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Korean Journal of Clinical Oncology > Volume 6(2); 2010 > Article
REVIEW
Korean J Clin Oncol. 2010;6(2): 57-63.         doi: https://doi.org/10.14216/kjco.10020
The Clinical Significance of 18F-Fluorodeoxyglucose Uptake on Axillary Lymph Nodes Metastasis in Breast Cancer
SooHee Go1, Hyung-Il Seo1, JeeYeon Lee1, YounJoo Jung2
1Department of Surgery, Pusan National University College of Medicine
2Breast Cancer Clinic, Busan Cancer Center, Pusan National University Hospital
Axillary LN meta가 있는 유방암에서 액와 림프절의 FDG uptake가 가지는 임상적 의미
고수희1, 서형일1, 이지연1, 정윤주2
1부산대학교 의과대학 외과
2부산대학교병원 부산지역암센터 유방암클리닉
Corresponding Author: Hyung-Il Seo ,Tel: +82-51-240-7238, Fax: +82-51-247-1365, Email: seohi71@hanmail.net
Received: November 20, 2010;  Accepted: December 23, 2010.
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ABSTRACT
Purpose: 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography(18F-FDG PET/CT) has been recommended as a diagnostic modality for preoperative staging of breast cancer. But, the information for FDG uptake on axillary lymph node(ALN) is not sufficient. Authors investigated the FDG uptake on ALN in preoperative 18F-FDG PET/CT and tumor characteristics to figure out their association and its clinical significance. Materials and
Methods: From Jan. to Dec. 2007, 176 patients had been performed preoperative 18F-FDG PET/CT. Only sixty-five cases were confirmed as ALN metastasis in pathologic report. Thirty-one patients with high FDG uptake of ALN (SUVmax>1.0) and thirty-four with low FDG uptake (SUVmax°¬1.0) in 18F-FDG PET/CT were classified as group A and B, respectively.
Results: The FDG uptake of ALN showed significant relationship with poor prognostic factors of primary tumor(worse histologic grade, negativity of estrogen and progesterone receptor, positivity of p53 and c-erbB2 gene, tumor necrosis, lymphovascular invasion) and ALN metastasis. In multivariate analysis, FDG uptake of ALN showed larger tumor size (p=0.001), higher Ki-67 (p=0.004), bigger and more metastatic ALN (p=0.017, <0.001) compared to low FDG uptake of ALN. The cut-off values of high FDG uptake were 1.85cm of primary tumor size, 17.5% of Ki-67, 2.5 and 0.95cm of number and size of metastatic ALN.
Conclusion: The most valuable sensitivity and specificity of FDG uptake in metastatic ALN were shown when the number and size of ALN was more than 3 or 0.95cm and they would be large enough to perform ultrasonographyguided biopsy. We recommend preoperative ALN biopsy for the cases of FDG uptake on ALN in preoperative 18FFDG PET/CT and the sentinel lymph node biopsy might be skipped if metastasis is confirmed on biopsy.
Keywords: 18F-Fluorodeoxyglucose uptake | Axillary lymph nodes | Breast cancer | Primary tumor characteristics
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