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 : 000F68 ( Pmc/Checkpoint ); précédent : 000F67; suivant : 000F69Prediction 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.
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.
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DOI: 10.1186/s12957-014-0424-2
PubMed: 25885028
PubMed Central: 4336728
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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 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lymph node/tumor ratio using FDG-PET/CT</title><author><name sortKey="Futamura, Manabu" sort="Futamura, Manabu" uniqKey="Futamura M" first="Manabu" last="Futamura">Manabu Futamura</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="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></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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<front><journal-meta><journal-id journal-id-type="nlm-ta">World J Surg Oncol</journal-id><journal-id journal-id-type="iso-abbrev">World J Surg Oncol</journal-id><journal-title-group><journal-title>World Journal of Surgical Oncology</journal-title></journal-title-group><issn pub-type="epub">1477-7819</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25885028</article-id><article-id pub-id-type="pmc">4336728</article-id><article-id pub-id-type="publisher-id">424</article-id><article-id pub-id-type="doi">10.1186/s12957-014-0424-2</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>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</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Futamura</surname><given-names>Manabu</given-names></name><address><email>mfutamur@gifu-u.ac.jp</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Asano</surname><given-names>Takahiko</given-names></name><address><email>tasa@gifu-u.ac.jp</email></address><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Kobayashi</surname><given-names>Kazuhiro</given-names></name><address><email>hern@live.jp</email></address><xref ref-type="aff" rid="Aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Morimitsu</surname><given-names>Kasumi</given-names></name><address><email>kasumimorimitsu@mail.goo.ne.jp</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Nawa</surname><given-names>Masahito</given-names></name><address><email>masax5x5@gmail.com</email></address><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Kanematsu</surname><given-names>Masako</given-names></name><address><email>m_kanematsu@hotmail.co.jp</email></address><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Morikawa</surname><given-names>Akemi</given-names></name><address><email>akemim103@yahoo.co.jp</email></address><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Mori</surname><given-names>Ryutaro</given-names></name><address><email>r-mori@wj8.so-net.ne.jp</email></address><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Yoshida</surname><given-names>Kazuhiro</given-names></name><address><email>k.yoshida@gifu-u.ac.jp</email></address><xref ref-type="aff" rid="Aff4"></xref></contrib><aff id="Aff1"><label></label>Department of Breast and Molecular Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</aff><aff id="Aff2"><label></label>Department of Radiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</aff><aff id="Aff3"><label></label>Department of Tumor Pathology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</aff><aff id="Aff4"><label></label>Department of Surgical Oncology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan</aff></contrib-group><pub-date pub-type="epub"><day>14</day><month>2</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>14</day><month>2</month><year>2015</year></pub-date><pub-date pub-type="collection"><year>2015</year></pub-date><volume>13</volume><elocation-id>49</elocation-id><history><date date-type="received"><day>2</day><month>8</month><year>2014</year></date><date date-type="accepted"><day>23</day><month>12</month><year>2014</year></date></history><permissions><copyright-statement>© Futamura et al.; licensee BioMed Central. 2015</copyright-statement><license license-type="open-access"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><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></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Axillary lymph node</kwd><kwd>Macrometastasis</kwd><kwd>Breast cancer</kwd><kwd>PET/CT</kwd><kwd>NT ratio</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2015</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc><affiliations><list><country><li>Japon</li></country><region><li>Préfecture de Gifu</li><li>Région du Chūbu</li></region><settlement><li>Gifu (ville)</li></settlement><orgName><li>Université de Gifu</li></orgName></list><tree><country name="Japon"><region name="Région du Chūbu"><name sortKey="Futamura, Manabu" sort="Futamura, Manabu" uniqKey="Futamura M" first="Manabu" last="Futamura">Manabu Futamura</name></region><name sortKey="Asano, Takahiko" sort="Asano, Takahiko" uniqKey="Asano T" first="Takahiko" last="Asano">Takahiko Asano</name><name sortKey="Kanematsu, Masako" sort="Kanematsu, Masako" uniqKey="Kanematsu M" first="Masako" last="Kanematsu">Masako Kanematsu</name><name sortKey="Kobayashi, Kazuhiro" sort="Kobayashi, Kazuhiro" uniqKey="Kobayashi K" first="Kazuhiro" last="Kobayashi">Kazuhiro Kobayashi</name><name sortKey="Mori, Ryutaro" sort="Mori, Ryutaro" uniqKey="Mori R" first="Ryutaro" last="Mori">Ryutaro Mori</name><name sortKey="Morikawa, Akemi" sort="Morikawa, Akemi" uniqKey="Morikawa A" first="Akemi" last="Morikawa">Akemi Morikawa</name><name sortKey="Morimitsu, Kasumi" sort="Morimitsu, Kasumi" uniqKey="Morimitsu K" first="Kasumi" last="Morimitsu">Kasumi Morimitsu</name><name sortKey="Nawa, Masahito" sort="Nawa, Masahito" uniqKey="Nawa M" first="Masahito" last="Nawa">Masahito Nawa</name><name sortKey="Yoshida, Kazuhiro" sort="Yoshida, Kazuhiro" uniqKey="Yoshida K" first="Kazuhiro" last="Yoshida">Kazuhiro Yoshida</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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