Agresti Roberto, Crippa Flavio, Sandri Marco, Martelli Gabriele, Tagliabue Elda, Alessi Alessandra, Pellitteri Cristina, Maccauro Marco, Maugeri Ilaria, Barbara Padovano, Rampa Mario, Moscaroli Alessandra, Ferraris Cristina, Carcangiu Maria Luisa, Bianchi Giulia, Greco Marco, Bombardieri Emilio
Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Breast. 2014 Aug;23(4):334-40. doi: 10.1016/j.breast.2014.01.001. Epub 2014 Jan 31.
Sentinel node (SN) biopsy is the standard method to evaluate axillary node involvement in breast cancer (BC). Positron emission tomography with 2-(fluorine-18)-fluoro-2-deoxy-D-glucose (FDG-PET) provides a non-invasive tool to evaluate regional nodes in BC in a metabolic-dependent, biomolecular-related way. In 1999, we initiated a prospective non-randomized study to compare these two methods and to test the hypothesis that FDG-PET results reflect biomolecular characteristics of the primary tumor, thereby yielding valuable prognostic information.
A total of 145 cT1N0 BC patients, aged 24-70 years, underwent FDG-PET and lymphoscintigraphy before surgery. SN biopsy was followed in all cases by complete axillary dissection. Pathologic evaluation in tissue sections for involvement of the SN and other non-SN nodes served as the basis of the comparison between FDG-PET imaging and SN biopsy.
FDG-PET and SN biopsy sensitivity was 72.6% and 88.7%, respectively, and negative predictive values were 80.5% and 92.2%, respectively. A subgroup of more aggressive tumors (ER-GIII, Her2+) was found mainly in the FDG-PET true-positive (FDG-PET+) patients, whereas LuminalA, Mib1 low-rate BCs were significantly undetected (p = 0.009) in FDG-PET false-negative (FDG-PET-) patients. Kaplan-Meier survival estimates after a median follow-up of more than 8 years showed significantly worse overall survival for FDG-PET+ patients in node-positive (N+) patients (p = 0.035) as compared to N+/FDG-PET- patients, which overlapped with survival curves of N- and FDG-PET+ or - patients.
Our findings suggest that FDG-PET results reflect intrinsic biologic features of primary BC tumors and have prognostic value with respect to nodal metastases. FDG-PET false negative cases appear to identify less aggressive indolent metastases. The possibility to identify a subgroup of N+ BC patients with an outcome comparable with N- BC patients could reduce the surgical and adjuvant therapeutic intervention.
前哨淋巴结（SN）活检是评估乳腺癌（BC）腋窝淋巴结受累情况的标准方法。2-（氟-18）-氟-2-脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）提供了一种非侵入性工具，以代谢依赖、生物分子相关的方式评估BC中的区域淋巴结。1999年，我们启动了一项前瞻性非随机研究，以比较这两种方法，并检验FDG-PET结果反映原发性肿瘤生物分子特征从而产生有价值的预后信息这一假设。
总共145例年龄在24至70岁之间的cT1N0 BC患者在手术前接受了FDG-PET和淋巴闪烁显像检查。所有病例在SN活检后均进行了完整的腋窝淋巴结清扫。对SN和其他非SN淋巴结受累情况的组织切片病理评估作为FDG-PET成像与SN活检之间比较的基础。
FDG-PET和SN活检的敏感性分别为72.6%和88.7%，阴性预测值分别为80.5%和92.2%。一组侵袭性更强的肿瘤（ER-GIII，Her2+）主要在FDG-PET真阳性（FDG-PET+）患者中发现，而在FDG-PET假阴性（FDG-PET-）患者中显著未检测到LuminalA、Mib1低率BC（p = 0.009）。中位随访超过8年后的Kaplan-Meier生存估计显示，与N+/FDG-PET-患者相比，FDG-PET+的淋巴结阳性（N+）患者的总生存期明显更差（p = 0.035），其与N-和FDG-PET+或-患者的生存曲线重叠。
我们的研究结果表明，FDG-PET结果反映了原发性BC肿瘤的内在生物学特征，并且对淋巴结转移具有预后价值。FDG-PET假阴性病例似乎识别出侵袭性较小的惰性转移。识别出一组预后与N- BC患者相当的N+ BC患者的可能性可以减少手术和辅助治疗干预。
