NDLI: 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

Content Provider	Springer Nature : BioMed Central
Author	Sae-lim, Chayanee Wu, Wen-Pei Chang, Ming-Che Lai, Hung-Wen Chen, Shu-Tian Chou, Chen-Te Liao, Chiung‑Ying Huang, Hsin-I Chen, Shou-Tung Chen, Dar-Ren Hung, Che-Lun
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.
Related Links	https://wjso.biomedcentral.com/counter/pdf/10.1186/s12957-023-03297-y.pdf
Ending Page	14
Page Count	14
Starting Page	1
File Format	HTM / HTML
ISSN	14777819
DOI	10.1186/s12957-023-03297-y
Journal	World Journal of Surgical Oncology
Issue Number	1
Volume Number	22
Language	English
Publisher	BioMed Central
Publisher Date	2024-01-06
Access Restriction	Open
Subject Keyword	Surgical Oncology Axillary lymph node Axillary staging Breast cancer Magnetic resonance imaging Positron emission tomography/computed tomography Sentinel lymph node biopsy (SLNB) Axillary lymph node disease burden
Content Type	Text
Resource Type	Article
Subject	Oncology Surgery
Journal Impact Factor	2.5/2023
5-Year Journal Impact Factor	2.8/2023

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