Axillary staging with 18F-FDG PET/CT in early breast cancer: impact of tumor subtypes
BACKGROUND: Breast cancer is one of the most common cancers in women globally. Axillary lymph node metastasis remains one of the most independent prognostic factors in breast cancer. OBJECTIVE: Evaluate the diagnostic accuracy of 18F-FDG-PET/CT in detecting axillary lymph node metastasis based on im...
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| Format: | Article |
| Language: | English |
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King Faisal Specialist Hospital and Research Centre
2025-05-01
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| Series: | Annals of Saudi Medicine |
| Online Access: | http://www.annsaudimed.net/doi/10.5144/0256-4947.2025.145 |
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| author | Abdullah Gunes Nuray Colapkulu-Akgul Caner Akgul Ibrahim Unlu Saffet Cinar |
| author_facet | Abdullah Gunes Nuray Colapkulu-Akgul Caner Akgul Ibrahim Unlu Saffet Cinar |
| author_sort | Abdullah Gunes |
| collection | DOAJ |
| description | BACKGROUND: Breast cancer is one of the most common cancers in women globally. Axillary lymph node metastasis remains one of the most independent prognostic factors in breast cancer. OBJECTIVE: Evaluate the diagnostic accuracy of 18F-FDG-PET/CT in detecting axillary lymph node metastasis based on immunohistochemical subtypes and its correlation with sentinel lymph node biopsy (SLNB) results. DESIGN: A retrospective cohort SETTING: Tertiary oncology center in Turkiye PATIENTS AND METHODS: Patients diagnosed with early-stage invasive ductal breast cancer and who underwent preoperative F-18 fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) evaluation were included in the study. Patients were divided into five immunohistochemical subtypes: Luminal A, Luminal B HER2 (−) (human epidermal growth factor receptor 2), Luminal B HER2 (+), HER2 (+), and triple negative. SLNB and SUVmax (Maximum Standard Unit Value) results were compared. MAIN OUTCOME MEASURES: Diagnostic accuracy of 18F-FDG PET/CT for detecting axillary metastasis was the primary outcome. Interrater reliability testing in determining the agreement between 18F-FDG PET/CT and SLNB was the secondary outcome. SAMPLE SIZE: 248 RESULTS: The sensitivity, specificity, PPV, NPV and accuracy of 18F-FDG-PET/CT for detecting axillary metastasis were 62%, 92%, 88%, 71% and 77%, respectively. Cohen's Kappa coefficient (0.54) showed moderate agreement with SLNB (P<.001). Tumors with positive HER2 gene amplification [HER2 (+) and Luminal B HER2 (+) have higher sensitivity than other subtypes (Luminal A, Luminal B HER2 (−) and triple negative). HER2 gene amplification also increases the agreement between 18F-FDG-PET/CT and SLNB results. CONCLUSION: 18F-FDG-PET/CT has a high specificity but low sensitivity for ipsilateral axillary metastasis in invasive ductal carcinoma. The presence of HER2 gene amplification can increase sensitivity and concordance with SLNB. LIMITATIONS: Retrospective design and limited number of patients for each subtype. |
| format | Article |
| id | doaj-art-92fe21367cff4c13a6abbc0ec486a27d |
| institution | DOAJ |
| issn | 0256-4947 0975-4466 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | King Faisal Specialist Hospital and Research Centre |
| record_format | Article |
| series | Annals of Saudi Medicine |
| spelling | doaj-art-92fe21367cff4c13a6abbc0ec486a27d2025-08-20T03:17:22ZengKing Faisal Specialist Hospital and Research CentreAnnals of Saudi Medicine0256-49470975-44662025-05-0145314515310.5144/0256-4947.2025.145Axillary staging with 18F-FDG PET/CT in early breast cancer: impact of tumor subtypesAbdullah Gunes0Nuray Colapkulu-Akgul1Caner Akgul2Ibrahim Unlu3Saffet Cinar4From the Department of General Surgery, Kocaeli City Hospital, Kocaeli, TurkiyeFrom the Department of General Surgery, Kocaeli Gebze Fatih State Hospital, Kocaeli, TurkiyeFrom the Department of General Surgery, Kocaeli Gebze Fatih State Hospital, Kocaeli, TurkiyeFrom the Department of General Surgery, Kocaeli City Hospital, Kocaeli, TurkiyeFrom the Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, TurkiyeBACKGROUND: Breast cancer is one of the most common cancers in women globally. Axillary lymph node metastasis remains one of the most independent prognostic factors in breast cancer. OBJECTIVE: Evaluate the diagnostic accuracy of 18F-FDG-PET/CT in detecting axillary lymph node metastasis based on immunohistochemical subtypes and its correlation with sentinel lymph node biopsy (SLNB) results. DESIGN: A retrospective cohort SETTING: Tertiary oncology center in Turkiye PATIENTS AND METHODS: Patients diagnosed with early-stage invasive ductal breast cancer and who underwent preoperative F-18 fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) evaluation were included in the study. Patients were divided into five immunohistochemical subtypes: Luminal A, Luminal B HER2 (−) (human epidermal growth factor receptor 2), Luminal B HER2 (+), HER2 (+), and triple negative. SLNB and SUVmax (Maximum Standard Unit Value) results were compared. MAIN OUTCOME MEASURES: Diagnostic accuracy of 18F-FDG PET/CT for detecting axillary metastasis was the primary outcome. Interrater reliability testing in determining the agreement between 18F-FDG PET/CT and SLNB was the secondary outcome. SAMPLE SIZE: 248 RESULTS: The sensitivity, specificity, PPV, NPV and accuracy of 18F-FDG-PET/CT for detecting axillary metastasis were 62%, 92%, 88%, 71% and 77%, respectively. Cohen's Kappa coefficient (0.54) showed moderate agreement with SLNB (P<.001). Tumors with positive HER2 gene amplification [HER2 (+) and Luminal B HER2 (+) have higher sensitivity than other subtypes (Luminal A, Luminal B HER2 (−) and triple negative). HER2 gene amplification also increases the agreement between 18F-FDG-PET/CT and SLNB results. CONCLUSION: 18F-FDG-PET/CT has a high specificity but low sensitivity for ipsilateral axillary metastasis in invasive ductal carcinoma. The presence of HER2 gene amplification can increase sensitivity and concordance with SLNB. LIMITATIONS: Retrospective design and limited number of patients for each subtype.http://www.annsaudimed.net/doi/10.5144/0256-4947.2025.145 |
| spellingShingle | Abdullah Gunes Nuray Colapkulu-Akgul Caner Akgul Ibrahim Unlu Saffet Cinar Axillary staging with 18F-FDG PET/CT in early breast cancer: impact of tumor subtypes Annals of Saudi Medicine |
| title | Axillary staging with 18F-FDG PET/CT in early breast cancer: impact of tumor subtypes |
| title_full | Axillary staging with 18F-FDG PET/CT in early breast cancer: impact of tumor subtypes |
| title_fullStr | Axillary staging with 18F-FDG PET/CT in early breast cancer: impact of tumor subtypes |
| title_full_unstemmed | Axillary staging with 18F-FDG PET/CT in early breast cancer: impact of tumor subtypes |
| title_short | Axillary staging with 18F-FDG PET/CT in early breast cancer: impact of tumor subtypes |
| title_sort | axillary staging with 18f fdg pet ct in early breast cancer impact of tumor subtypes |
| url | http://www.annsaudimed.net/doi/10.5144/0256-4947.2025.145 |
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