TITLE: Evaluation of fluorodeoxyglucose positron emission tomography in the detection of axillary lymph node metastases in patients with early-stage breast cancer.
REF: Annals of Surgical Oncology 10:622-627 (2003) http://www.annalssurgicaloncology.o...stract/10/6/622
STUDY TYPE: prospective trial
PATIENTS: 32 patients in France with breast cancer and clinically negative axillary nodes. All patients received an FDG PET scan in addition to sentinal node biopsy and axillary dissection.
FINDINGS: The sentinal node was positive in 14/32 patients (43%) and falsely negative in 1/15 (6.6%). PET was positive in 3/14 (20%) patients with positive sentinal nodes. PET sensitivity was 20%, specificity was 100%, and positive predictive value was 100%.
CONCLUSION: in patients with a positive FDG PET scan of the axilla, sentinal node biopsy can be skipped and axillary node dissection be the primary procedure.
COMMENT: these are fragile statistics but point out that a negative PET scan in this situation is pretty useless. The real value is in the positive PET scan which would allow proceding directly to axillary dissection. In this small series of patients, PET would decrease the sentinal lymph node biopsy rate by 20% which seems to be of little clinical benefit. Neither PET nor SLN biopsy caught all positive nodes.