From the Departments of *Nuclear Medicine, †Surgery, and ‡Pathology, Seoul Korea Cancer Center Hospital, Seoul, Republic of Korea.
Clin Nucl Med. 2014 Apr;39(4):e249-53. doi: 10.1097/RLU.0b013e3182a75477.
The authors evaluated the usefulness of axillary lymph node (ALN) to primary breast tumor SUV ratio (determined by 18F-FDG PET/CT) for predicting the presence of ALN metastasis in breast cancer.
One hundred thirty-six consecutive female patients with breast cancer were enrolled in this retrospective study between January 2009 and November 2012. All patients underwent surgical resection without neoadjuvant chemotherapy, and ALN metastases were histologically confirmed by ALN dissection (n = 75) or sentinel lymph node (LN) biopsy (n = 61). The maximum SUVs of FDG-avid ALNs (SUVLN) and of primary breast tumors were measured on preoperative 18F-FDG PET/CT images, and ALN to primary breast tumor SUV ratios (LN/T ratios) were calculated. In a subgroup of patients with FDG-avid ALNs, optimal cutoff values for SUVLN and LN/T ratio were determined by receiver operating characteristic curve analysis for predicting the presence of ALN metastasis. Subsequently, the diagnostic performances of visual analysis (presence of FDG-avidity), SUVLN, and LN/T ratio for the prediction of ALN metastasis were determined.
In a subgroup of patients with FDG-avid ALNs (n = 65), the area under the curve and the optimal criteria of SUVLN for detecting ALN metastasis were 0.655 and greater than 2.1, and those of LN/T ratio were 0.739 and greater than 0.2, respectively. For these criteria, the sensitivity, specificity, and diagnostic accuracy of detecting ALN metastasis were 71.4%, 77.3%, and 74.3%, respectively, for visual analysis; 47.1%, 93.9%, and 69.9%, respectively, for SUVLN; and 62.9%, 92.4%, and 77.2%, respectively, for LN/T ratio in all patients. The specificity of LN/T ratio was significantly higher than that of visual analysis (P = 0.0259). Although the sensitivity of LN/T ratio was higher than that of SUVLN, it did not reach a statistical significance (P = 0.0874).
The LN/T ratio better predicts the presence of ALN metastasis than visual analysis or SUVLN in breast cancer.
作者评估了腋窝淋巴结（ALN）与原发乳腺癌肿瘤 SUV 比值（通过 18F-FDG PET/CT 确定）在预测乳腺癌中 ALN 转移存在方面的有用性。
本回顾性研究纳入了 2009 年 1 月至 2012 年 11 月期间连续收治的 136 例女性乳腺癌患者。所有患者均接受了无新辅助化疗的手术切除，ALN 转移通过腋窝淋巴结清扫术（n = 75）或前哨淋巴结活检术（n = 61）得到组织学证实。在术前 18F-FDG PET/CT 图像上测量 FDG 摄取的 ALN（SUVLN）和原发乳腺癌肿瘤的最大 SUV，并计算 ALN 与原发乳腺癌肿瘤 SUV 比值（LN/T 比值）。在 FDG 摄取的 ALN 患者亚组中，通过受试者工作特征曲线分析确定 SUVLN 和 LN/T 比值的最佳截断值，以预测 ALN 转移的存在。随后，确定视觉分析（存在 FDG 摄取）、SUVLN 和 LN/T 比值对 ALN 转移预测的诊断性能。
在 FDG 摄取的 ALN 患者亚组（n = 65）中，SUVLN 用于检测 ALN 转移的曲线下面积和最佳标准分别为 0.655 和大于 2.1，LN/T 比值分别为 0.739 和大于 0.2。对于这些标准，视觉分析分别检测 ALN 转移的敏感性、特异性和诊断准确性为 71.4%、77.3%和 74.3%；SUVLN 分别为 47.1%、93.9%和 69.9%；LN/T 比值分别为 62.9%、92.4%和 77.2%。LN/T 比值的特异性明显高于视觉分析（P = 0.0259）。尽管 LN/T 比值的敏感性高于 SUVLN，但未达到统计学意义（P = 0.0874）。
LN/T 比值在预测乳腺癌中 ALN 转移的存在方面优于视觉分析或 SUVLN。
