Pretreatment PET Imaging of Lymph Nodes Predicts Recurrence in Breast Cancer Patients
Disease-free survival for invasive ductal breast cancer (IDC) patients may be easier to predict with the help of F-18-fludeoxyglucose positron emission tomography (PET)/computed tomography (CT) scans, according to research published in the September issue of The Journal of Nuclear Medicine. New data show that high maximum standard uptake value (SUVmax) of F-18-FDG in the lymph nodes prior to treatment could be an independent indicator of disease recurrence.
“Many studies have revealed that breast cancer patients with axillary lymph node metastasis have a significantly poorer prognosis than those without nodal metastases,” noted Sang-Woo Lee, MD, PhD, one of the authors of “F-18-FDG Uptake by Metastatic Axillary Lymph Nodes on Pretreatment PET/CT as a Prognostic Factor for Recurrence in Patients with Invasive Ductal Breast Cancer.” “However, the prognostic value of F-18-FDG uptake in metastatic axillary lymph nodes with PET/CT has not been investigated in IDC patients,” he added.
In the study, researchers followed 65 female patients with IDC who had undergone pretreatment F-18-FDG PET/CT and who had pathologically confirmed axillary lymph node involvement without distant metastases. Factors such as age, TNM (tumor, lymph node and metastases) stage, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, and SUVmax for the primary-tumor and axillary lymph nodes were analyzed. Patients underwent treatment and were followed for a range of 21-57 months (median of 36 months).
Among the patients, 53 were disease-free and 12 had disease recurrence during the follow-up period. While both the primary-tumor and nodal SUVmax were higher in patients with recurrence, the nodal SUVmax was significantly higher. In addition, compared to the other factors that were analyzed, only nodal SUVmax was found to be an independent determinant of disease-free survival. Using a receiver-operating-characteristic curve, the researchers demonstrated that a nodal SUVmax of 2.8 was the optimal cutoff for predicting disease-free survival.
“One of the important roles of molecular imaging in cancer research is to noninvasively predict precise prognosis. Our results showed significant improvement in the accuracy of risk prediction for disease-free survival rates when nodal SUVmax was added to well-known established risk factors,” said Lee. “Our study suggests that 18F-FDG PET/CT could yield useful information for risk stratification and treatment strategies in IDC patients with axillary lymph node involvement.”
KEY POINTS
Whereas CT gives detailed anatomic information, PET
gives functional information, and a new type of scan that
combines the two (PET/CT) is more useful than either type
alone in many oncologic, cardiologic, and neurologic
indications.
The tracers used in PET are taken up preferentially in
tissues in which metabolism is enhanced, such as tumors
compared with normal tissue, or in viable myocardium
compared with infarcted myocardium.
A major application of PET is in the workup of
indeterminate solitary pulmonary nodules. Other uses of
PET in oncology are to diagnose, stage, and restage
disease and to assess the effectiveness of chemotherapy
in various types of malignancies.
In cardiology, PET can be used to diagnose coronary artery
disease and to determine myocardial viability.
In neurology, PET is used to differentiate between tumor
recurrence and radiation necrosis in patients who have
undergone radiotherapy for brain tumors, to differentiate
Alzheimer disease from other dementias, and to locate
epileptic foci.
An estimated one in eight women will develop breast cancer in her lifetime. According to the American Cancer Society, an estimated 280,000 new cases of breast cancer were diagnosed among women in 2011, and nearly 40,000 died from the disease.
Authors of the article “F-18-FDG Uptake by Metastatic Axillary Lymph Nodes on Pretreatment PET/CT as a Prognostic Factor for Recurrence in Patients with Invasive Ductal Breast Cancer”include Bong-Il Song, Sang-Woo Lee, Shin Young Jeong, Byeong-Cheol Ahn and Jaetae Lee, Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Korea; Yee Soo Chae, Department of Internal Medicine. Kyungpook National University Hospital, Daegu, Korea; and Won Kee Lee, Center of Biostatistics, School of Medicine, Kyungpook National University Hospital, Daegu, Korea.
What is a PET Scan for Lymph Nodes?
A PET scan, or positron emission tomography, is often used in the identification of certain cancers. While there are many scans available to physicians, PET scans are often more accurate in identifying cancers as they can detect what kind of activity is taking place within a tumor’s cells and determine whether it is benign or malignant. PET scans are particularly useful in assessing lymph nodes and in the treatment of lymphomas, both primary and secondary.
Function
A PET scan is often used in the identification of cancerous tumors. PET scans differ from other scans, such as X-rays, as they do not take photographs of the tumor; instead, a PET scan analyzes cell activity and diagnoses cancers based on the high activity within a cancerous cell. A physician will order a PET scan to analyze the lymph nodes if one or several nodes are under suspicion of being cancerous.
Preparation
A PET scan is usually performed on an outpatient basis. It’s a rather simple procedure, from the patient’s perspective, and the only requirement is to refrain from eating or drinking for 6 hours prior to the time of the scheduled scan.
Please visit the SNMMI Newsroom to view the PDF of the study, including images, and further reading about molecular imaging and personalized medicine. To schedule an interview with the researchers, please contact Susan Martonik at (703) 652-6773 or .(JavaScript must be enabled to view this email address) and past issues of The Journal of Nuclear Medicine can be found online at http://jnm.snmjournals.org.
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