Gunes Abdullah, Colapkulu-Akgul Nuray, Akgul Caner, Unlu Ibrahim, Cinar Saffet
From the Department of General Surgery, Kocaeli City Hospital, Kocaeli, Turkiye.
From the Department of General Surgery, Kocaeli Gebze Fatih State Hospital, Kocaeli, Turkiye.
Ann Saudi Med. 2025 May-Jun;45(3):145-153. doi: 10.5144/0256-4947.2025.145. Epub 2025 Jun 5.
Breast cancer is one of the most common cancers in women globally. Axillary lymph node metastasis remains one of the most independent prognostic factors in breast cancer.
Evaluate the diagnostic accuracy of 18F-FDG-PET/CT in detecting axillary lymph node metastasis based on immunohistochemical subtypes and its correlation with sentinel lymph node biopsy (SLNB) results.
A retrospective cohort.
Tertiary oncology center in Turkiye.
Patients diagnosed with early-stage invasive ductal breast cancer and who underwent preoperative F-18 fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) evaluation were included in the study. Patients were divided into five immunohistochemical subtypes: Luminal A, Luminal B HER2 (-) (human epidermal growth factor receptor 2), Luminal B HER2 (+), HER2 (+), and triple negative. SLNB and SUVmax (Maximum Standard Unit Value) results were compared.
Diagnostic accuracy of 18F-FDG PET/CT for detecting axillary metastasis was the primary outcome. Interrater reliability testing in determining the agreement between 18F-FDG PET/CT and SLNB was the secondary outcome.
The sensitivity, specificity, PPV, NPV and accuracy of 18F-FDG-PET/CT for detecting axillary metastasis were 62%, 92%, 88%, 71% and 77%, respectively. Cohen's Kappa coefficient (0.54) showed moderate agreement with SLNB (<.001). Tumors with positive HER2 gene amplification [HER2 (+) and Luminal B HER2 (+) have higher sensitivity than other subtypes (Luminal A, Luminal B HER2 (-) and triple negative). HER2 gene amplification also increases the agreement between 18F-FDG-PET/CT and SLNB results.
18F-FDG-PET/CT has a high specificity but low sensitivity for ipsilateral axillary metastasis in invasive ductal carcinoma. The presence of HER2 gene amplification can increase sensitivity and concordance with SLNB.
Retrospective design and limited number of patients for each subtype.
乳腺癌是全球女性中最常见的癌症之一。腋窝淋巴结转移仍然是乳腺癌最重要的独立预后因素之一。
基于免疫组织化学亚型评估18F-FDG-PET/CT检测腋窝淋巴结转移的诊断准确性及其与前哨淋巴结活检（SLNB）结果的相关性。
一项回顾性队列研究。
土耳其的三级肿瘤中心。
本研究纳入了被诊断为早期浸润性导管癌且接受术前F-18氟脱氧葡萄糖正电子发射计算机断层扫描（18F-FDG PET/CT）评估的患者。患者被分为五种免疫组织化学亚型：Luminal A、Luminal B HER2（-）（人表皮生长因子受体2）、Luminal B HER2（+）、HER2（+）和三阴性。比较了SLNB和SUVmax（最大标准摄取值）结果。
18F-FDG PET/CT检测腋窝转移的诊断准确性是主要观察指标。确定18F-FDG PET/CT与SLNB之间一致性的观察者间可靠性测试是次要观察指标。
248例。
18F-FDG-PET/CT检测腋窝转移的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为62%、92%、88%、71%和77%。科恩kappa系数（0.54）显示与SLNB有中度一致性（<0.001）。HER2基因扩增阳性的肿瘤[HER2（+）和Luminal B HER2（+）]比其他亚型（Luminal A、Luminal B HER2（-）和三阴性）具有更高的敏感性。HER2基因扩增也增加了18F-FDG-PET/CT与SLNB结果之间的一致性。
18F-FDG-PET/CT对浸润性导管癌同侧腋窝转移具有高特异性但低敏感性。HER2基因扩增的存在可提高敏感性并与SLNB结果具有一致性。
回顾性设计以及各亚型患者数量有限。
