Prediction of macrometastasis in axillary lymph nodes of patients with invasive breast cancer and the utility of the SUV lymph node/tumor ratio using FDG-PET/CT
Identifieur interne : 001975 ( Main/Curation ); précédent : 001974; suivant : 001976Prediction of macrometastasis in axillary lymph nodes of patients with invasive breast cancer and the utility of the SUV lymph node/tumor ratio using FDG-PET/CT
Auteurs : Manabu Futamura [Japon] ; Takahiko Asano [Japon] ; Kazuhiro Kobayashi [Japon] ; Kasumi Morimitsu [Japon] ; Masahito Nawa [Japon] ; Masako Kanematsu [Japon] ; Akemi Morikawa [Japon] ; Ryutaro Mori [Japon] ; Kazuhiro Yoshida [Japon]Source :
- World Journal of Surgical Oncology [ 1477-7819 ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen, Aisselle, Biopsie de noeud lymphatique sentinelle, Courbe ROC, Femelle, Fluorodésoxyglucose F18 (pharmacocinétique), Grading des tumeurs, Humains, Invasion tumorale, Micrométastase tumorale, Métastase lymphatique, Noeuds lymphatiques (anatomopathologie), Pronostic, Radiopharmaceutiques (pharmacocinétique), Répartition dans les tissus, Stade de la tumeur, Tomodensitométrie (utilisation), Tomographie par émission de positons (utilisation), Tumeurs du sein (métabolisme), Tumeurs du sein (secondaire), Études de suivi.
- MESH :
- anatomopathologie : Noeuds lymphatiques.
- métabolisme : Tumeurs du sein.
- pharmacocinétique : Fluorodésoxyglucose F18, Radiopharmaceutiques.
- secondaire : Tumeurs du sein.
- utilisation : Tomodensitométrie, Tomographie par émission de positons.
- Adulte d'âge moyen, Aisselle, Biopsie de noeud lymphatique sentinelle, Courbe ROC, Femelle, Grading des tumeurs, Humains, Invasion tumorale, Micrométastase tumorale, Métastase lymphatique, Pronostic, Répartition dans les tissus, Stade de la tumeur, Études de suivi.
English descriptors
- KwdEn :
- Axilla, Breast Neoplasms (metabolism), Breast Neoplasms (secondary), Female, Fluorodeoxyglucose F18 (pharmacokinetics), Follow-Up Studies, Humans, Lymph Nodes (pathology), Lymphatic Metastasis, Middle Aged, Neoplasm Grading, Neoplasm Invasiveness, Neoplasm Micrometastasis, Neoplasm Staging, Positron-Emission Tomography (utilization), Prognosis, ROC Curve, Radiopharmaceuticals (pharmacokinetics), Sentinel Lymph Node Biopsy, Tissue Distribution, Tomography, X-Ray Computed (utilization).
- MESH :
- chemical , pharmacokinetics : Fluorodeoxyglucose F18, Radiopharmaceuticals.
- metabolism : Breast Neoplasms.
- pathology : Lymph Nodes.
- secondary : Breast Neoplasms.
- utilization : Positron-Emission Tomography, Tomography, X-Ray Computed.
- Axilla, Female, Follow-Up Studies, Humans, Lymphatic Metastasis, Middle Aged, Neoplasm Grading, Neoplasm Invasiveness, Neoplasm Micrometastasis, Neoplasm Staging, Prognosis, ROC Curve, Sentinel Lymph Node Biopsy, Tissue Distribution.
Abstract
Axillary lymph node dissection (ALND) is important for improving the prognosis of patients with node-positive breast cancer. However, ALND can be avoided in select micrometastatic cases, preventing complications such as lymphedema or paresthesia of the upper limb. To appropriately omit ALND from treatment, evaluation of the axillary tumor burden is critical. The present study evaluated a method for preoperative quantification of axillary lymph node metastasis using positron emission tomography/computed tomography (PET/CT).
The records of breast cancer patients who received radical surgery at the Gifu University Hospital (Gifu, Japan) between 2009 and 2014 were reviewed. The axillary lymph nodes were preoperatively evaluated by PET/CT. Lymph nodes were dissected by sentinel lymph node biopsy (SLNB) or ALND and were histologically diagnosed by experienced pathologists. The maximum standardized uptake value (SUVmax) was measured in both the axillary lymph node (SUV-LN) and primary tumor (SUV-T). The SUV-LN/T ratio (NT ratio) was calculated by dividing the SUV-LN by the SUV-T, and the efficacies of the NT ratio and SUV-LN were compared using receiver operating characteristic (ROC) curve analysis. The diagnostic performance was also compared between the techniques with the McNemar test.
A total of 171 operable invasive breast cancer patients were enrolled, comprising 69 node-positive patients (macrometastasis (Mac): n = 55; micrometastasis (Mic): n = 14) and 102 node-negative patients (Neg). The NT ratio for node-positive patients was significantly higher than in node-negative patients (0.5 vs. 0.316, respectively,
The NT ratio and SUV-LN are significantly higher in patients with axillary macrometastasis than in those with micrometastasis or no metastasis. The NT ratio and SUV-LN can help quantify axillary lymph node metastasis and may assist in macrometastasis identification, particularly in patients with an SUV-T ≥2.5.
The online version of this article (doi:10.1186/s12957-014-0424-2) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12957-014-0424-2
PubMed: 25885028
PubMed Central: 4336728
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PMC:4336728Le document en format XML
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and Molecular Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Breast and Molecular Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu</wicri:regionArea><orgName type="university">Université de Gifu</orgName><placeName><settlement type="city">Gifu (ville)</settlement><region type="province">Région du Chūbu</region><region type="prefecture">Préfecture de Gifu</region></placeName></affiliation></author><author><name sortKey="Asano, Takahiko" sort="Asano, Takahiko" uniqKey="Asano T" first="Takahiko" last="Asano">Takahiko Asano</name><affiliation wicri:level="4"><nlm:aff id="Aff2">Department of Radiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Radiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu</wicri:regionArea><orgName type="university">Université de Gifu</orgName><placeName><settlement type="city">Gifu (ville)</settlement><region type="province">Région du Chūbu</region><region type="prefecture">Préfecture de Gifu</region></placeName></affiliation></author><author><name sortKey="Kobayashi, Kazuhiro" sort="Kobayashi, Kazuhiro" uniqKey="Kobayashi K" first="Kazuhiro" last="Kobayashi">Kazuhiro Kobayashi</name><affiliation wicri:level="4"><nlm:aff id="Aff3">Department of Tumor Pathology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Tumor Pathology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu</wicri:regionArea><orgName type="university">Université de Gifu</orgName><placeName><settlement type="city">Gifu (ville)</settlement><region type="province">Région du Chūbu</region><region type="prefecture">Préfecture de Gifu</region></placeName></affiliation></author><author><name sortKey="Morimitsu, Kasumi" sort="Morimitsu, Kasumi" uniqKey="Morimitsu K" first="Kasumi" last="Morimitsu">Kasumi Morimitsu</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Breast and Molecular Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Breast and Molecular Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu</wicri:regionArea><orgName type="university">Université de Gifu</orgName><placeName><settlement type="city">Gifu (ville)</settlement><region type="province">Région du Chūbu</region><region type="prefecture">Préfecture de Gifu</region></placeName></affiliation></author><author><name sortKey="Nawa, Masahito" sort="Nawa, Masahito" uniqKey="Nawa M" first="Masahito" last="Nawa">Masahito Nawa</name><affiliation wicri:level="4"><nlm:aff id="Aff4">Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu</wicri:regionArea><orgName type="university">Université de Gifu</orgName><placeName><settlement type="city">Gifu (ville)</settlement><region type="province">Région du Chūbu</region><region type="prefecture">Préfecture de Gifu</region></placeName></affiliation></author><author><name sortKey="Kanematsu, Masako" sort="Kanematsu, Masako" uniqKey="Kanematsu M" first="Masako" last="Kanematsu">Masako Kanematsu</name><affiliation wicri:level="4"><nlm:aff id="Aff4">Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu</wicri:regionArea><orgName type="university">Université de Gifu</orgName><placeName><settlement type="city">Gifu (ville)</settlement><region type="province">Région du Chūbu</region><region type="prefecture">Préfecture de Gifu</region></placeName></affiliation></author><author><name sortKey="Morikawa, Akemi" sort="Morikawa, Akemi" uniqKey="Morikawa A" first="Akemi" last="Morikawa">Akemi Morikawa</name><affiliation wicri:level="4"><nlm:aff id="Aff4">Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu</wicri:regionArea><orgName type="university">Université de Gifu</orgName><placeName><settlement type="city">Gifu (ville)</settlement><region type="province">Région du Chūbu</region><region type="prefecture">Préfecture de Gifu</region></placeName></affiliation></author><author><name sortKey="Mori, Ryutaro" sort="Mori, Ryutaro" uniqKey="Mori R" first="Ryutaro" last="Mori">Ryutaro Mori</name><affiliation wicri:level="4"><nlm:aff id="Aff4">Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu</wicri:regionArea><orgName type="university">Université de Gifu</orgName><placeName><settlement type="city">Gifu (ville)</settlement><region type="province">Région du Chūbu</region><region type="prefecture">Préfecture de Gifu</region></placeName></affiliation></author><author><name sortKey="Yoshida, Kazuhiro" sort="Yoshida, Kazuhiro" uniqKey="Yoshida K" first="Kazuhiro" last="Yoshida">Kazuhiro Yoshida</name><affiliation wicri:level="4"><nlm:aff id="Aff4">Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu</wicri:regionArea><orgName type="university">Université de Gifu</orgName><placeName><settlement type="city">Gifu (ville)</settlement><region type="province">Région du Chūbu</region><region type="prefecture">Préfecture de Gifu</region></placeName></affiliation></author></analytic><series><title level="j">World Journal of Surgical Oncology</title><idno type="eISSN">1477-7819</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Axilla</term><term>Breast Neoplasms (metabolism)</term><term>Breast Neoplasms (secondary)</term><term>Female</term><term>Fluorodeoxyglucose F18 (pharmacokinetics)</term><term>Follow-Up Studies</term><term>Humans</term><term>Lymph Nodes (pathology)</term><term>Lymphatic Metastasis</term><term>Middle Aged</term><term>Neoplasm Grading</term><term>Neoplasm Invasiveness</term><term>Neoplasm Micrometastasis</term><term>Neoplasm Staging</term><term>Positron-Emission Tomography (utilization)</term><term>Prognosis</term><term>ROC Curve</term><term>Radiopharmaceuticals (pharmacokinetics)</term><term>Sentinel Lymph Node Biopsy</term><term>Tissue Distribution</term><term>Tomography, X-Ray Computed (utilization)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Aisselle</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Courbe ROC</term><term>Femelle</term><term>Fluorodésoxyglucose F18 (pharmacocinétique)</term><term>Grading des tumeurs</term><term>Humains</term><term>Invasion tumorale</term><term>Micrométastase tumorale</term><term>Métastase lymphatique</term><term>Noeuds lymphatiques (anatomopathologie)</term><term>Pronostic</term><term>Radiopharmaceutiques (pharmacocinétique)</term><term>Répartition dans les tissus</term><term>Stade de la tumeur</term><term>Tomodensitométrie (utilisation)</term><term>Tomographie par émission de positons (utilisation)</term><term>Tumeurs du sein (métabolisme)</term><term>Tumeurs du sein (secondaire)</term><term>Études de suivi</term></keywords><keywords scheme="MESH" type="chemical" qualifier="pharmacokinetics" xml:lang="en"><term>Fluorodeoxyglucose F18</term><term>Radiopharmaceuticals</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Noeuds lymphatiques</term></keywords><keywords scheme="MESH" qualifier="metabolism" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="métabolisme" xml:lang="fr"><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Lymph Nodes</term></keywords><keywords scheme="MESH" qualifier="pharmacocinétique" xml:lang="fr"><term>Fluorodésoxyglucose F18</term><term>Radiopharmaceutiques</term></keywords><keywords scheme="MESH" qualifier="secondaire" xml:lang="fr"><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="secondary" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="utilisation" xml:lang="fr"><term>Tomodensitométrie</term><term>Tomographie par émission de positons</term></keywords><keywords scheme="MESH" qualifier="utilization" xml:lang="en"><term>Positron-Emission Tomography</term><term>Tomography, X-Ray Computed</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Axilla</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Lymphatic Metastasis</term><term>Middle Aged</term><term>Neoplasm Grading</term><term>Neoplasm Invasiveness</term><term>Neoplasm Micrometastasis</term><term>Neoplasm Staging</term><term>Prognosis</term><term>ROC Curve</term><term>Sentinel Lymph Node Biopsy</term><term>Tissue Distribution</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Aisselle</term><term>Biopsie de noeud lymphatique sentinelle</term><term>Courbe ROC</term><term>Femelle</term><term>Grading des tumeurs</term><term>Humains</term><term>Invasion tumorale</term><term>Micrométastase tumorale</term><term>Métastase lymphatique</term><term>Pronostic</term><term>Répartition dans les tissus</term><term>Stade de la tumeur</term><term>Études de suivi</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Axillary lymph node dissection (ALND) is important for improving the prognosis of patients with node-positive breast cancer. However, ALND can be avoided in select micrometastatic cases, preventing complications such as lymphedema or paresthesia of the upper limb. To appropriately omit ALND from treatment, evaluation of the axillary tumor burden is critical. The present study evaluated a method for preoperative quantification of axillary lymph node metastasis using positron emission tomography/computed tomography (PET/CT).</p></sec><sec><title>Methods</title><p>The records of breast cancer patients who received radical surgery at the Gifu University Hospital (Gifu, Japan) between 2009 and 2014 were reviewed. The axillary lymph nodes were preoperatively evaluated by PET/CT. Lymph nodes were dissected by sentinel lymph node biopsy (SLNB) or ALND and were histologically diagnosed by experienced pathologists. The maximum standardized uptake value (SUVmax) was measured in both the axillary lymph node (SUV-LN) and primary tumor (SUV-T). The SUV-LN/T ratio (NT ratio) was calculated by dividing the SUV-LN by the SUV-T, and the efficacies of the NT ratio and SUV-LN were compared using receiver operating characteristic (ROC) curve analysis. The diagnostic performance was also compared between the techniques with the McNemar test.</p></sec><sec><title>Results</title><p>A total of 171 operable invasive breast cancer patients were enrolled, comprising 69 node-positive patients (macrometastasis (Mac): n = 55; micrometastasis (Mic): n = 14) and 102 node-negative patients (Neg). The NT ratio for node-positive patients was significantly higher than in node-negative patients (0.5 vs. 0.316, respectively, <italic>P</italic> = 0.041). The NT ratio for Mac patients (0.571) was significantly higher than in Mic (0.227) and Neg (0.316) patients (<italic>P</italic> <0.01 and <italic>P</italic> = 0.021, respectively). The areas under the curves (AUCs) by ROC analysis for the NT ratio and SUV-LN were 0.647 and 0.811, respectively (<italic>P</italic> <0.01). In patients with an SUV-T ≥2.5, the modified AUCs for the NT ratio and SUV-LV were 0.757 and 0.797 (not significant).</p></sec><sec><title>Conclusion</title><p>The NT ratio and SUV-LN are significantly higher in patients with axillary macrometastasis than in those with micrometastasis or no metastasis. The NT ratio and SUV-LN can help quantify axillary lymph node metastasis and may assist in macrometastasis identification, particularly in patients with an SUV-T ≥2.5.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12957-014-0424-2) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Orr, Rk" uniqKey="Orr R">RK Orr</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Clarke, M" uniqKey="Clarke M">M Clarke</name></author><author><name sortKey="Collins, R" uniqKey="Collins R">R Collins</name></author><author><name sortKey="Darby, S" uniqKey="Darby S">S Darby</name></author><author><name sortKey="Davies, C" uniqKey="Davies C">C Davies</name></author><author><name sortKey="Elphinstone, P" uniqKey="Elphinstone P">P Elphinstone</name></author><author><name 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