11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society Semih Gorgulu,

11th Biennial Meeting of the International Gynecologic Cancer Society11th Biennial Meeting of the International Gynecologic Cancer Society

Semih Gorgulu, MDSemih Gorgulu, MD

Gulhane Military Medical Academy, Dept. of SurgeryGulhane Military Medical Academy, Dept. of Surgery

Ankara, TURKEYAnkara, TURKEY

FDG-PET WITH SENTINEL LYMPH NODE BIOPSY FOR EVALUATION OF AXİLLARY

INVOLVEMENT IN BREAST CANCER


Breast Cancer

Jemal, A et al CA Cancer J Clin 2006;56:106-130


The single most powerful independent predictor of recurrence and survival

Clinical examination and currently available imaging techniques are

inaccurate for axillary staging

The best procedure examining the axillary lymph nodes is still

standard axillary lymph node dissection and pathological node

examination

Significant short & long term sequelae

LymheodemaRestriction of arm and

shoulder movementNumbness of upper arm skin

Provides staging & prognostic information


Axillary staging through a minimally invasive and less morbid surgical approach

More precise and consistent identification of the node with

highest pathological yield

A reliable axillary staging technique, although a limited

number of false negative results are a feature of all published

experience

But still involves a surgical procedure


Positron Emission Tomography (PET)

Nuclear medicine imaging modality

Biochemical & physiologic activity

Anatomic imageMalignant cells exhibit

increased glycolitic activity Radio labeled glucose

analog [F-18] Fluorodeoxyglucose

(FDG)


Analyze the value of FDG PET scanning in detecting axillary lymph node involvement in women with primary

breast cancer undergoing sentinel lymph node (SN) biopsy

24 women with newly diagnosed invasive breast cancer underwent FDG-PET. İmages were blindly interpreted by two experienced readers for abnormally increased axillary

FDG uptake. After SN biopsy all patients underwent complete axillary lymph node dissection


Characteristic Total No. %Age (Years)

≤ 50 8 33.3

≥ 51 16 66.6

Histologic type

Ductal 19 79.1

Lobular 4 16.6

Mixed 1 4.1

Tumor grade

I 4 16.6

II 9 37.5

III 11 45.8


Characteristics Total No. %

Tumor size (cm)

≤ 0.5 1 4.1

0.5-1.0 4 16.6

1.1-2.0 13 54.1

2.0-5.0 6 25

> 5.0 - -

ER-PR receptor status

Positive 17 70.8

Negative 7 29.1


11 patients (45.8 %) Metastatic SLN

FDG-PET 3 patients

Tumor size in PET (-) patients 8-34 mm

No false positive findings with FDG-PET

Sensitivity 27.2 %

Specificity 100 %

Positive predictive value 100 %

Negative predictive value 61.9 %


Authors Year CasesSensitivity

(%)Specificity

(%)

Avril 1996 51 79 96

Utech 1996 124 100 75

Adler 1997 52 95 66

Crippa 1998 68 85 91

Smithe 1998 50 90 91

Schirrmeister 2001 117 79 92

Zornosa 2003 200 84 97

Barranger 2003 32 20 100

Fehr 2004 24 20 93

Wahl 2004 360 61 80

Gorgulu 2006 24 27 100


After the promising initial results, more recent studies showed that FDG-PET is not yet sufficiently sensitive in detection of lymph node metastases

This limitation has become particularly clear since the introduction of aggressive pathological examination

Currently FDG-PET cannot be routinely used for axillary staging of operable breast cancer

CONCLUSIONS


Gulhane Military Medical Academy Gulhane Military Medical Academy Ankara TURKEYAnkara TURKEY

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11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society Semih Gorgulu,