| Title | Early SUVmax is the best predictor of axillary lymph node metastasis in stage III breast cancers |
| Authors | Zhang, Jiangong Shi, Xun Xiao, Yong Ma, Chao Cao, Gang Liu, Yongbo Li, Yonggang |
| Affiliation | Soochow Univ, Dept Radiol, Affiliated Hosp 1, Suzhou, Peoples R China Nantong Univ, Peoples Hosp Yancheng 1, Dept Nucl Med, Affiliated Hosp 4, Yancheng, Peoples R China Nantong Univ, Peoples Hosp Yancheng 1, Affiliated Hosp 4, Dept MRI Room, Yancheng, Peoples R China Tongji Univ, Dept Nucl Med, Peoples Hosp 10, Shanghai, Peoples R China Peking Univ, Dept Radiol, Luan Hosp, Changzhi, Peoples R China |
| Issue Date | May-2021 |
| Publisher | QUANTITATIVE IMAGING IN MEDICINE AND SURGERY |
| Abstract | Background: Although fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose (F-18-FDG) positron emission/computed tomography (PET/CT) imaging has been investigated for its ability to evaluate lymph node metastasis of breast cancer, few comparative analyses have evaluated the preoperative and postoperative regional lymph node metastasis of breast cancer by dual-phase imaging, especially in patients with stage III (N2) disease. Methods: The clinical, pathological, and imaging data of 40 patients with stage III (N2) breast cancer were retrospectively analyzed. All patients underwent dual-time point F-18-FDG imaging before surgery and postoperative pathology examinations were obtained. The short-axis lymph node diameter was measured, and the maximum standardized uptake value (SUVmax) and the percentage difference of SUVmax between dual-phase (Delta SUVmax) were calculated to compare metastatic and non-metastatic lymph nodes on dual-time point images. Results: A total of 398 axillary lymph nodes were inspected, and 209 lymph nodes were matched with those on PET/CT images, including 97 metastatic and 112 non-metastatic lymph nodes. The SUVmax values were significantly different between metastatic and non-metastatic lymph nodes, in both the early and delayed scans (P<0.001). For metastatic lymph nodes, the SUVmax value on the delayed scan (6.17 +/- 2.62) was significantly higher compared with the early scan (5.45 +/- 1.35;Delta SUVmax=0.08 +/- 0.21, P<0.001). Moreover, the SUVmax values were not significantly different between the delayed (2.82 +/- 0.91) and early scans (2.79 +/- 0.72;Delta SUVmax=-0.00 +/- 0.11, P=0.77). The short diameters were not significantly different between metastatic and non-metastatic lymph nodes (P=0.12), and the SUVmax values of metastatic lymph nodes with short diameters of >4.00 and <= 6.00 mm were not significantly different between the early and delayed scans (P=0.06). However, the SUVmax values of metastatic lymph nodes with short diameters of >6.00 and <= 8.00 mm (7.11 +/- 0.19 vs. 5.96 +/- 0.08) and short diameters of >8.00 and <= 10.00 mm (10.76 +/- 0.35 vs. 6.82 +/- 0.50) were higher on the delayed scan versus the early scan, respectively (P<0.01 for each comparison). The difference between the Delta SUVmax values among the three subgroups was statistically significant (F=78.98, P<0.001). The receiver operating characteristic (ROC) curve analysis of the lymph nodes showed that the area under the curve (AUC) of the early and delayed PET/CT scans was 0.961 (0.925-0.983, P=0.013) and 0.897 (0.847-0.934, P=0.022), respectively. The ROC curves of the early and delayed scans were also significantly different (z=4.46, P<0.001). AUC of the Delta SUVmax for the early scan was significantly lower compared with delayed scans (z=8.95 vs. 9.13, respectively; P<0.001). Conclusions: Dual-time point 18F-FDG PET imaging significantly improved the prediction and detection of axillary lymph node metastasis, compared with prediction based on size of lymph node alone, in patients with stage III breast cancer. We found that lymph nodes with continuously increased SUVmax values tended to show metastasis, and early SUVmax assessment offers the best capacity for prediction of axillary lymph node metastasis. |
| URI | http://hdl.handle.net/20.500.11897/610319 |
| ISSN | 2223-4292 |
| DOI | 10.21037/qims-20-423 |
| Indexed | SCI(E) |
| Appears in Collections: | 待认领 |
