagnostic performance of dedicated axillary hybrid 18F-2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) in detecting axillary pathological complete response (pCR) following neoadjuvant systemic therapy (NST) in clinically node-positive breast cancer patients. MATERIALS AND METHODS Ten prospectively included clinically node-positive breast cancer patients underwent dedicated axillary hybrid 18F-FDG PET/MRI after completing NST followed by axillary surgery. PET images were reviewed by a nuclear medicine physician and coronal T1-weighted and T2-weighted MRI images by a radiologist. All axillary lymph nodes visible on PET/MRI were matched with those removed during axillary surgery. Diagnostic performance parameters were calculated based on patient-by-patient and node-by-node validation with histopathology of the axillary surgical specimen as the reference standard. RESULTS Six patients achieved axillary pCR at final histopathology. A total of 84 surgically harvested axillary lymph nodes were matched with axillary lymph nodes depicted on PET/MRI. Histopathological examination of the matched axillary lymph nodes resulted in 10 lymph nodes with residual axillary disease of which eight contained macrometastases and two micrometastases. The patient-by-patient analysis yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 25%, 100%, 100%, and 67%, respectively. The diagnostic performance parameters of the node-by-node analysis were 0%, 96%, 0%, and 88%, respectively. Excluding micrometastases from the node-by-node analysis increased the negative predictive value to 90%. CONCLUSION This pilot study suggests that the negative predictive value and sensitivity of dedicated axillary 18F-FDG PET/MRI are insufficiently accurate to detect axillary pCR or exclude residual axillary disease following NST in clinically node-positive breast cancer patients.
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Affiliation(s)
- C M de Mooij
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - S Samiei
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - C Mitea
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | - L F S Kooreman
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Pathology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - E M Heuts
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - R G H Beets-Tan
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands; Department of Radiology, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - M L Smidt
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
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Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
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Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Abel F, Landsmann A, Hejduk P, Ruppert C, Borkowski K, Ciritsis A, Rossi C, Boss A. Detecting Abnormal Axillary Lymph Nodes on Mammograms Using a Deep Convolutional Neural Network. Diagnostics (Basel) 2022; 12:diagnostics12061347. [PMID: 35741157 PMCID: PMC9221636 DOI: 10.3390/diagnostics12061347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to determine the feasibility of a deep convolutional neural network (dCNN) to accurately detect abnormal axillary lymph nodes on mammograms. In this retrospective study, 107 mammographic images in mediolateral oblique projection from 74 patients were labeled to three classes: (1) “breast tissue”, (2) “benign lymph nodes”, and (3) “suspicious lymph nodes”. Following data preprocessing, a dCNN model was trained and validated with 5385 images. Subsequently, the trained dCNN was tested on a “real-world” dataset and the performance compared to human readers. For visualization, colored probability maps of the classification were calculated using a sliding window approach. The accuracy was 98% for the training and 99% for the validation set. Confusion matrices of the “real-world” dataset for the three classes with radiological reports as ground truth yielded an accuracy of 98.51% for breast tissue, 98.63% for benign lymph nodes, and 95.96% for suspicious lymph nodes. Intraclass correlation of the dCNN and the readers was excellent (0.98), and Kappa values were nearly perfect (0.93–0.97). The colormaps successfully detected abnormal lymph nodes with excellent image quality. In this proof-of-principle study in a small patient cohort from a single institution, we found that deep convolutional networks can be trained with high accuracy and reliability to detect abnormal axillary lymph nodes on mammograms.
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Groheux D. FDG-PET/CT for Primary Staging and Detection of Recurrence of Breast Cancer. Semin Nucl Med 2022; 52:508-519. [PMID: 35636977 DOI: 10.1053/j.semnuclmed.2022.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/04/2022] [Indexed: 12/22/2022]
Abstract
Breast cancer is the most frequent cancer diagnosed in women worldwide. Accurate baseline staging is necessary to plan optimal breast cancer management. Early detection and staging of recurrence are also essential for optimal therapeutic management. Hybrid FDG-PET/CT imaging offers high sensitivity in detecting extra axillary lymph nodes and distant metastases. Although FDG-PET/CT has some limitations for low proliferative tumors, low-grade tumors and for well-differentiated luminal breast cancer, PET/CT is useful for the initial staging of breast cancer, regardless of tumor phenotype (luminal, triple negative, or HER2+) and of tumor grade. Although FDG-PET/CT performs better for invasive ductal carcinoma (invasive carcinoma of no specific subtype), it is also helpful for staging invasive lobular carcinomas. At initial staging, FDG-PET/CT becomes very useful for staging from clinical stage IIB (T2N1 or T3N0). FDG-PET/CT could be useful in patients with clinical stage IIA (T1N1 or T2N0), but there is not enough strong evidence to recommend routine use in this subgroup. For clinical stage I (T1N0) patients, FDG-PET/CT offers no added value. In patients with recurrent breast cancer, FDG-PET/CT is more effective than conventional imaging in detecting locoregional or distant recurrence, whether suspected by clinical examination, conventional imaging, or elevation of a tumor marker (CA 15.3 or CEA). PET/CT is effective even in the presence of normal tumor markers. PET/CT is also a powerful imaging modality for performing a whole-body workup of a known recurrence and for determining whether or not the recurrence is isolated.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; University Paris-Diderot, INSERM U976, HIPI, Paris, France; Centre d'Imagerie Radio-isotopique, La Rochelle, France.
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Bhowmik A, Eskreis-Winkler S. Deep learning in breast imaging. BJR Open 2022; 4:20210060. [PMID: 36105427 PMCID: PMC9459862 DOI: 10.1259/bjro.20210060] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/04/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022] Open
Abstract
Millions of breast imaging exams are performed each year in an effort to reduce the morbidity and mortality of breast cancer. Breast imaging exams are performed for cancer screening, diagnostic work-up of suspicious findings, evaluating extent of disease in recently diagnosed breast cancer patients, and determining treatment response. Yet, the interpretation of breast imaging can be subjective, tedious, time-consuming, and prone to human error. Retrospective and small reader studies suggest that deep learning (DL) has great potential to perform medical imaging tasks at or above human-level performance, and may be used to automate aspects of the breast cancer screening process, improve cancer detection rates, decrease unnecessary callbacks and biopsies, optimize patient risk assessment, and open up new possibilities for disease prognostication. Prospective trials are urgently needed to validate these proposed tools, paving the way for real-world clinical use. New regulatory frameworks must also be developed to address the unique ethical, medicolegal, and quality control issues that DL algorithms present. In this article, we review the basics of DL, describe recent DL breast imaging applications including cancer detection and risk prediction, and discuss the challenges and future directions of artificial intelligence-based systems in the field of breast cancer.
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Affiliation(s)
- Arka Bhowmik
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Sarah Eskreis-Winkler
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
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Song D, Yang F, Zhang Y, Guo Y, Qu Y, Zhang X, Zhu Y, Cui S. Dynamic contrast-enhanced MRI radiomics nomogram for predicting axillary lymph node metastasis in breast cancer. Cancer Imaging 2022; 22:17. [PMID: 35379339 PMCID: PMC8981871 DOI: 10.1186/s40644-022-00450-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/01/2022] [Indexed: 12/20/2022] Open
Abstract
Purpose The goal of this study is to develop and validate a radiomics nomogram integrating the radiomics features from DCE-MRI and clinical factors for the preoperative diagnosis of axillary lymph node (ALN) metastasis in breast cancer patients. Procedures A total of 432 patients with breast cancer were enrolled in this retrospective study and divided into a training cohort (n = 296) and a validation cohort (n = 136). Radiomics features were extracted from the second phase of dynamic contrast enhanced (DCE) MRI images. The least absolute shrinkage and selection operator (LASSO) regression method was used to screen optimal features and construct a radiomics signature in the training cohort. Multivariable logistic regression analysis was used to establish a radiomics nomogram model based on the radiomics signature and clinical factors. The predictive performance of the nomogram was quantified with respect to discrimination and calibration, which was further evaluated in the independent validation cohort. Results Fourteen ALN metastasis-related features were selected to construct the radiomics signature, with an area under the curve (AUC) of 0.847 and 0.805 in the training and validation cohorts, respectively. The nomogram was established by incorporating the histological grade, multifocality, MRI report lymph node status and radiomics signature and showed good calibration and excellent performance for ALN detection (AUC of 0.907 and 0.874 in the training and validation cohorts, respectively). The decision curve, which demonstrated the radiomics nomogram, displayed promising clinical utility. Conclusions The radiomics nomogram can be used as a noninvasive and reliable tool to assist clinicians in accurately predicting ALN metastasis in breast cancer preoperatively. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00450-w.
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Affiliation(s)
- Deling Song
- Graduate Faculty, Hebei North University, 12 Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China.,Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang New District, Ouhai District, Wenzhou, 32000, Zhejiang, China
| | - Fei Yang
- Department of Radiology, The First Affiliated Hospital of Hebei North University, 12 Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China
| | - Yujiao Zhang
- Department of Radiology, The First Affiliated Hospital of Hebei North University, 12 Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China
| | - Yazhe Guo
- Department of Radiology, The First Affiliated Hospital of Hebei North University, 12 Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China
| | - Yingwu Qu
- Department of Radiology, The First Affiliated Hospital of Hebei North University, 12 Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China
| | - Xiaochen Zhang
- Department of Radiology, The First Affiliated Hospital of Hebei North University, 12 Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China
| | - Yuexiang Zhu
- Department of Radiology, The First Affiliated Hospital of Hebei North University, 12 Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China
| | - Shujun Cui
- Department of Radiology, The First Affiliated Hospital of Hebei North University, 12 Changqing Road, Qiaoxi District, Zhangjiakou, 075000, China.
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Ge I, Erbes T, Juhasz-Böss I. Prognostic value and management of regional lymph nodes in locoregional breast cancer recurrence: a systematic review of the literature. Arch Gynecol Obstet 2022; 306:943-957. [PMID: 35122159 PMCID: PMC9470629 DOI: 10.1007/s00404-021-06352-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Management of regional lymph nodes in breast cancer recurrence has been heterogeneous. To facilitate clinical practice, this review aims to give an overview on the prognosis, staging and operative management of (inapparent) regional lymph nodes. METHODS Current national and international guidelines are reviewed and a structured search of the literature between Jan 1, 1999 and Feb 1, 2021 on the repeat sentinel node biopsy (re-SNB) procedure was performed. RESULTS Positive regional lymph nodes in recurrent breast cancer indicate a poorer outcome with axillary recurrences being the most favorable tumor site among all nodal regions. Most preferred staging method is ultrasound ± guided biopsy. PET-CT, scintimammography, SPECT-CT may improve visualization of affected lymph nodes outside the axilla. Concerning operative management 30 articles on re-SNB were identified with a mean harvesting rate of 66.4%, aberrant drainage and aberrant metastasis in 1/3 of the cases. Total rate of metastasis is 17.9%. After previous axillary dissection (ALND) the re-SNB has a significantly lower harvesting rate and higher aberrant drainage and aberrant metastasis rate. The prognostic outcome after re-SNB has been favorable. CONCLUSION Nodal status in recurrent disease has prognostic value. The choice of operative management of clinically inapparent regional lymph nodes during local recurrence should be based on the previous nodal staging method. Patients with previous ALND should be spared a second systematic ALND. Re-SNB or no axillary surgery at all are possible alternatives. Lymphoscintigraphy may be performed to identify extraaxillary drainage. However, for definite recommendations randomized controlled studies are heavily needed.
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Affiliation(s)
- Isabell Ge
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany. .,Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Thalia Erbes
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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To NH, Hersant B, Chaffai I, Kalsoum S, Gautheron V, Ghith S, Grellier N, Belkacemi Y. Clinical significance of internal mammary lymph node incidentally detected during free-flap breast reconstruction: Case report and systematic review of the literature. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2021.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Xue M, Che S, Tian Y, Xie L, Huang L, Zhao L, Guo N, Li J. Nomogram Based on Breast MRI and Clinicopathologic Features for Predicting Axillary Lymph Node Metastasis in Patients with Early-Stage Invasive Breast Cancer: A Retrospective Study. Clin Breast Cancer 2021; 22:e428-e437. [PMID: 34865995 DOI: 10.1016/j.clbc.2021.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION To establish a nomogram for predicting axillary lymph node (ALN) involvement in patients with early-stage invasive breast cancer (BC) based on magnetic resonance imaging (MRI) features and clinicopathological characteristics. MATERIALS AND METHODS Patients with confirmed early-stage invasive BC between 03/2016 and 05/2017 were retrospectively reviewed at the National Cancer Center/Cancer Hospital. Risk factors for ALN metastasis (ALNM) were identified by univariable and multivariable logistic regression analysis. The independent risk factors were used to create a nomogram. RESULTS This study included 214 early-stage invasive BC patients, including 57 (26.6%) with positive ALNs. Tumor location (OR = 4.019, 95% CI: 1.304 -12.383, P = .015), tumor size (OR = 3.702, 95%CI: 1.517 -9.034, P = .004), multifocality (OR = 3.534, 95%CI: 1.249 -9.995, P = .017), MR-reported suspicious ALN (OR = 9.829, 95%CI: 4.132 -23.384, P <0.001), apparent diffusion coefficient (ADC) value (OR = 0.367, 95%CI: 0.158 -0.852, P = .020), and lymphovascular invasion (LVI) (OR = 3.530, 95%CI: 1.483 -8.400, P = .004) were identified as independent risk factors associated with ALNM. A nomogram was created for predicting the probability of ALNM by using these risk factors. The calibration curve of the nomogram showed that the nomogram predictions are consistent with the actual ALNM rate. The area under the curve was 0.88 (95% CI: 0.83 -0.93). The nomogram had a bootstrapped-concordance index of 0.88 and was well-calibrated. CONCLUSION The nomogram based on MRI and clinicopathologic features might be a useful tool for predicting ALNM in early-stage invasive BC and could help clinical decision-making.
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Affiliation(s)
- Mei Xue
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shunan Che
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tian
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Liling Huang
- Department of Medical Oncology, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, National Cancer Center/ National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyun Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Guo
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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15
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Morawitz J, Bruckmann NM, Dietzel F, Ullrich T, Bittner AK, Hoffmann O, Ruckhäberle E, Mohrmann S, Häberle L, Ingenwerth M, Abrar DB, Sawicki LM, Breuckmann K, Fendler WP, Herrmann K, Buchbender C, Antoch G, Umutlu L, Kirchner J. Comparison of nodal staging between CT, MRI, and [ 18F]-FDG PET/MRI in patients with newly diagnosed breast cancer. Eur J Nucl Med Mol Imaging 2021; 49:992-1001. [PMID: 34476552 PMCID: PMC8803812 DOI: 10.1007/s00259-021-05502-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/20/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE To compare CT, MRI, and [18F]-fluorodeoxyglucose positron emission tomography ([18F]-FDG PET/MRI) for nodal status, regarding quantity and location of metastatic locoregional lymph nodes in patients with newly diagnosed breast cancer. MATERIALS AND METHODS One hundred eighty-two patients (mean age 52.7 ± 11.9 years) were included in this prospective double-center study. Patients underwent dedicated contrast-enhanced chest/abdomen/pelvis computed tomography (CT) and whole-body ([18F]-FDG PET/) magnet resonance imaging (MRI). Thoracal datasets were evaluated separately regarding quantity, lymph node station (axillary levels I-III, supraclavicular, internal mammary chain), and lesion character (benign vs. malign). Histopathology served as reference standard for patient-based analysis. Patient-based and lesion-based analyses were compared by a McNemar test. Sensitivity, specificity, positive and negative predictive values, and accuracy were assessed for all three imaging modalities. RESULTS On a patient-based analysis, PET/MRI correctly detected significantly more nodal positive patients than MRI (p < 0.0001) and CT (p < 0.0001). No statistically significant difference was seen between CT and MRI. PET/MRI detected 193 lesions in 75 patients (41.2%), while MRI detected 123 lesions in 56 patients (30.8%) and CT detected 104 lesions in 50 patients, respectively. Differences were statistically significant on a lesion-based analysis (PET/MRI vs. MRI, p < 0.0001; PET/MRI vs. CT, p < 0.0001; MRI vs. CT, p = 0.015). Subgroup analysis for different lymph node stations showed that PET/MRI detected significantly more lymph node metastases than MRI and CT in each location (axillary levels I-III, supraclavicular, mammary internal chain). MRI was superior to CT only in axillary level I (p = 0.0291). CONCLUSION [18F]-FDG PET/MRI outperforms CT or MRI in detecting nodal involvement on a patient-based analysis and on a lesion-based analysis. Furthermore, PET/MRI was superior to CT or MRI in detecting lymph node metastases in all lymph node stations. Of all the tested imaging modalities, PET/MRI showed the highest sensitivity, whereas CT showed the lowest sensitivity, but was most specific.
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Affiliation(s)
- Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
| | - Nils-Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Tim Ullrich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Ann-Kathrin Bittner
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Oliver Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology, Medical Faculty, University Dusseldorf, 40225, Dusseldorf, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, Medical Faculty, University Dusseldorf, 40225, Dusseldorf, Germany
| | - Lena Häberle
- Institute of Pathology, Medical Faculty, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Marc Ingenwerth
- Institute of Pathology, University Hospital Essen, West German Cancer Center, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Lino Morris Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Katharina Breuckmann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Christian Buchbender
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany
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Chung HL, Le-Petross HT, Leung JWT. Imaging Updates to Breast Cancer Lymph Node Management. Radiographics 2021; 41:1283-1299. [PMID: 34469221 DOI: 10.1148/rg.2021210053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Metastatic lymph node involvement in breast cancer is a key determinant of the overall stage of disease and prognosis. Historically, lymph node status was determined by surgery first, with adjuvant treatments determined based on the results of the final surgical pathologic analysis. While this sequence is still applicable in many cases, neoadjuvant systemic treatment (NST) is increasingly being administered as the initial treatment. In cases that demonstrate good therapeutic response to drug therapies, NST may permit the option to perform less radical surgeries subsequently. Current breast cancer treatment has become multidisciplinary, with overlapping roles from the different disciplines. As surgery may be postponed, imaging and image-guided lymph node interventions have gained importance as the primary means of lymph node assessment. Imaging enables evaluation of all regional nodal basins, including locations where surgery is not usually performed. By differentiating limited versus extensive nodal involvement, imaging findings help determine whether initial treatment should be surgical or medical. If medical treatment with NST is indicated, imaging is performed to monitor the in vivo nodal response to drug therapy and ultimately to help determine the surgical technique to perform on the basis of the final imaging findings after NST. The authors discuss the imaging features of nodal metastases and the indications and techniques for the various image-guided procedures. The relative usefulness and shortcomings of the various imaging examinations are reviewed to discuss how they can be applied when biopsy results are not available. The role of imaging in the multidisciplinary team approach is emphasized based on past clinical trials of lymph node management and recent evolving knowledge of breast cancer staging. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hannah L Chung
- From the Department of Breast Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Huong T Le-Petross
- From the Department of Breast Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
| | - Jessica W T Leung
- From the Department of Breast Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030
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Groheux D, Hindie E. Breast cancer: initial workup and staging with FDG PET/CT. Clin Transl Imaging 2021; 9:221-231. [PMID: 33937141 PMCID: PMC8075837 DOI: 10.1007/s40336-021-00426-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022]
Abstract
Purpose Precise staging is needed to plan optimal management in breast cancer. 18F-fluorodeoxyglucose positron emission tomography coupled with computed tomography (FDG-PET/CT) offers high sensitivity in detecting extra axillary lymph nodes and distant metastases. This review aims to clarify in which groups of patients staging with FDG-PET/CT would be beneficial and should be offered. We also discuss how tumor biology and breast cancer subtypes should be taken into account when interpreting FDG-PET/CT scans. Methods We performed a comprehensive literature review and rigorous appraisal of research studies assessing indications for FDG-PET/CT in breast cancer. This assessment regarding breast cancer served as a basis for the recommendations set by a working group of the French Society of Nuclear Medicine, in collaboration with oncological societies, for developing good clinical practice recommendations on the use of FDG-PET/CT in oncology. Results FDG-PET/CT is useful for initial staging of breast cancer, independently of tumor phenotype (triple negative, luminal or HER2 +) and regardless of tumor grade. Considering histological subtype, FDG-PET/CT performs better for staging invasive ductal carcinoma, although it is also helpful for staging invasive lobular carcinomas. Based on the available data, FDG-PET/CT becomes useful for staging starting from clinical stage IIB. FDG-PET/CT is possibly useful in patients with clinical stage IIA (T1N1 or T2N0), but there is not enough strong data to recommend routine use in this subgroup. For clinical stage I (T1N0) patients, staging with FDG-PET/CT offers no added value. Conclusion FDG-PET/CT is useful for staging patients with breast cancer, starting from clinical stage IIB.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France
- University Paris-Diderot, INSERM U976, HIPI, Paris, France
| | - Elif Hindie
- Department of Nuclear Medicine, Bordeaux University Hospital, Bordeaux, France
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Diagnostic Performance of Noninvasive Imaging for Assessment of Axillary Response After Neoadjuvant Systemic Therapy in Clinically Node-positive Breast Cancer: A Systematic Review and Meta-analysis. Ann Surg 2021; 273:694-700. [PMID: 33201095 DOI: 10.1097/sla.0000000000004356] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study was to perform a systematic review and meta-analysis to determine the diagnostic performance of current noninvasive imaging modalities for assessment of axillary response after neoadjuvant systemic therapy (NST) in clinically node-positive breast cancer patients. SUMMARY OF BACKGROUND DATA NST can lead to downstaging of axillary lymph node disease. Imaging can potentially provide information about the axillary response to NST and, consequently, tailor the surgical management. METHODS PubMed and Embase were searched for studies that compared noninvasive imaging after NST with axillary surgery outcome to identify axillary response in patients with initial pathologically proven axillary lymph node metastasis. Two reviewers independently screened the studies and extracted the data. A meta-analysis was performed by computing the pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS Thirteen studies describing 2380 patients were included for final analysis. Of these patients, 1322 had undergone axillary ultrasound, 849 breast MRI, and 209 whole-body 18F-FDG PET-CT. The overall axillary pathologic complete response rate was 39.5% (941/2380). For axillary ultrasound, the pooled sensitivity, specificity, PPV, and NPV were 65%, 69%, 77%, 50%, respectively. For breast MRI, the pooled sensitivity, specificity, PPV, and NPV were 60%, 76%, 78%, 58%, respectively. For whole-body 18F-FDG PET-CT, the pooled sensitivity, specificity, PPV, and NPV were 38%, 86%, 78%, 49%, respectively. CONCLUSIONS The diagnostic performance of current noninvasive imaging modalities is limited to accurately assess axillary response after NST in clinically node-positive breast cancer patients.
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Extra-axillary nodal metastases in breast cancer: comparison of ultrasound, MRI, PET/CT, and CT. Clin Imaging 2021; 79:113-118. [PMID: 33933824 DOI: 10.1016/j.clinimag.2021.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate how ultrasound (US), MRI, PET/CT, and CT predict extra-axillary nodal metastases. SUBJECTS AND METHODS This IRB approved, retrospective study consisted of 124 suspicious supraclavicular and 88 internal mammary (IM) nodal cases with US and at least one additional cross-sectional examination (MRI, PET/CT or CT) from a total of 1472 invasive cancers with staging nodal US between January 2016-January 2019. Imaging findings were compared with the true node status, determined by fine needle aspirate (FNA) biopsy or evidence of response to chemotherapy on follow up imaging. RESULTS In the supraclavicular region, US had accuracy 98.2%, consisting of 97 true positives (TP), 27 false positives (FP), and 1348 true negative (TN). 93.5% of suspicious supraclavicular nodes had FNA for a PPV 78.2%. PET/CT had accuracy 88.6% (26 TP, 5 TN and 4 false negatives (FN)). CT exams had accuracy 61.7% (42 TP, 16 TN, 7 FP, and 29 FN). In the IM region, US had accuracy 93.2% (82 TP, 1 FP, 5 FN, and 1384 TN) but only 43.2% of suspicious IM nodes had FNA for a PPV 98.8%. MRI had accuracy 100.0% (all 47 TP). PET/CT exams had accuracy 96.8% (30 TP and 1FN). CT exams had accuracy 62.7% (36 TP, 1 TN, and 22 FN). CONCLUSION US/FNA has accuracy 98.2% and 93.2% in the supraclavicular and IM regions, however only 43.2% of suspicious IM nodes are directly sampled. In these cases, MRI or PET/CT can be used to problem solve and guide treatment decisions.
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20
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Lee J, Kim HS, Jangili P, Kang HG, Sharma A, Kim JS. Fluorescent Probe for Monitoring Hydrogen Peroxide in COX-2-Positive Cancer Cells. ACS APPLIED BIO MATERIALS 2021; 4:2073-2079. [PMID: 35014334 DOI: 10.1021/acsabm.0c01135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hydrogen peroxide (H2O2), an important marker for oxidative stress, plays a vital role in cellular biological functions. Overproduction of H2O2 causes oxidative damage to cellular functions and promotes cancer and other neurodegenerative diseases. Also, cyclooxygenase-2 (COX-2) enzyme is known to be expressed in several cancer types and exerts multifaceted roles in carcinogenesis and resistance to cancer treatment. Hence, it is important to monitor the H2O2 concentration changes in the COX-2-expressing cancer cells. Herein, we have developed a molecular fluorescent ratiometric H2O2-responsive probe (NPDIN) composed of indomethacin (COX-2 inhibitor) conjugated with 1,8-napthalimide boronate ester as fluorescent reporter through a chemical linker. The probe was capable of imaging the endogenous H2O2 in COX-2 overexpressing cancer cell lines (A549, LoVo, HT29, and Caco-2). Further studies revealed the critical role of the indomethacin moiety in the cellular uptake behavior of NPDIN in COX-2-overexpressing cancer cells. Collectively, our results demonstrated NPDIN as a COX-2-positive cancer-targeting sensitive ratiometric fluorescent probe (I554/I398) for H2O2 imaging and showed its promising biological applications in the future.
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Affiliation(s)
- Jiyeong Lee
- Department of Biomedical Laboratory Science, School of Medicine, Eulji University, Daejeon 34824, South Korea
| | - Hyeong Seok Kim
- Department of Chemistry, Korea University, Seoul 02841, South Korea
| | - Paramesh Jangili
- Department of Chemistry, Korea University, Seoul 02841, South Korea
| | - Hee-Gyoo Kang
- Department of Biomedical Laboratory Science, College of Health Science, Eulji University, Seongnam 13135, South Korea
| | - Amit Sharma
- CSIR-Central Scientific Instruments Organization, Sector-30C, Chandigarh 160030, India
| | - Jong Seung Kim
- Department of Chemistry, Korea University, Seoul 02841, South Korea
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Tian Q, Cai Y, Li N, Liu Q, Gu B, Chen ZG, Song S. Ellagic acid-Fe nanoscale coordination polymer with higher longitudinal relaxivity for dual-modality T 1-weighted magnetic resonance and photoacoustic tumor imaging. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2020; 28:102219. [PMID: 32474078 DOI: 10.1016/j.nano.2020.102219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/14/2020] [Accepted: 04/30/2020] [Indexed: 11/16/2022]
Abstract
Dual-modality contrast agents for T1-weighted magnetic resonance imaging (MRI) and photoacoustic imaging have attracted substantial attention as they combine the advantages of unlimited penetration depth and high sensitivity. However, most of the reported agents are Gd-based materials that exhibit nephrotoxicity, and few studies have focused on Fe-based materials owing to their lower relaxivity. This work describes the development of an ellagic acid (EA)-Fe nanoscale coordination polymer with high longitudinal relaxivity and strong near-infrared absorption for dual-modality T1-weighted MRI and photoacoustic imaging. The longitudinal relaxivity (r1) of the prepared EA-Fe@BSA nanoparticles was 2.54 mM-1 s-1, an increase of 185% compared with previously reported gallic acid-Fe nanoparticles. Furthermore, in vitro and in vivo experiments demonstrate that the EA-Fe@BSA NPs are an excellent T1-weighted MRI and photoacoustic dual-modality contrast agent with the advantages of convenient synthesis and low toxicity, exhibiting great potential for clinical use in tumor imaging.
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Affiliation(s)
- Qiwei Tian
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China; College of Chemistry and Materials Science, Shanghai Normal University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Center for Biomedical Imaging, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Yu Cai
- College of Chemistry and Materials Science, Shanghai Normal University, Shanghai, China
| | - Nan Li
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Center for Biomedical Imaging, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Qiufang Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Center for Biomedical Imaging, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Bingxin Gu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Center for Biomedical Imaging, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Zhi-Gang Chen
- School of Mechanical & Mining Engineering, University of Queensland, Brisbane, Australia.
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Center for Biomedical Imaging, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China.
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Yoo TK, Kang BJ, Kim SH, Song BJ, Ahn J, Park WC, Chae BJ. Axillary lymph node dissection is not obligatory in breast cancer patients with biopsy-proven axillary lymph node metastasis. Breast Cancer Res Treat 2020; 181:403-409. [PMID: 32328848 DOI: 10.1007/s10549-020-05636-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The ACOSOG Z0011 trial demonstrated that axillary lymph node dissection (ALND) is unnecessary in select patients with cT1-2N0 tumors undergoing breast-conserving therapy with 1-2 positive sentinel lymph nodes (SLNs). However, patients with preoperatively confirmed ALN metastasis were not included and may be subjected to unnecessary ALND. The aim of this study is to identify patients who can be considered for ALND omission when the preoperative ALN biopsy results are positive. METHODS Breast cancer patients who underwent preoperative ALN biopsy and primary surgery were retrospectively reviewed. Among patients with positive ALN biopsy results, clinicopathological and imaging characteristics were compared according to LN disease burden (1-2 positive LNs vs. ≥ 3 positive LNs). RESULTS A total of 542 patients were included in the analysis. Among them, 225 (41.5%) patients had a preoperative positive ALN biopsy. More than 40% of the patients (n = 99, 44.0%) with a positive biopsy had only 1-2 positive ALNs. The association between nodal burden and imaging factors was strongest when ≥ 2 suspicious LNs were identified on PET/CT images (HR 8.795, 95% CI 4.756 to 13.262). More than one imaging modality showing ≥ 2 suspicious LNs was also strongly correlated with ≥ 3 positive ALNs (HR 5.148, 95% CI 2.881 to 9.200). CONCLUSIONS Nearly half of patients with a preoperative biopsy-proven ALN metastasis had only 1-2 positive LNs on ALND. Patients meeting ACOSOG Z0011 criteria with only one suspicious LN on PET/CT or those presenting with few abnormal ALNs on only one imaging modality appear appropriate for SLNB and consideration of ALND omission.
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MESH Headings
- Axilla
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Lymph Nodes/pathology
- Lymph Nodes/surgery
- Lymphatic Metastasis
- Mastectomy, Segmental/methods
- Middle Aged
- Positron Emission Tomography Computed Tomography
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Sentinel Lymph Node Biopsy/methods
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Affiliation(s)
- Tae-Kyung Yoo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Bong Joo Kang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Byung Joo Song
- Division of Breast-Thyroid Surgery, Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Gyeonggi-do, 14647, Republic of Korea
| | - Juneyoung Ahn
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Woo-Chan Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Byung Joo Chae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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Chang JM, Leung JWT, Moy L, Ha SM, Moon WK. Axillary Nodal Evaluation in Breast Cancer: State of the Art. Radiology 2020; 295:500-515. [PMID: 32315268 DOI: 10.1148/radiol.2020192534] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Axillary lymph node (LN) metastasis is the most important predictor of overall recurrence and survival in patients with breast cancer, and accurate assessment of axillary LN involvement is an essential component in staging breast cancer. Axillary management in patients with breast cancer has become much less invasive and individualized with the introduction of sentinel LN biopsy (SLNB). Emerging evidence indicates that axillary LN dissection may be avoided in selected patients with node-positive as well as node-negative cancer. Thus, assessment of nodal disease burden to guide multidisciplinary treatment decision making is now considered to be a critical role of axillary imaging and can be achieved with axillary US, MRI, and US-guided biopsy. For the node-positive patients treated with neoadjuvant chemotherapy, restaging of the axilla with US and MRI and targeted axillary dissection in addition to SLNB is highly recommended to minimize the false-negative rate of SLNB. Efforts continue to develop prediction models that incorporate imaging features to predict nodal disease burden and to select proper candidates for SLNB. As methods of axillary nodal evaluation evolve, breast radiologists and surgeons must work closely to maximize the potential role of imaging and to provide the most optimized treatment for patients.
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Affiliation(s)
- Jung Min Chang
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.C., S.M.H., W.K.M.); Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (J.W.T.L.); Department of Radiology, New York University Langone Medical Center, New York, NY (L.M.); NYU Center for Advanced Imaging Innovation and Research, New York, NY (L.M.)
| | - Jessica W T Leung
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.C., S.M.H., W.K.M.); Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (J.W.T.L.); Department of Radiology, New York University Langone Medical Center, New York, NY (L.M.); NYU Center for Advanced Imaging Innovation and Research, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.C., S.M.H., W.K.M.); Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (J.W.T.L.); Department of Radiology, New York University Langone Medical Center, New York, NY (L.M.); NYU Center for Advanced Imaging Innovation and Research, New York, NY (L.M.)
| | - Su Min Ha
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.C., S.M.H., W.K.M.); Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (J.W.T.L.); Department of Radiology, New York University Langone Medical Center, New York, NY (L.M.); NYU Center for Advanced Imaging Innovation and Research, New York, NY (L.M.)
| | - Woo Kyung Moon
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.M.C., S.M.H., W.K.M.); Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (J.W.T.L.); Department of Radiology, New York University Langone Medical Center, New York, NY (L.M.); NYU Center for Advanced Imaging Innovation and Research, New York, NY (L.M.)
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de Barros ACSD, de Andrade DA. Extended Sentinel Node Biopsy in Breast Cancer Patients who Achieve Complete Nodal Response with Neoadjuvant Chemotherapy. Eur J Breast Health 2020; 16:99-105. [PMID: 32285030 DOI: 10.5152/ejbh.2020.4730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/17/2020] [Indexed: 01/21/2023]
Abstract
Neoadjuvant chemotherapy (NAC) can eradicate axillary disease in breast cancer (BC) patients. Sentinel node biopsy (SNB) in patients with positive axilla who accomplish complete clinical response after NAC is a new opportunity for changing paradigms and decreasing the extension and the morbidity of axillary surgery. The aim of this article is to review the limits of SNB in this setting and present the current status of an expanded modification of this technique. False-negative rates (FNRs) of conventional SNB exceed the threshold of 10%, and are not acceptable. The extended SNB (ESNB) entails the removal of at least 3 lymph nodes (LNs) including the sentinel node (SN) mapped by dual tracers and a marked lymph node (LN) that was found previously metastatic. This node by node removal procedure greatly reduces the FNRs of the procedure. Despite that axillary lymph node dissection (ALND) is still the standard of care for patients with involved LNs before NAC, the ESNB is a valid option for selected patients in whom axillary positive disease is converted to negative. When ESNB is negative in such cases (immunohistochemistry included), the omission of ALND seems to be safe.
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25
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Ha R, Chang P, Karcich J, Mutasa S, Fardanesh R, Wynn RT, Liu MZ, Jambawalikar S. Axillary Lymph Node Evaluation Utilizing Convolutional Neural Networks Using MRI Dataset. J Digit Imaging 2019; 31:851-856. [PMID: 29696472 DOI: 10.1007/s10278-018-0086-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The aim of this study is to evaluate the role of convolutional neural network (CNN) in predicting axillary lymph node metastasis, using a breast MRI dataset. An institutional review board (IRB)-approved retrospective review of our database from 1/2013 to 6/2016 identified 275 axillary lymph nodes for this study. Biopsy-proven 133 metastatic axillary lymph nodes and 142 negative control lymph nodes were identified based on benign biopsies (100) and from healthy MRI screening patients (42) with at least 3 years of negative follow-up. For each breast MRI, axillary lymph node was identified on first T1 post contrast dynamic images and underwent 3D segmentation using an open source software platform 3D Slicer. A 32 × 32 patch was then extracted from the center slice of the segmented tumor data. A CNN was designed for lymph node prediction based on each of these cropped images. The CNN consisted of seven convolutional layers and max-pooling layers with 50% dropout applied in the linear layer. In addition, data augmentation and L2 regularization were performed to limit overfitting. Training was implemented using the Adam optimizer, an algorithm for first-order gradient-based optimization of stochastic objective functions, based on adaptive estimates of lower-order moments. Code for this study was written in Python using the TensorFlow module (1.0.0). Experiments and CNN training were done on a Linux workstation with NVIDIA GTX 1070 Pascal GPU. Two class axillary lymph node metastasis prediction models were evaluated. For each lymph node, a final softmax score threshold of 0.5 was used for classification. Based on this, CNN achieved a mean five-fold cross-validation accuracy of 84.3%. It is feasible for current deep CNN architectures to be trained to predict likelihood of axillary lymph node metastasis. Larger dataset will likely improve our prediction model and can potentially be a non-invasive alternative to core needle biopsy and even sentinel lymph node evaluation.
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Affiliation(s)
- Richard Ha
- Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA.
| | - Peter Chang
- Department of Radiology, T32 Training Grant (NIH T32EB001631), UC San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Jenika Karcich
- Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Simukayi Mutasa
- Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Reza Fardanesh
- Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Ralph T Wynn
- Department of Radiology, 622 West 168th Street, PB-1-301, New York, NY, 10032, USA
| | - Michael Z Liu
- Department of Medical Physics, Columbia University Medical Center, 177 Ft. Washington Ave., Milstein Bldg Room 3-124B, New York, NY, 10032-3784, USA
| | - Sachin Jambawalikar
- Department of Medical Physics, Columbia University Medical Center, 177 Ft. Washington Ave., Milstein Bldg Room 3-124B, New York, NY, 10032-3784, USA
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26
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Han L, Zhu Y, Liu Z, Yu T, He C, Jiang W, Kan Y, Dong D, Tian J, Luo Y. Radiomic nomogram for prediction of axillary lymph node metastasis in breast cancer. Eur Radiol 2019; 29:3820-3829. [PMID: 30701328 DOI: 10.1007/s00330-018-5981-2] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/17/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To develop a radiomic nomogram for preoperative prediction of axillary lymph node (LN) metastasis in breast cancer patients. METHODS Preoperative magnetic resonance imaging data from 411 breast cancer patients was studied. Patients were assigned to either a training cohort (n = 279) or a validation cohort (n = 132). Eight hundred eight radiomic features were extracted from the first phase of T1-DCE images. A support vector machine was used to develop a radiomic signature, and logistic regression was used to develop a nomogram. RESULTS The radiomic signature based on 12 LN status-related features was constructed to predict LN metastasis, its prediction ability was moderate, with an area under the curve (AUC) of 0.76 and 0.78 in training and validation cohorts, respectively. Based on a radiomic signature and clinical features, a nomogram was developed and showed excellent predictive ability for LN metastasis (AUC 0.84 and 0.87 in training and validation sets, respectively). Another radiomic signature was constructed to distinguish the number of metastatic LNs (less than 2 positive nodes/more than 2 positive nodes), which also showed moderate performance (AUC 0.79). CONCLUSIONS We developed a nomogram and a radiomic signature that can be used to identify LN metastasis and distinguish the number of metastatic LNs (less than 2 positive nodes/more than 2 positive nodes). Both nomogram and radiomic signature can be used as tools to assist clinicians in assessing LN metastasis in breast cancer patients. KEY POINTS • ALNM is an important factor affecting breast cancer patients' treatment and prognosis. • Traditional imaging examinations have limited value for evaluating axillary LNs status. • We developed a radiomic nomogram based on MR imagings to predict LN metastasis.
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Affiliation(s)
- Lu Han
- Cancer Hospital of China Medical University, Shenyang, 110042, China
- Liaoning Cancer Hospital & Institute, Shenyang, 110042, China
| | - Yongbei Zhu
- CAS Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Institute of Automation, Beijing, 100190, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Institute of Automation, Beijing, 100190, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Tao Yu
- Cancer Hospital of China Medical University, Shenyang, 110042, China
- Liaoning Cancer Hospital & Institute, Shenyang, 110042, China
| | - Cuiju He
- Cancer Hospital of China Medical University, Shenyang, 110042, China
- Liaoning Cancer Hospital & Institute, Shenyang, 110042, China
| | - Wenyan Jiang
- Cancer Hospital of China Medical University, Shenyang, 110042, China
- Liaoning Cancer Hospital & Institute, Shenyang, 110042, China
| | - Yangyang Kan
- Cancer Hospital of China Medical University, Shenyang, 110042, China
- Liaoning Cancer Hospital & Institute, Shenyang, 110042, China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Institute of Automation, Beijing, 100190, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Chinese Academy of Sciences, Institute of Automation, Beijing, 100190, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, 100191, China
| | - Yahong Luo
- Cancer Hospital of China Medical University, Shenyang, 110042, China.
- Liaoning Cancer Hospital & Institute, Shenyang, 110042, China.
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27
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Diagnosing and Managing the Malignant Axilla in Breast Cancer. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-0299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Guvenc I, Whitman GJ, Liu P, Yalniz C, Ma J, Dogan BE. Diffusion‐weighted MR imaging increases diagnostic accuracy of breast MR imaging for predicting axillary metastases in breast cancer patients. Breast J 2019; 25:47-55. [DOI: 10.1111/tbj.13151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Inanc Guvenc
- Department of Radiology Medical Park Ankara Ankara Turkey
- Departments of Radiology and Breast Imaging The University of Texas M. D. Anderson Cancer Center Houston Texas
| | - Gary J. Whitman
- Departments of Radiology and Breast Imaging The University of Texas M. D. Anderson Cancer Center Houston Texas
| | - Ping Liu
- Department of Biostatistics The University of Texas M. D. Anderson Cancer Center Houston Texas
| | - Ceren Yalniz
- Departments of Radiology and Breast Imaging The University of Texas M. D. Anderson Cancer Center Houston Texas
| | - Jingfei Ma
- Department of Imaging Physics The University of Texas M. D. Anderson Cancer Center Houston Texas
| | - Basak E. Dogan
- Departments of Radiology and Breast Imaging The University of Texas M. D. Anderson Cancer Center Houston Texas
- Departments of Radiology and Breast Imaging The University of Texas Southwestern Medical Center Dallas Texas
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Lee RD, Park JG, Ryu DW, Kim YS. Diagnostic value of magnetic resonance imaging using superparamagnetic iron oxide for axillary node metastasis in patients with breast cancer: a meta-analysis. KOSIN MEDICAL JOURNAL 2018. [DOI: 10.7180/kmj.2018.33.3.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives Identification of axillary metastases in breast cancer is important for staging disease and planning treatment, but current techniques are associated with a number of adverse events. This report evaluates the diagnostic accuracy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) techniques for identification of axillary metastases in breast cancer patients. Methods We performed a meta-analysis of previous studies that compared SPIO enhanced MRI with histological diagnosis after surgery or biopsy. We searched PubMed, Ovid, Springer Link, and Cochrane library to identify studies reporting data for SPIO enhanced MRI for detection of axillary lymph node metastases in breast cancer until December 2013. The following keywords were used: “magnetic resonance imaging AND axilla” and “superparamagnetic iron oxide AND axilla”. Eligible studies were those that compared SPIO enhanced MRI with histological diagnosis. Sensitivity and specificity were calculated for every study; summary receiver operating characteristic and subgroup analyses were done. Study quality and heterogeneity were also assessed. Results There were 7 publications that met the criteria for inclusion in our meta-analysis. SROC curve analysis for per patient data showed an overall sensitivity of 0.83 (95% Confidence interval (CI): 0.75–0.89) and overall specificity of 0.97 (95% CI: 0.94–0.98). Overall weighted area under the curve was 0.9563. Conclusions SPIO enhanced MRI showed a trend toward high diagnostic accuracy in detection of lymph node metastases for breast cancer. So, when the breast cancer patients has axillary metastases histologically, SPIO enhanced MRI may be effective diagnostic imaging modality for axillary metastases.
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Use of Quantitative Morphological and Functional Features for Assessment of Axillary Lymph Node in Breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2610801. [PMID: 30003092 PMCID: PMC5998166 DOI: 10.1155/2018/2610801] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/29/2018] [Indexed: 01/09/2023]
Abstract
Background Axillary lymph-node assessment is considered one of the most important prognostic factors concerning breast cancer survival. Objective We investigated the discriminative power of morphological and functional features in assessing the axillary lymph node. Methods We retrospectively analysed data from 52 consecutive patients who undergone DCE-MRI and were diagnosed with primary breast carcinoma: 94 lymph nodes were identified. Per each lymph node, we extracted morphological features: circularity, compactness, convexity, curvature, elongation, diameter, eccentricity, irregularity, radial length, entropy, rectangularity, roughness, smoothness, sphericity, spiculation, surface, and volume. Moreover, we extracted functional features: time to peak (TTP), maximum signal difference (MSD), wash-in intercept (WII), wash-out intercept (WOI), wash-in slope (WIS), wash-out slope (WOS), area under gadolinium curve (AUGC), area under wash-in (AUWI), and area under wash-out (AUWO). Selection of important features in predicting metastasis has been done by means of receiver operating characteristic (ROC) analysis. Performance of linear discriminant analysis was analysed. Results All morphological features but circularity showed a significant difference between median values of metastatic lymph nodes group and nonmetastatic lymph nodes group. All dynamic parameters except for MSD and WOS showed a statistically significant difference between median values of metastatic lymph nodes group and nonmetastatic lymph nodes group. Best results for discrimination of metastatic and nonmetastatic lymph nodes were obtained by AUGC (accuracy 75.8%), WIS (accuracy 71.0%), WOS (accuracy 71.0%), and AUCWO (accuracy 72.6%) for dynamic features and by compactness (accuracy 82.3%), curvature (accuracy 71.0%), radial length (accuracy 71.0%), roughness (accuracy 74.2%), smoothness (accuracy 77.2%), and speculation (accuracy 72.6%) for morphological features. Linear combination of all morphological and/or of all dynamic features did not increase accuracy in metastatic lymph nodes discrimination. Conclusions Compactness as morphological feature and area under time-intensity curve as dynamic feature were the best parameters in identifying metastatic lymph nodes on breast MRI.
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31
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Lowes S, Leaver A, Cox K, Satchithananda K, Cosgrove D, Lim A. Evolving imaging techniques for staging axillary lymph nodes in breast cancer. Clin Radiol 2018; 73:396-409. [DOI: 10.1016/j.crad.2018.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/02/2018] [Indexed: 12/18/2022]
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32
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Zahoor S, Haji A, Battoo A, Qurieshi M, Mir W, Shah M. Sentinel Lymph Node Biopsy in Breast Cancer: A Clinical Review and Update. J Breast Cancer 2017; 20:217-227. [PMID: 28970846 PMCID: PMC5620435 DOI: 10.4048/jbc.2017.20.3.217] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/22/2017] [Indexed: 12/20/2022] Open
Abstract
Sentinel lymph node biopsy has become a standard staging tool in the surgical management of breast cancer. The positive impact of sentinel lymph node biopsy on postoperative negative outcomes in breast cancer patients, without compromising the oncological outcomes, is its major advantage. It has evolved over the last few decades and has proven its utility beyond early breast cancer. Its applicability and efficacy in patients with clinically positive axilla who have had a complete clinical response after neoadjuvant chemotherapy is being aggressively evaluated at present. This article discusses how sentinel lymph node biopsy has evolved and is becoming a useful tool in new clinical scenarios of breast cancer management.
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Affiliation(s)
- Sheikh Zahoor
- Department of Surgical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Altaf Haji
- Department of Surgical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Azhar Battoo
- Department of Surgical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mariya Qurieshi
- Department of Community Medicine, Government Medical College, Srinagar, India
| | - Wahid Mir
- Department of Surgical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Mudasir Shah
- Department of Surgical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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Ahmed M, Jozsa F, Douek M. Is there a role for sentinel node biopsy in the pre-operative ultrasound positive axilla? Breast Cancer Res Treat 2017; 165:225-228. [PMID: 28597050 DOI: 10.1007/s10549-017-4313-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Abstract
Axillary management in breast cancer is becoming increasingly conservative. This approach is based on the identification of low axillary burden on sentinel node biopsy (SNB). The modern practice of routine pre-operative axillary ultrasound has meant that patients are 'fast tracked' to axillary node clearance (ANC) in the presence of a histologically confirmed positive axilla. This practice reduces the number of patients undergoing SNB compared to the original trials, which evaluated the role of SNB, and those assessing safety of omission of ANC in low axillary burden. The risk of depriving patients with low axillary burden the opportunity to avoid ANC as a consequence of pre-operative ultrasound is discussed.
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Affiliation(s)
- M Ahmed
- Division of Cancer Studies, Research Oncology, King's College London, London, SE1 9RT, UK.
| | - F Jozsa
- Division of Cancer Studies, Research Oncology, King's College London, London, SE1 9RT, UK
| | - M Douek
- Division of Cancer Studies, Research Oncology, King's College London, London, SE1 9RT, UK
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Orsaria P, Chiaravalloti A, Fiorentini A, Pistolese C, Vanni G, Granai AV, Varvaras D, Danieli R, Schillaci O, Petrella G, Buonomo OC. PET Probe-Guided Surgery in Patients with Breast Cancer: Proposal for a Methodological Approach. ACTA ACUST UNITED AC 2017; 31:101-110. [PMID: 28064227 DOI: 10.21873/invivo.11031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/17/2016] [Accepted: 12/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although it is valuable for detecting distant metastases, identifying recurrence, and evaluating responses to chemotherapy, the role of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in assessing locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. In the current report, we describe a new PET probe-based clinical approach, with evaluation of the technical performance of a handheld high-energy gamma probe for intraoperative localization of breast carcinomas, and evaluation of lymph node metastases during radio-guided oncological surgery. PATIENTS AND METHODS Three patients underwent a PET/CT scan immediately prior to surgery following the standard clinical protocol. Intraoperatively, tumors were localized and resected with the assistance of a hand-held gamma probe. PET-guided assessment of the presence or absence of regional nodal spread of malignancy was compared with the reference standard of histopathological examination. RESULTS In all three cases, perioperative 18F-FDG PET/CT imaging and intraoperative gamma probe detection verified complete resection of the hypermetabolic lesions and demonstrated no additional suspicious occult disease. CONCLUSION This innovative approach demonstrates great promise for providing real-time access to metabolic and morphological tumor information that may lead to an optimal disease-tailored approach. In carefully selected indications, a PET probe can be a useful adjunct in surgical practice, but further trials with a larger number of patients need to be performed to verify these findings.
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Affiliation(s)
- Paolo Orsaria
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | | | - Alessandro Fiorentini
- Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Chiara Pistolese
- Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Gianluca Vanni
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy
| | | | | | - Roberta Danieli
- Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, Tor Vergata University Hospital, Rome, Italy
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Shinkins B, Yang Y, Abel L, Fanshawe TR. Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological review of health technology assessments. BMC Med Res Methodol 2017; 17:56. [PMID: 28410588 PMCID: PMC5391551 DOI: 10.1186/s12874-017-0331-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/27/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. METHODS We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. RESULTS The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. CONCLUSIONS The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests.
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Affiliation(s)
- Bethany Shinkins
- Test Evaluation Group, Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Worsely Building, Clarendon Way, Leeds, LS2 9LJ, UK.
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Lucy Abel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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Bekhouche A, Tardivon A. Statut ganglionnaire axillaire chez les patientes prises en charge pour un cancer du sein : évaluation préopératoire et évolution de la prise en charge. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Agliata G, Valeri G, Argalia G, Tarabelli E, Giuseppetti GM. Role of Contrast-Enhanced Sonography in the Evaluation of Axillary Lymph Nodes in Breast Carcinoma: A Monocentric Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:505-511. [PMID: 28098400 DOI: 10.7863/ultra.16.04012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of contrast-enhanced sonography for characterization of the lymph node status (metastatic or not) in patients with breast carcinomas by comparison with sentinel lymph node biopsy. METHODS From January to August 2015, 50 female patients with a histologic diagnosis of invasive breast carcinoma were prospectively examined by ipsilateral axillary contrast-enhanced sonography. The test was performed by a single radiologist using an ultrasound system with a broadband 8-12-MHz, 38-mm high-resolution linear transducer. For the target lymph node, we chose a node with a sonographic pattern that was suspicious for malignancy: ie, a longitudinal-to-transverse diameter ratio of less than 2, absence of a central hyperechogenic hilum, or both. In cases with a lack of sonographic signs of malignancy, we evaluated the node with the maximal transverse diameter. Nodes were considered malignant in cases with total absence of contrast enhancement and in those with enhancement alterations. Within 1 week, all patients underwent sentinel lymph node biopsy, followed by a histologic test. RESULTS The histologic test showed benignity in 22 of 50 sentinel lymph nodes, whereas 28 were metastatic. Among the 22 patients with negative biopsy results, contrast-enhanced sonography showed 18 concordances and 4 false-positives results; among the 28 with positive biopsy results, contrast-enhanced sonography obtained 100% correct characterizations of the axillary status. The sensitivity, specificity, and accuracy were 100%, 82%, and 92%, respectively. CONCLUSIONS Contrast-enhanced sonography appears to be a method with high accuracy for characterization of axillary lymph nodes, very close to the reference-standard sentinel lymph node biopsy. This technique seems to have overall high sensitivity.
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Affiliation(s)
- Giacomo Agliata
- Scuola di Specializzazione in Radiodiagnostica, Università Politecnica delle Marche, Ancona, Italy
| | - Gianluca Valeri
- Clinica di Radiologia d'Urgenza e dell'Area Oncologica, Ospedali Riuniti, Ancona, Italy
| | - Giulio Argalia
- Clinica di Radiologia d'Urgenza e dell'Area Oncologica, Ospedali Riuniti, Ancona, Italy
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Additional Prone 18F-FDG PET/CT Acquisition to Improve the Visualization of the Primary Tumor and Regional Lymph Node Metastases in Stage II/III Breast Cancer. Clin Nucl Med 2016; 41:e181-6. [PMID: 26704731 DOI: 10.1097/rlu.0000000000001101] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To prospectively compare prone and supine acquired 18F-FDG PET/CT for visualization of primary tumors and regional lymph nodes in stage II/III breast cancer patients. MATERIALS AND METHODS One hundred ninety-eight patients were included consecutively from August 2010 to April 2012. One hour after administration of 180-240 MBq 18F-FDG, PET/CT images of the thorax were firstly acquired in prone position. Subsequently, a standard PET/CT in supine position from skull base to thighs was made. Both sets of images were tested in a univariate and a multivariate analysis for the number of lesions per breast or lymph node (LN) region and anatomical mismatch between PET and CT images. RESULTS Images in prone position showed less compression of breast tissue, more primary tumor (PT) multifocality (P < 0.001) and more avid axillary LNs (P < 0.001) compared with supine position. Anatomical mismatch of the axillary LN metastases was found more often on supine PET/CT images compared with prone (P = 0.004). Prone images showed a smaller PT functional volume compared with supine position (P < 0.001). CONCLUSIONS Prone position PET/CT improved the visualization of PT multifocality and the number of detected axillary lymph nodes. Therefore, it is a valuable addition to standard supine PET/CT in the protocol for locoregional assessment in stage II/III breast cancer patients.
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Huxley N, Jones-Hughes T, Coelho H, Snowsill T, Cooper C, Meng Y, Hyde C, Mújica-Mota R. A systematic review and economic evaluation of intraoperative tests [RD-100i one-step nucleic acid amplification (OSNA) system and Metasin test] for detecting sentinel lymph node metastases in breast cancer. Health Technol Assess 2015; 19:v-xxv, 1-215. [PMID: 25586547 DOI: 10.3310/hta19020] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In breast cancer patients, sentinel lymph node biopsy is carried out at the same time as the removal of the primary tumour to postoperatively test with histopathology for regional metastases in the sentinel lymph node. Those patients with positive test results are then operated on 2-4 weeks after primary surgery to remove the lymph nodes from the axilla (axillary lymph node dissection, ALND). New molecular tests RD-100i [one-step nucleic acid amplification (OSNA); based on messenger RNA amplification to identify the cytokeratin-19 (CK19) gene marker] (Sysmex, Norderstedt, Germany) and Metasin (using the CK19 and mammaglobin gene markers) (Cellular Pathology, Princess Alexandra Hospital NHS Trust, Harlow, UK) are intended to provide an intraoperative diagnosis, thereby avoiding the need for postoperative histopathology and, in positive cases, a second operation for ALND. OBJECTIVE To evaluate the clinical effectiveness and cost-effectiveness of using OSNA and Metasin in the NHS in England for the intraoperative diagnosis of sentinel lymph nodes metastases, compared with postoperative histopathology, the current standard. DATA SOURCES Electronic databases including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library and the Health Economic Evaluations Database as well as clinical trial registries, grey literature and conference proceedings were searched up to July 2012. REVIEW METHODS A systematic review of the evidence was carried out using standard methods. Single-gate studies were used to estimate the accuracy of OSNA with histopathology as the reference standard. The cost-effectiveness analysis adapted an existing simulation model of the long-term costs and health implications of early breast cancer diagnostic outcomes. The model accounted for the costs of an extended first operation with intraoperative testing, the loss of health-related quality of life (disutility) from waiting for postoperative test results, disutility and costs of a second operation, and long-term costs and disutility from lymphoedema related to ALND, adjuvant therapy, locoregional recurrence and metastatic recurrence. RESULTS A total of 724 references were identified in the searches, of which 17 studies assessing test accuracy were included in the review, 15 on OSNA and two on Metasin. Both Metasin studies were unpublished. OSNA sensitivity of 84.5% [95% confidence interval (CI) 74.7% to 91.0%] and specificity of 91.8% (95% CI 87.8% to 94.6%) for patient nodal status were estimated in a meta-analysis of five studies [unadjusted for tissue allocation bias (TAB)]. At these values and a 20% node-positive rate, OSNA resulted in lifetime discounted cost-savings of £498 and a quality-adjusted life-year (QALY) loss of 0.048 relative to histopathology, that is, £4324 saved per QALY lost. The most favourable plausible scenario for OSNA in terms of the node-positive rate (range 10-40%), diagnostic accuracy values (91.3% sensitivity and 94.2% specificity, from three reports that adjusted for TAB), the costs of histopathology, OSNA and second surgery, and long-term costs and utilities resulted in a maximum saving per QALY lost of £10,500; OSNA sensitivity and specificity would need to be ≥ 95% for this figure to be ≥ £20,000. LIMITATIONS There is limited evidence on the diagnostic test accuracy of intraoperative tests. The quality of information on costs of resource utilisation during the diagnostic pathway is low and no evidence exists on the disutility of waiting for a second surgery. No comparative studies exist that report clinical outcomes of intraoperative diagnostic tests. These knowledge gaps have more influence on the decision than current uncertainty in the performance of postoperative histopathology in standard practice. CONCLUSIONS One-step nucleic acid amplification is not cost-effective for the intraoperative diagnosis of sentinel lymph node metastases. OSNA is less accurate than histopathology and the consequent loss of health benefits in this patient group is not compensated for by health gains elsewhere in the health system that may be obtained with the cost-savings made. The evidence on Metasin is insufficient to evaluate its cost-effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002889. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Nicola Huxley
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Tracey Jones-Hughes
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Chris Cooper
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Yang Meng
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Rubén Mújica-Mota
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
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Ergul N, Kadioglu H, Yildiz S, Yucel SB, Gucin Z, Erdogan EB, Aydin M, Muslumanoglu M. Assessment of multifocality and axillary nodal involvement in early-stage breast cancer patients using 18F-FDG PET/CT compared to contrast-enhanced and diffusion-weighted magnetic resonance imaging and sentinel node biopsy. Acta Radiol 2015; 56:917-23. [PMID: 25013091 DOI: 10.1177/0284185114539786] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 05/23/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Non-invasive evaluation of the extent of axillary nodal involvement in early-stage breast cancer (ESBC) patients and accurate assessment of multifocality are both challenging. Few reports have explored whether 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) might be more useful than other diagnostic methods in these contexts. PURPOSE To prospectively evaluate the diagnostic utility of FDG PET/CT, contrast-enhanced, and diffusion-weighted magnetic resonance imaging (DCE-MRI and DWI), and sentinel lymph node biopsy (SNB), in detection of axillary metastatic lymph nodes in ESBC patients; and to explore the utilities of FDG PET/CT and DCE-MRI for identification of multifocality. MATERIAL AND METHODS Twenty-four female patients (mean age, 47 ± 9.9 years; range, 24-68 years) with ESBC underwent whole-body FDG PET/CT and breast MRI prior to operation. SNB and axillary lymph node dissection (ALND) were performed on all patients, as was mastectomy or wide local tumor excision. Histopathological findings served as the gold standard when evaluating either multifocality or axillary nodal involvement. RESULTS The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, of PET/CT and DCE-MRI, used to detect multifocality, were as follows: 67% versus 78%, 100% versus 53%, 100% versus 50%, 83% versus 80%, and 88% versus 63%. SNB afforded the highest sensitivity (93%) in terms of detection of axillary metastasis. The sensitivity, NPV, and accuracy of PET/CT were 67%, 62%, and 75% respectively, thus higher than the equivalent values of either DCE-MRI or DWI. CONCLUSION For assessment of multifocality in ESBC patients, highly specific results of PET/CT should be taken into account along with DCE-MRI findings. For evaluation of axillary nodal involvement, PET/CT has higher sensitivity, NPV, and accuracy values than DCE-MRI and DWI and may guide a surgical decision to proceed or not to SNB or ALND.
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Affiliation(s)
- Nurhan Ergul
- Department of Nuclear Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Huseyin Kadioglu
- Department of Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Seyma Yildiz
- Department of Radiology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Serap Baskaya Yucel
- Department of Radiation Oncology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Zuhal Gucin
- Department of Pathology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ezgi Basak Erdogan
- Department of Nuclear Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mehmet Aydin
- Department of Nuclear Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Department of Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Rahman M, Mohammed S. Breast cancer metastasis and the lymphatic system. Oncol Lett 2015; 10:1233-1239. [PMID: 26622656 DOI: 10.3892/ol.2015.3486] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/23/2015] [Indexed: 01/07/2023] Open
Abstract
Breast cancer remains the leading cause of cancer mortality worldwide, despite a significant decline in death rates due to early detection. The majority of cancer mortalities are due to the metastasis of tumor cells to other organs. Metastasis or tumor cell dissemination occurs via the hematogenous and lymphatic systems. For many carcinomas, the dissemination of tumor cells via lymphatic drainage of the tumor is the most common metastatic route. Such lymphatic drainage collects at the regional lymph nodes and the dissection and pathological examination of these nodes for lodged cancer cells is the gold standard procedure to detect metastasis. The present report provides an overview of the lymphatic system and its clinical significance as a prognostic factor, in addition to the interactions between the primary tumor and its microenvironment, and the influence of genomic subtypes on the resulting organ-specific pattern of tumor cell dissemination. It also examines the seemingly protracted asymptomatic period, during which the disseminated cells remain dormant, leading to the manifestation of metastasis decades after the successful treatment of the primary tumor.
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Affiliation(s)
- Munazzah Rahman
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA
| | - Sulma Mohammed
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA ; Purdue Center for Cancer Research, West Lafayette, IN 47907, USA ; Bindley Bioscience, Purdue Discovery Park, West Lafayette, IN 47907, USA
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Preston L, Carroll C, Gardois P, Paisley S, Kaltenthaler E. Improving search efficiency for systematic reviews of diagnostic test accuracy: an exploratory study to assess the viability of limiting to MEDLINE, EMBASE and reference checking. Syst Rev 2015; 4:82. [PMID: 26113080 PMCID: PMC4482161 DOI: 10.1186/s13643-015-0074-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/03/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Increasing numbers of systematic reviews evaluating the diagnostic test accuracy of technologies are being published. Currently, review teams tend to apply conventional systematic review standards to identify relevant studies for inclusion, for example sensitive searches of multiple bibliographic databases. There has been little evaluation of the efficiency of searching only one or two such databases for this type of review. The aim of this study was to assess the viability of an approach that restricted searches to MEDLINE, EMBASE and the reference lists of included studies. METHODS A convenience sample of nine Health Technology Assessment (HTA) systematic reviews of diagnostic test accuracy, with 302 included citations, was analysed to determine the number and proportion of included citations that were indexed in and retrieved from MEDLINE and EMBASE. An assessment was also made of the number and proportion of citations not retrieved from these databases but that could have been identified from the reference lists of included citations. RESULTS 287/302 (95 %) of the included citations in the nine reviews were indexed across MEDLINE and EMBASE. The reviews' searches of MEDLINE and EMBASE accounted for 85 % of the included citations (256/302). Of the forty-six (15 %) included citations not retrieved by the published searches, 24 (8 %) could be found in the reference lists of included citations. Only 22/302 (7 %) of the included citations were not found by the proposed, more efficient approach. CONCLUSIONS The proposed approach would have accounted for 280/302 (93 %) of included citations in this sample of nine systematic reviews. This exploratory study suggests that there might be a case for restricting searches for systematic reviews of diagnostic test accuracy studies to MEDLINE, EMBASE and the reference lists of included citations. The conduct of such reviews might be rendered more efficient by using this approach.
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Affiliation(s)
- Louise Preston
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, England.
| | - Christopher Carroll
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, England.
| | - Paolo Gardois
- Department of Public Health and Pediatrics, University of Turin, Piazza Polonia, 94, 10125, Turin, Italy.
| | - Suzy Paisley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, England.
| | - Eva Kaltenthaler
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S1 4DA, England.
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The SAVE Review: Sonographic Analysis Versus Excision for Axillary Staging in Breast Cancer. J Am Coll Surg 2015; 220:560-7. [DOI: 10.1016/j.jamcollsurg.2014.12.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/24/2022]
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Kuijs VJL, Moossdorff M, Schipper RJ, Beets-Tan RGH, Heuts EM, Keymeulen KBMI, Smidt ML, Lobbes MBI. The role of MRI in axillary lymph node imaging in breast cancer patients: a systematic review. Insights Imaging 2015; 6:203-15. [PMID: 25800994 PMCID: PMC4376816 DOI: 10.1007/s13244-015-0404-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 12/12/2022] Open
Abstract
Objectives To assess whether MRI can exclude axillary lymph node metastasis, potentially replacing sentinel lymph node biopsy (SLNB), and consequently eliminating the risk of SLNB-associated morbidity. Methods PubMed, Cochrane, Medline and Embase databases were searched for relevant publications up to July 2014. Studies were selected based on predefined inclusion and exclusion criteria and independently assessed by two reviewers using a standardised extraction form. Results Sixteen eligible studies were selected from 1,372 publications identified by the search. A dedicated axillary protocol [sensitivity 84.7 %, negative predictive value (NPV) 95.0 %] was superior to a standard protocol covering both the breast and axilla simultaneously (sensitivity 82.0 %, NPV 82.6 %). Dynamic, contrast-enhanced MRI had a lower median sensitivity (60.0 %) and NPV (80.0 %) compared to non-enhanced T1w/T2w sequences (88.4, 94.7 %), diffusion-weighted imaging (84.2, 90.6 %) and ultrasmall superparamagnetic iron oxide (USPIO)- enhanced T2*w sequences (83.0, 95.9 %). The most promising results seem to be achievable when using non-enhanced T1w/T2w and USPIO-enhanced T2*w sequences in combination with a dedicated axillary protocol (sensitivity 84.7 % and NPV 95.0 %). Conclusions The diagnostic performance of some MRI protocols for excluding axillary lymph node metastases approaches the NPV needed to replace SLNB. However, current observations are based on studies with heterogeneous study designs and limited populations. Main Messages • Some axillary MRI protocols approach the NPV of an SLNB procedure. • Dedicated axillary MRI is more accurate than protocols also covering the breast. • T1w/T2w protocols combined with USPIO-enhanced sequences are the most promising sequences.
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Affiliation(s)
- V J L Kuijs
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Norman G, Fayter D, Lewis-Light K, Chisholm J, McHugh K, Levine D, Jenney M, Mandeville H, Gatz S, Phillips B. An emerging evidence base for PET-CT in the management of childhood rhabdomyosarcoma: systematic review. BMJ Open 2015; 5:e006030. [PMID: 25573522 PMCID: PMC4289735 DOI: 10.1136/bmjopen-2014-006030] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 10/30/2014] [Accepted: 11/06/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Rhabdomyosarcoma (RMS) management depends on risk stratification at diagnosis and treatment response. Assessment methods include CT, MRI, bone scintigraphy, histological analysis and bone marrow biopsy. Advanced functional imaging (FI) has potential to improve staging accuracy and management strategies. METHODS AND ANALYSIS We conducted a systematic review (PROSPERO 2013:CRD42013006128) of diagnostic accuracy and clinical effectiveness of FI in histologically proven paediatric RMS. PRISMA guidance was followed. We searched 10 databases to November 2013. Studies with ≥10 patients with RMS which compared positron emission tomography (PET), PET-CT or diffusion-weighted imaging (DWI) MRI to conventional imaging at any treatment stage were included. Study quality was assessed. Limited, heterogeneous effectiveness data required narrative synthesis, illustrated by plotting sensitivity and specificity in receiver operating curve (ROC) space. RESULTS Eight studies (six PET-CT, two PET) with 272 RMS patients in total were included. No DWI-MRI studies met inclusion criteria. Pooled estimates were not calculated due to sparseness of data. Limited evidence indicated initial PET-CT results were predictive of survival. PET-CT changed management of 7/40 patients. Nodal involvement PET-CT: sensitivity ranged from 80% to 100%; specificity from 89% to 100%. Distant metastatic involvement: PET-CT sensitivity ranged from 95% to 100%; specificity from 80% to100%. Data on metastases in different sites were sparse. Limited data were found on outcome prediction by PET-CT response. DISSEMINATION AND ETHICS PET/PET-CT may increase initial staging accuracy in paediatric RMS, specifically in the detection of nodal involvement and distant metastatic spread. There is a need to further assess PET-CT for this population, ideally in a representative, unbiased and transparently selected cohort of patients.
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Affiliation(s)
- Gill Norman
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | - Debra Fayter
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | - Kate Lewis-Light
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | | | | | | | | | | | | | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
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Noninvasive nodal restaging in clinically node positive breast cancer patients after neoadjuvant systemic therapy: A systematic review. Eur J Radiol 2015; 84:41-47. [DOI: 10.1016/j.ejrad.2014.09.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/21/2014] [Accepted: 09/26/2014] [Indexed: 11/19/2022]
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Liu Y. Role of FDG PET-CT in evaluation of locoregional nodal disease for initial staging of breast cancer. World J Clin Oncol 2014; 5:982-989. [PMID: 25493234 PMCID: PMC4259958 DOI: 10.5306/wjco.v5.i5.982] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/05/2014] [Accepted: 05/16/2014] [Indexed: 02/06/2023] Open
Abstract
Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is not indicated or recommended in the initial staging of early breast cancer. Although it is valuable for detecting distant metastasis, providing prognostic information, identifying recurrence and evaluating response to chemotherapy, the role of FDG PET/CT in evaluating locoregional nodal status for initial staging of breast cancer has not yet been well-defined in clinical practice. FDG PET/CT has high specificity but compromised sensitivity for identifying axillary nodal disease in breast cancer. Positive axillary FDG PET/CT is a good predictor of axillary disease and correlates well with sentinel lymph node biopsy (SLNB). FDG PET/CT may help to identify patients with high axillary lymph node burden who could then move directly to axillary lymph node dissection (ALND) and would not require the additional step of SLNB. However, FDG PET/CT cannot replace SLNB or ALND due to unsatisfactory sensitivity. The spatial resolution of PET instruments precludes the detection of small nodal metastases. Although there is still disagreement regarding the management of internal mammary node (IMN) disease in breast cancer, it is known that IMN involvement is of prognostic significance, and IMN metastasis has been associated with higher rates of distant metastasis and lower overall survival rates. Limited clinical observations suggested that FDG PET/CT has advantages over conventional modalities in detecting and uncovering occult extra-axillary especially IMN lesions with upstaging the disease and an impact on the adjuvant management.
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Gallamini A, Zwarthoed C, Borra A. Positron Emission Tomography (PET) in Oncology. Cancers (Basel) 2014; 6:1821-89. [PMID: 25268160 PMCID: PMC4276948 DOI: 10.3390/cancers6041821] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/25/2014] [Accepted: 08/07/2014] [Indexed: 02/07/2023] Open
Abstract
Since its introduction in the early nineties as a promising functional imaging technique in the management of neoplastic disorders, FDG-PET, and subsequently FDG-PET/CT, has become a cornerstone in several oncologic procedures such as tumor staging and restaging, treatment efficacy assessment during or after treatment end and radiotherapy planning. Moreover, the continuous technological progress of image generation and the introduction of sophisticated software to use PET scan as a biomarker paved the way to calculate new prognostic markers such as the metabolic tumor volume (MTV) and the total amount of tumor glycolysis (TLG). FDG-PET/CT proved more sensitive than contrast-enhanced CT scan in staging of several type of lymphoma or in detecting widespread tumor dissemination in several solid cancers, such as breast, lung, colon, ovary and head and neck carcinoma. As a consequence the stage of patients was upgraded, with a change of treatment in 10%-15% of them. One of the most evident advantages of FDG-PET was its ability to detect, very early during treatment, significant changes in glucose metabolism or even complete shutoff of the neoplastic cell metabolism as a surrogate of tumor chemosensitivity assessment. This could enable clinicians to detect much earlier the effectiveness of a given antineoplastic treatment, as compared to the traditional radiological detection of tumor shrinkage, which usually takes time and occurs much later.
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Affiliation(s)
- Andrea Gallamini
- Department of Research and Medical Innovation, Antoine Lacassagne Cancer Center, Nice University, Nice Cedex 2-06189 Nice, France.
| | - Colette Zwarthoed
- Department of Nuclear Medicine, Antoine Lacassagne Cancer Center, Nice University, Nice Cedex 2-06189 Nice, France.
| | - Anna Borra
- Hematology Department S. Croce Hospital, Via M. Coppino 26, Cuneo 12100, Italy.
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Annunziata S, Caldarella C, Treglia G. Cost-effectiveness of Fluorine-18-Fluorodeoxyglucose positron emission tomography in tumours other than lung cancer: A systematic review. World J Radiol 2014; 6:48-55. [PMID: 24765240 PMCID: PMC3986420 DOI: 10.4329/wjr.v6.i3.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 12/31/2013] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To systematically review published data on the cost-effectiveness of Fluorine-18-Fluorodeoxyglucose positron emission tomography (FDG-PET) or PET/computed tomography (PET/CT) in tumours other than lung cancer.
METHODS: A comprehensive literature search of studies published in PubMed/MEDLINE, Scopus and Embase databases through the 10th of October in 2013 was carried out. A search algorithm based on a combination of the terms: (1) “PET” or “ PET/computed tomography (PET/CT)” or “positron emission tomography”; and (2) “cost-effectiveness” or “cost-utility” or “cost-efficacy” or “technology assessment” or “health technology assessment” was used. Only cost-effectiveness or cost-utility analyses in English language were included. Exclusion criteria were: (1) articles not within the field of interest of this review; (2) review articles, editorials or letters, conference proceedings; and (3) outcome evaluation studies, cost studies or health technology assessment reports. For each included study, information was collected concerning basic study, type of tumours evaluated, perspective/type of study, results, unit and comparison alternatives.
RESULTS: Sixteen studies were included. Head and neck tumours were evaluated in 4 articles, lymphoma in 4, colon-rectum tumours in 3 and breast tumours in 2. Only one article was retrieved for melanoma, oesophagus and ovary tumours. Cost-effectiveness results of FDG-PET or PET/CT ranged from dominated to dominant.
CONCLUSION: Literature evidence about the cost-effectiveness of FDG-PET or PET/CT in tumours other than lung cancer is still limited. Nevertheless, FDG-PET or PET/CT seems to be cost-effective in selective indications in oncology (staging and restaging of head and neck tumours, staging and treatment evaluation in lymphoma).
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Nodal status assessment in breast cancer: strategies of clinical grounds and quality of life implications. Int J Breast Cancer 2014; 2014:469803. [PMID: 24672730 PMCID: PMC3942203 DOI: 10.1155/2014/469803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/31/2013] [Accepted: 01/01/2014] [Indexed: 11/18/2022] Open
Abstract
Even in the era of gene-expression profiling, the nodal status still remains the primary prognostic discriminant in breast cancer patients. The exclusion of node involvement using noninvasive methods could reduce the rate of axillary surgery, thereby preventing from suffering complications. However, lymphatic mapping with sentinel node biopsy (SNB) is one of the most interesting recent developments in surgical oncology. Optimization of procedure could be implemented by dual mapping injection site skills, resection of all hot or blue nodes through tracer combination, and improvement in atypical drainage patterns mapping. This anatomical analysis suggests safety measures in patients with high probability of node metastasis through a renewed interest in surgical management. The perspective of a guided axillary sampling (GAS) could represent a potential development of recent anatomical and functional acquisitions, offering a dynamic technique shared according to clinical and anatomical disease parameters. Furthermore, the surgical staging procedures may adopt a conservative approach through the evaluation of upper arm lymphatics, thus defining a functional model aimed at the reduction of short- and long-term adverse events. Quality results in breast cancer surgery need to generate oncological safety devoid of complications through renewed clinical experience.
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