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CC BY-NC-ND 4.0 · World J Nucl Med 2022; 21(02): 120-126
DOI: 10.1055/s-0042-1750333
Original Article

Prediction of Sentinel Lymph Node Biopsy Status in Breast Cancers with PET/CT Negative Axilla

Sheela Chinnappan
1   Department of Radio-diagnosis, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
,
Piyush Chandra
2   Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
,
Senthil Kumar
3   Department of Surgical Oncology, MIOT International, Chennai, Tamil Nadu, India
,
M.B. Sridev
3   Department of Surgical Oncology, MIOT International, Chennai, Tamil Nadu, India
,
Deepti Jain
4   Department of Pathology, MIOT International, Chennai, Tamil Nadu, India
,
Ganesan Chandran
2   Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
,
Satish Nath
2   Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
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Abstract

Background and Aim Prior knowledge of axillary node status can spare a lot of patients with early breast cancer morbidity due to an unnecessary axillary dissection. Our study compared various metabolic and pathological features that can predict the sentinel lymph node biopsy (SLNB) status in patients with positron emission tomography/computed tomography (PET/CT) negative axilla.

Patients and Methods All consecutive patients with early breast cancers (< 5 cm) with PET/CT negative axilla who underwent breast surgery and SLNB from November 2016 to February 2020 were included. Various primary tumor (PT) pathological variables and metabolic variables on PET/CT such as maximum standardized uptake value (PT-SUVmax), metabolic tumor volume (PT-MTV), and total lesion glycolysis (PT-TLG) were compared using univariate and multivariate analyses for prediction of SLNB status.

Results Overall 70 patients, all female, with mean age 55.6 years (range: 33–77) and mean tumor size 2.2 cm (range: 0.7–4.5), were included. SLNB was positive in 20% of patients (n = 14) with nonsentinel nodes positive in 4% (n = 3) patients. Comparing SLNB positive and negative groups, univariate analysis showed significant association of SLNB with low tumor grade, positive lymphovascular invasion (LVI), positive estrogen receptor (ER) status with lower mean Ki-67 index (34.41 vs. 52.02%; p = 0.02), PT-SUVmax (5.40 vs. 8.68; p = 0.036), PT-MTV (4.71 cc vs. 7.46 cc; p = 0.05), and PT-TLG (15.12 g/mL.cc vs. 37.10 g/mL.cc; p = 0.006). On multivariate analysis, only LVI status was a significant independent predictor of SLNB status (odds ratio = 6.23; 95% confidence interval: 1.15–33.6; p = 0.033).

Conclusion SLNB is positive in approximately 20% of early breast cancers with PET/CT negative axilla and SLNB status appears to be independent of PT size. SLNB+ PTs were more likely to be LVI+ and ER + ve, with lower grade/Ki-67/metabolic activity (SUVmax/MTV/TLG) compared with SLNB–ve tumors. Logistic regression analysis revealed LVI status as the only significant independent predictor of sentinel lymph node status.

Keywords

sentinel lymph node biopsy - breast cancers - PET/CT negative axilla - prediction


Publikationsverlauf

Artikel online veröffentlicht:
28. Juni 2022

© 2022. World Association of Radiopharmaceutical and Molecular Therapy (WARMTH). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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