Abstract
Introduction
18F-FDG PET/CT has high positive predictive value for the detection of avid lymph node
metastases in breast cancer patients. We analysed the effect of upstaging lymph nodes
by PET/CT on short-term outcome in stage II/III breast cancer patients.
Patients and methods
A total of 278 stage II/III primary breast cancer patients (mean age 48.9 years, range
19–75 years) were re-staged with 18F-FDG PET/CT before start of pre-operative systemic treatment (PST). Patients were
divided in three groups based on risk for local recurrence: a low – (T2N0), intermediate
– (T0-2N1 and T3N0) and a high-risk group (T0-3N2–3, T3N1 and T4). Within these groups
we looked at local recurrence-free survival (LRFS), recurrence-free survival (RFS)
and overall survival (OS) within the first 3 years of follow-up.
Results
With a median follow-up (FU) of 50 months the RFS, LRFS and OS were 87%, 88% and 92%
respectively for the whole group. PET/CT upstaged 43 patients from the low- and intermediate
risk group to the high-risk group, based on detection of ≥4 avid axillary nodes or
occult N2/3-disease. Patients upstaged with PET/CT had more events for all three analyses
compared to the original risk groups, which resulted in a significantly worse RFS
(69.8%; p = 0.03) a nearly significantly worse LRFS (p = 0.052) and no effect in OS
(p = 0.433).
Discussion
Additional PET/CT staging allows breast cancer patients to be treated according to
the true stage, still stage II/III breast cancer patients upstaged to N2/3 by PET/CT
have worse short-term outcome, despite adjustment of treatment, than patients staged
high-risk with conventional imaging.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Preoperative chemotherapy in primary operable breast cancer: results from the European Organization for Research and Treatment of Cancer trial 10902.J Clin Oncol. 2001; 19: 4224-4237
- Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes.J Clin Oncol. 2012; 30: 1796-1804https://doi.org/10.1200/JCO.2011.38.8595
- 18F-FDG PET/CT in staging patients with locally advanced or inflammatory breast cancer: comparison to conventional staging.J Nucl Med. 2013; 54: 5-11https://doi.org/10.2967/jnumed.112.106864
- 18F-FDG PET/CT as a staging procedure in primary stage II and III breast cancer: comparison with conventional imaging techniques.Breast Cancer Res Treat. 2012; 131: 117-126https://doi.org/10.1007/s10549-011-1767-9
- Additional value of PET-CT in staging of clinical stage IIB and III breast cancer.Breast J. 2010; 16: 617-624https://doi.org/10.1111/j.1524-4741.2010.00987.x
- Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer: meta-analysis of its accuracy and utility in staging the axilla.Ann Surg. 2011; 254: 243-251https://doi.org/10.1097/SLA.0b013e31821f1564
- Value of preoperative ultrasound-guided axillary lymph node biopsy for preventing completion axillary lymph node dissection in breast cancer: a systematic review and meta-analysis.Ann Surg Oncol. 2014; 21: 51-59https://doi.org/10.1245/s10434-013-3229-6
- A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer.N Engl J Med. 2003; 349: 546-553https://doi.org/10.1056/NEJMoa012782
- Preoperative PET/CT in early-stage breast cancer.Ann Oncol. 2012; 23: 2277-2282https://doi.org/10.1093/annonc/mds002
- Locoregional lymph node involvement on 18F-FDG PET/CT in breast cancer patients scheduled for neoadjuvant chemotherapy.Breast Cancer Res Treat. 2012; 135: 231-240https://doi.org/10.1007/s10549-012-2179-1
- Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009.Ann Oncol. 2009; 20: 1319-1329https://doi.org/10.1093/annonc/mdp322
- Regional nodal irradiation in early-stage breast cancer.N Engl J Med. 2015; 373: 307-316https://doi.org/10.1056/NEJMoa1415340
- Internal mammary and medial supraclavicular irradiation in breast cancer.N Engl J Med. 2015; 373: 317-327https://doi.org/10.1056/NEJMoa1415369
- Pre-chemotherapy 18F-FDG PET/CT upstages nodal stage in stage II-III breast cancer patients treated with neoadjuvant chemotherapy.Breast Cancer Res Treat. 2013; 141: 249-254https://doi.org/10.1007/s10549-013-2678-8
- Marking the axilla with radioactive iodine seeds (MARI procedure) may reduce the need for axillary dissection after neoadjuvant chemotherapy for breast cancer.Br J Surg. 2010; 97: 1226-1231https://doi.org/10.1002/bjs.7073
- Prevention of brown adipose tissue activation in 18F-FDG PET/CT of breast cancer patients receiving neoadjuvant systemic therapy.J Nucl Med Technol. 2010; 38: 24-27https://doi.org/10.2967/jnmt.109.065557
- Irradiation of the internal mammary and medial supraclavicular lymph nodes in stage I to III breast cancer: 10 years results of the EORTC Radiation Oncology and Breast Cancer Groups phase III trial 22922/10925.Eur J Cancer. 2013; 47
- Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials.Lancet. 2014; 383: 2127-2135https://doi.org/10.1016/S0140-6736(14)60488-8
- Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials.Radiother Oncol. 2007; 82: 247-253https://doi.org/10.1016/j.radonc.2007.02.001
- Nodal irradiation after breast-cancer surgery in the era of effective adjuvant therapy.N Engl J Med. 2015; 373: 1-3https://doi.org/10.1056/NEJMoa1009540.6
- Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS):a randomised, multicentre, open-label, phase 3 non-inferiority trial Mila.Lancet Oncol. 2014; 15: 1303-1310https://doi.org/10.1016/S1470-2045(14)70460-7
- Influence of internal mammary node irradiation on long-term outcome and contralateral breast cancer incidence in node-negative breast cancer patients.Radiother Oncol. 2013; 108: 259-265https://doi.org/10.1016/j.radonc.2013.06.028
- Feasibility of FDG PET/CT to monitor the response of axillary lymph node metastases to neoadjuvant chemotherapy in breast cancer patients.Eur J Nucl Med Mol Imaging. 2010; 37: 1069-1076https://doi.org/10.1007/s00259-009-1343-2
- 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; 123: 281-290https://doi.org/10.1007/s10549-010-0771-9
- Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study.Lancet Oncol. 2013; 14: 609-618https://doi.org/10.1016/S1470-2045(13)70166-9
- Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial.JAMA. 2013; 310: 1455-1461https://doi.org/10.1001/jama.2013.278932
Article info
Publication history
Published online: October 31, 2016
Accepted:
October 7,
2016
Identification
Copyright
© 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
