How to Cite
Abstract
We aimed to evaluate different imaging strategies for diagnosis of axillary LNMs in patients with primary breast cancer (BC). 168 consecutive patients with primary BC were included in the study. Functional imaging by scintigraphy (AxSc) with 99mTc-MIBI was performed in static and tomography modes 15 min after i/v injection. Focal areas of tracer accumulation in axial region were considered as sings of LNMs. Ultrasound (US) examination of axillary region was performed on 7.5 kH scanner. Nodes with diameter more than 1 cm were considered abnormal. All patients were operated with axial LN dissection and subsequent histological evaluation. Scintigraphic signs of LNMs revealed in 65 patients: 48 —true positive, 17—false positive. Among 103 women with normal AxSc results 27 had LNMs and 76—uninvolved nodes. Sensitivity (Sen), Specificity (Sp) and Accuracy (Ac) of AxSc were as follows: 64%, 82% and 74%. Sonography diagnosed LNMs in 74 women: 56 were metastatic on histology while other 18—uninvolved. On the contrary, 19 of 94 US normal sized nodes were metastatic on histology. US had following values when used for diagnosis of axillary LNMs: Sen—75%, Sp—81%, Ac—78%. When LNMs were diagnosed as the combination of concordantly abnormal US and AxSc examinations Sp reached 95%, Sen dropped down to 56% and Ac — to 77%. Another model was based on the assumption that LNMs must be diagnosed in all patients with abnormal US or AxSc examinations. According to this strategy Sen reached 83%, Sp—68% and Ac—74%. Thus, we found comparative accuracy of US and AxSc in diagnosis of axillary LNMs in patients with primary BC. Combination of both modalities can significantly improve sensitivity (83%) or specificity (95%) of final conclusion which is determined by established diagnostic strategy and criteria’s that are used for BC diagnosis.References
Abe K., Sasaki M., Kuwabara Y. et al. Comparison of 18FDG-PET with 99mTc-HDMP scintigraphy for the detection of bone metastases in patients with breast cancer // Ann. Nucl. Med. — 2005. — Vol. 19. — P. 573-579.
Alvarez S., Anorbe E., Alcorta P. et al. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review // Am J Roentgenol — 2006. — Vol. 18. — P. 1342-1348.
Bourez R., Rutgers E., van de Velde C. Will we need lymph node dissection at all in the future? // Clin Breast Cancer—2002. — Vol. 3. — P. 315-322.
Buscombe J.R., Holloway B., Roche N. et al. Position of nuclear medicine in the diagnostic work-up of breast cancer // Q. J. Nucl. Med. Mol. Imaging. — 2004. — Vol. 48. — P. 109-118.
Canavese G., Catturich A., Vecchio C. et al: Prognostic role of lymph-node level involvement in patients undergoing axillary dissection for breast cancer. // Eur J Surg Oncol — 1998. — Vol. 24. — P. 104-109.
Fredriksson I., Liljegren G., Arnesson L.G. et al: Consequences of axillary recurrence after conservative breast surgery // Br J Surg — 2002. — Vol. 89. — P. 902 -908.
Gelmon K.A. The ongoing debate about nodes // Clin Breast Cancer — 2010. — Vol. 10. P. 265-266.
Hatoum H.A., Jamali F.R., El Saghir N.S. et al: Ratio between positive lymph nodes and total excised axillary lymph nodes as an independent prognostic factor for overall survival in patients with nonmetastatic lymph node-positive breast cancer. // Ann Surg Oncol — 2009. — Vol. 16. — P. 3388-3395.
Krag D.N., Anderson S.J., Julian T.B. et al.: Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial // Lancet Oncol — 2007. — Vol. 8. — P. 881-888.
Lastoria S., Piccolo S., Varrella P. et al. Comparative results of Tc99m-MIBI and Tc99m MDP scintimammography in patients with breast abnormalities // J. Nucl. Med. — 1995. — Vol. 36. — P. 51.
Lee J.H., Rosen E.L., Mankoff D.A. The role of radiotracer imaging in the diagnosis and management of patients with breast cancer: part 1-overview, detection, and staging // J. Nucl. Med. — 2009. — Vol. 50. — P. 569-581.
Louis-Sylvestre C, Clough K., Asselain B et al. Axillary treatment in conservative management of operable breast cancer: dissection or radiotherapy? Results of a randomized study with 15 years of follow-up // J Clin Oncol — 2004. — Vol. 22. — P. 97-101.
Mansi L., Rambaldi P.F., Gregorio F. et al. Scintimammography with technetium-99m-tetrofosmin in the diagnosis of breast cancer and lymph node metastases // Eur. J. Nucl. Med. - 1996. — Vol. 23. — P. 932-939.
Mathijssen I.M., Strijdhorst H., Kiestra S.K. et al.: Added value of ultrasound in screening the clinically negative axilla in breast cancer // J Surg Oncol — 2006. — Vol. 94. — P. 364-367.
Peare R., Staff R.T., Heys S.D. The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature // Breast Cancer Res Treat — 2010. — Vol. 123. — P. 281-290.
Recht A., Gray R., Davidson N.E. et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: Experience of the Eastern Cooperative Oncology Group // J Clin Oncol — 1999. — Vol. 17. — P. 1689-1700.
Ren C., Jin S., Zhou Q. et al. Clinical significance of 99mTc-MIBI breast imaging in the diagnosis of early breast cancer // Asian. J. Surg. — 2002. — Vol. 25. — P. 126-129.
Rutqvist L.E., Rose C., Cavallin-Stahl E. A systematic overview of radiation therapy effects in breast cancer. // Acta Oncol — 2003. Vol. 42. — P. 532-545.
Sloka J.S., Hollett P.D., Mathews M. A quantitative review of the use of FDG-PET in the axillary staging of breast cancer // Med Sci Monit — 2007. — Vol. 13. — P. RA 37-46.
Straver M.E., Meijnen P., van Tienhoven G. et al. Sentinel node identification rate and nodal involvement in the EORTC 10981-22023 AMAROS trial // Ann Surg Oncol — 2010. — Vol. 17. P. 1854-1861.
Strom E.A., Woodward W.A., Katz A. et al. Clinical investigation: regional nodal failure patterns in breast cancer treated with mastectomy without radiotherapy // Int J Radiat Oncol Biol Phys — 2005. Vol. 63. — P. 1508 -1513
Tai P., Yu E., Joseph K. Prognostic significance of number of positive nodes: a long-term study of one to two nodes versus three nodes in breast cancer patients // Int J Radiat Oncol Biol Phys — 2010. Vol. 77. P. 180-187.
Taillefer R. Clinical applications of 99mTc-sestamibi scintigraphy// Semin. Nucl. Med. — 2005. — Vol. 35. — P. 100-115.
Veronesi U., Arnone P., Veronesi P. et al. The value of radiotherapy on metastatic mammary nodes in breast cancer. Results of large series // Ann Oncol. — 2008. Vol. 19. — P. 1553-1560.
Zgajnar J., Hocevar M., Podkrajsek M. et al. Patients with preoperatively ultrasonically uninvolved axillary lymph nodes: a distinct subgroup of early breast cancer patients // Breast Cancer Res Treat — 2006. — Vol. 97. P. 293-299.
All the Copyright statements for authors are present in the standart Publishing Agreement (Public Offer) to Publish an Article in an Academic Periodical 'Problems in oncology' ...