Fluorine-18 2-deoxy-2-fluoro-D-glucose PET in the preoperative staging of breast cancer: comparison with the standard staging procedures

The present study compared the diagnostic accuracy of fluorine-18 2-deoxy-2-fluoro-D-glucose positron emission tomography (FDG-PET) with conventional staging techniques. The differentiation between malignant and benign lesions and the detection of multifocal disease, axillary and internal lymph node involvement, and distant metastases were evaluated. One hundred and seventeen female patients were prospectively examined using FDG-PET and conventional staging methods such as chest X-ray, ultrasonography of the breast and liver, mammography and bone scintigraphy. All patients were examined on a modern full-ring PET scanner. Histopathological analysis of resected specimens was employed as the reference method. The readers of FDG-PET were blinded to the results of the other imaging methods and to the site of the breast tumour. The sensitivity and specificity of FDG-PET in detecting malignant breast lesions were 93% and 75% respectively. FDG-PET was twofold more sensitive (sensitivity 63%, specificity 95%) in detecting multifocal lesions than the combination of mammography and ultrasonography (sensitivity 32%, specificity 93%). Sensitivity and specificity of FDG-PET in detecting axillary lymph node metastases were 79% and 92% (41% and 96% for clinical evaluation). FDG-PET correctly indicated distant metastases in seven patients. False-positive or false-negative findings were not encountered with FDG-PET. Chest X-ray was false-negative in three of five patients with lung metastases. Bone scintigraphy was false-positive in four patients. Three patients were upstaged since FDG-PET detected distant metastases missed with the standard staging procedure. It is concluded that, compared with the imaging methods currently employed for initial staging, FDG-PET is as accurate in interpreting the primary tumour and more accurate in screening for lymph node metastases and distant metastases. Due to a false-negative rate of 20% in detecting axillary lymph node metastases, FDG-PET cannot replace histological evaluation of axillary status.     

Whole-body FDG PET/CT is more accurate than conventional imaging for staging primary breast cancer patients

Purpose

This retrospective study aimed (1) to compare the diagnostic accuracy of whole-body FDG PET/CT for initial breast cancer staging with the accuracy of a conventional, multimodal imaging algorithm, and (2) to assess potential alteration in patient management based on the FDG PET/CT findings.

Methods

Patients with primary breast cancer (106 women, mean age 57?±?13?years) underwent whole-body FDG PET/CT and conventional imaging (X-ray mammography, MR mammography, chest plain radiography, bone scintigraphy and breast, axillary and liver ultrasonography). The diagnostic accuracies of FDG PET/CT and a conventional algorithm were compared. Diagnostic accuracy was assessed in terms of primary tumour detection rate, correct assessment of primary lesion focality, T stage and the detection rates for lymph node and distant metastases. Histopathology, imaging or clinical follow-up served as the standards of reference.

Results

FDG PET/CT was significantly more accurate for detecting axillary lymph node and distant metastases (p?=?0.0125 and p?Conclusion Full-dose, intravenous contrast-enhanced FDG PET/CT was more accurate than conventional imaging for initial breast cancer staging due to the higher detection rate of metastases and synchronous tumours, although the study had several limitations including a retrospective design, a possible selection bias and a relevant false-positive rate for the detection of axillary lymph node metastases. FDG PET/CT resulted in a change of treatment in a substantial proportion of patients.     

Impact of FDG PET on the preoperative staging of newly diagnosed breast cancer

Purpose The main objective of this study was to determine the efficacy of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG PET) to assess the impact of this technique in staging of patients with newly diagnosed breast cancer. Methods Two hundred and seventy-one consecutive patients (median age = 51 ± 11 years) with biopsy-proven primary breast cancer who were examined by FDG PET were enrolled in this prospective preoperative staging study. Whole-body FDG-PET images were acquired approximately 60 min after the intravenous administration of FDG (5.2 MBq/kg). Visual assessment and the maximum standardized uptake value (SUVmax) of breast lesions for semiquantitative analysis were carried out. The PET results were compared with the histopathology results. Results For the tumor, node, metastases (TNM) staging, 240 patients (250 breasts) were considered eligible based on the criteria that were established for this analysis. Significant differences were noted in SUVmax of lesions according to the TNM staging (p < 0.05). The average SUVmax of the primary tumor was calculated in patients with axillary involvement (n = 58) and for the ones without axillary metastasis (n = 79), and SUVmax were 4.1 ± 3.5 and 2.8 ± 2.3, respectively, with a significant difference between the two groups (p = 0.03). PET imaging revealed pathological FDG uptake in 54% (46/85) of patients with axillary lymph node metastases. The sensitivities of FDG PET for detecting axillary lymph node metastasis were found 41% in pN1, 67% in pN2, and 100% in pN3, and the specificity was 89% for pN0 stage. Detection of extra-axillary regional node or distant metastatic lesions revealed by PET scan in 22 of 24 patients resulted in a significant change in the TNM stage. Distant metastasis without axillary lymph node metastasis was noted in 21% (5/24) of patients. The results revealed that FDG PET upgraded TNM stage in 9.2% (22/240) of patients and 7.5% (18/240) of patients were diagnosed as having one or more distant metastases. Conclusion FDG PET was able to identify extra-axillary regional nodal and distant lesions in newly diagnosed patients with breast cancer; FDG PET may alter the staging and management of therapy in patients with newly diagnosed breast cancer.     

Detection of axillary lymph node metastases in breast carcinoma by technetium-99m sestamibi breast scintigraphy,ultrasound and conventional mammography

Axillary lymph node status is important in the staging of breast carcinoma. To evaluate the accuracy of technetium-99m sestamibi breast scintigraphy in detecting metastatic axillary lymph nodes as compared with other accepted imaging modalities, we performed^99mTc-sestamibi breast scintigraphy, conventional mammography and ultrasound in 36 patients with primary untreated breast carcinoma. With histopathology as the gold standard,^99mTc-sestamibi breast scintigraphy was found to yield true-positive results in 7 of 11 cases (64%) of axillary lymph node metastases and true-negative results in 18 of 20 cases (90%); it has an accuracy of 81%, a positive predictive value of 77.8% and a negative predictive value of 81.8%.     

Breast cancer staging in a single session: whole-body PET/CT mammography

Our objective was to compare the diagnostic accuracy of an all-in-one protocol of whole-body 18F-FDG PET/CT and integrated 18F-FDG PET/CT mammography with the diagnostic accuracy of a multimodality algorithm for initial breast cancer staging. METHODS: Forty women (mean age, 58.3 y; range, 30.8-78.4 y; SD, 12 y) with suspected breast cancer were included. For the primary tumor, we compared 18F-FDG PET/CT mammography versus MRI mammography; for axillary lymph node status, 18F-FDG PET/CT versus clinical investigation and ultrasound; and for distant metastases, 18F-FDG PET/CT versus a multimodality staging algorithm. Histopathology and clinical follow-up served as the standard of reference. The Fisher exact test evaluated the significance of differences (P < 0.05). Alterations in patient management caused by 18F-FDG PET/CT were documented. RESULTS: No significant differences were found in the detection rate of breast cancer lesions (18F-FDG PET/CT, 95%; MRI, 100%; P = 1). 18F-FDG PET/CT correctly classified lesion focality significantly more often than did MRI (18F-FDG PET/CT, 79%; MRI, 73%; P < 0.001). MRI correctly defined the T stage significantly more often than did 18F-FDG PET/CT (MRI, 77%; 18F-FDG PET/CT, 54%; P = 0.001). 18F-FDG PET/CT detected axillary lymph node metastases in 80% of cases; clinical investigation/ultrasound, in 70%. This difference was not statistically significant (P = 0.067). Distant metastases were detected with 18F-FDG PET/CT in 100% of cases, and the multimodality algorithm identified distant metastases in 70%. This difference was not statistically significant (P = 1). Three patients had extraaxillary lymph node metastases that were detected only by PET/CT (cervical, retroperitoneal, mediastinal/internal mammary group). 18F-FDG PET/CT changed patient management in 12.5% of cases. CONCLUSION: Our data suggest that a whole-body 18F-FDG PET/CT mammography protocol may be used for staging breast cancer in a single session. This initial assessment of the 18F-FDG PET/CT protocol indicates similar accuracy to MRI for the detection of breast cancer lesions. Although MRI seems to be more accurate when assessing the T stage of the tumor, 18F-FDG PET/CT seems able to more accurately define lesion focality. Although 18F-FDG PET/CT mammography was able to detect axillary lymph node metastases with a high sensitivity, this method cannot soon be expected to replace the combination of clinical examination, ultrasound, and sentinel lymph node biopsy for axillary assessment.     

Fluorodeoxyglucose-PET in the management of malignant melanoma

FDG-PET is of limited use in patients with early-stage disease without nodal or distant metastases (stage I-II), because sentinel node biopsy is much more sensitive in detecting microscopic lymph node metastases. Because of the high tumor-to-background ratio, FDG-PET can highlight metastases at unusual sites that are easily missed with conventional imaging modalities. PET has been shown to have a strong role in detecting metastatic disease. FDG-PET is more sensitive than CT for detecting metastatic lesions in skin, lymph nodes, and abdomen, but CT is equivalent to or more sensitive than FDG-PET for detecting small pulmonary lesions. FDG-PET identifies the location and number of metastatic lesions in stage III and IV disease and therefore is important for surgical planning. Most of the false-negative FDG-PET results are caused by micrometastases and lesion smaller than 10 mm. Postsurgical inflammation, other inflammatory lesions, and some benign tumors cause some false-positive FDG-PET results.     

乳腺癌及腋淋巴结转移~(99)Tc~m-tetrofosmin与~(99)Tc~m-MIBI显像的对比研究

目的　比较99Tcm tetrofosmin和99Tcm 甲氧基异丁基异腈 (MIBI)显像诊断乳腺癌和腋淋巴结转移的临床价值。方法　对 5 2例乳腺肿瘤患者进行99Tcm tetrofosmin和99Tcm MIBI显像。患者均在 2周内行外科手术治疗 ,并做病理检查。结果　 2 6例患者病理检查证实为乳腺癌 ,其中 30例为良性病变。99Tcm tetrofosmin显像发现乳腺癌 2 1例 ,其中 11例合并腋淋巴结转移 ;99Tcm MIBI显像发现乳腺癌 19例 ,其中 12例合并腋淋巴结转移。99Tcm tetrofosmin和99Tcm MIBI显像对乳腺癌诊断的灵敏度、特异性和准确性分别为 80 8%、76 7%、78 6 %和 73 1%、73 3%、73 2 % ;诊断腋淋巴结转移的灵敏度、特异性和准确性分别为 6 8 8%、80 0 %、76 0 %和 75 0 %、80 0 %、76 9%。结论　99Tcm tetrofosmin显像对乳腺癌的检出优于99Tcm MIBI显像     

FDG-PET for axillary lymph node staging in primary breast cancer

Management of the axilla in patients with operable breast cancer is still one of the most controversial areas in clinical oncology. The best procedure to examine the lymph nodes is still standard axillary lymph node dissection; nevertheless, the morbidity associated with this procedure is well known. Based on these considerations, it is important for progress in the treatment of operable breast cancer that strategies are found that permit a less invasive method of axillary sampling which does not impair the patient's quality of life. The technique of sentinel lymph node (SLN) biopsy has recently been proposed for this purpose, with very important results. SLN has now become routine practice in the surgical management of breast cancer, and in many institutions patients with a negative SLN biopsy are spared axillary dissection, while those with a positive SLN biopsy are submitted to axillary node dissection. The good accuracy of SLN biopsy represents a significant advance in the management of primary breast cancer; however, false negative axillary results can occur in a variable percentage of patients, and the contribution of the SLN procedure to the detection of metastases in the internal mammary and supraclavicular lymph nodes is not clear. Among the recently developed imaging modalities, positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) has in particular been applied to the study of lymph node metastases in cancer patients. Several clinical studies have been carried out to evaluate the accuracy of PET in the axillary staging of operable primary breast cancer. These studies have sometimes provided conflicting results, either supporting the possibility of using FDG-PET to select patients who need axillary dissection or questioning whether FDG-PET can accurately assess the axillary status in primary breast cancer. All the limitations and the advantages of FDG-PET are discussed in this paper, by examining the performance of scanner technology and the possible causes of the false negative results. In the experience of the authors, comparing FDG-PET with SLN biopsy in the same series of patients, the results seem to indicate that the lower sensitivity of PET is restricted to micrometastases. Of course, this limitation of PET has to be analysed in relation to the importance of such small axillary metastases for the outcome of patients with breast cancer. The added value offered by PET in breast cancer staging in comparison with intraoperative detection of the sentinel node lies in the fact that FDG-PET is a non-invasive procedure that allows, within a single examination, the biological characterisation of breast cancer and viewing of the entire body.     

Preoperative staging of biliary carcinoma using 18F-fluorodeoxyglucose PET: prospective comparison with PET+CT, MDCT and histopathology

The aim of this study was to evaluate the value of positron emission tomography with ¹⁸F-labeled fluorodeoxyglucose (FDG-PET) as a preoperative diagnostic investigation in patients with biliary carcinoma. Seventy-two patients with potentially resectable biliary carcinoma underwent preoperative multidetector-row computed tomography (MDCT) and FDG-PET. Both diagnoses were compared with subsequent histopathology and follow-up results. In 64 lesions with biliary carcinoma, 57 (89%) revealed an intense focal accumulation on FDG-PET and were interpreted as malignant. On the other hand, eight benign lesions did not show any specific accumulation. Detection rate of FDG-PET in the nodular type of the tumour (96% or 27/28) was superior to that of the infiltrating type (74% or 17/23) (p = 0.037). For the evaluation of lymph node metastasis, the overall accuracy was 69% (35/51) in both FDG-PET and MDCT: FDG-PET had a lower sensitivity (33% vs. 57%) and a higher specificity (97% vs. 79%) than MDCT, although the values were not significantly different. FDG-PET revealed all six lesions of distant metastases in six patients including two lesions missed by MDCT. FDG-PET has high detectability of biliary malignancies. Like MDCT, FDG-PET offers only modest accuracy for regional lymph node staging, but it may reveal distant metastases missed by MDCT.     

The Potential of F-18-FDG PET in Breast Cancer. Detection of Primary Lesions, Axillary Lymph Node Metastases, or Distant Metastases

This retrospective study was done to evaluate the utility of 2-[F-18]fluoro-2-deoxy-D-glucose positron emission tomography (F-18-FDG PET) in identifying primary and recurrent breast cancer and lymph node metastases. One hundred whole-body PET scans of 87 patients were reviewed. PET results obtained with F-18-FDG and an ECAT/EXACT-921 or an ECAT-931 (Siemens/CTI) were based on visual interpretation, or standardized uptake values (SUVs), related to histology and also compared to computerized tomography (CT) and mammography results. The sensitivity for PET in detecting primary (N = 35 studies) and recurrent breast cancer (N = 65 studies) was 96% and 85% with a specificity of 91% and 73%. The sensitivity for lymph node metastases at the time of initial diagnosis was 100% with a specificity of 100%. Quantitative SUV information did not improve the accuracy of F-18-FDG PET in identifying primary breast cancers. The results suggest that whole-body PET is useful in detecting recurrence or metastases, may be useful in detecting lymph node metastases prior to initial axillary lymph node dissection, but is less sensitive in excluding axillary lymph nodes metastases later in the course of the disease.     

Scintimammography with technetium-99m tetrofosmin in the diagnosis of breast cancer and lymph node metastases

The aim of the study was to evaluate the possible role of scintimammography (SMM) with technetium-99m tetrofosmin in breast cancer. Thirty-three patients with breast disease and ten normal controls were included in the study. Planar scintigraphic images in supine anterior, prone lateral and lateral views, with the patient lying in lateral recumbency, were acquired. A qualitative analysis evaluating both breasts and lymph nodes was performed. All breast lesions were verified after surgery and/or by fine-needle aspiration. In 8 of the 33 patients, mammography was inconclusive because of mastectomy or dense breasts. For mammography, a sensitivity of 95.6%, a specificity of 66.7% and an accuracy of 89.6% were obtained. At SMM, 26 out of 28 malignant lesions (average size 2.8 cm, range 0.4–12 cm), including two recurrences, were detected with a 92.8% sensitivity, a 100% specificity and a 95.1% accuracy. The smallest detectable carcinoma measured 0.6 cm. Two false-negative results on SMM were found in a 0.4-cm intraductal carcinoma and in the only mucinous papillary carcinoma in our series. With regard to lymph node analysis, 11 out of 12 axillary metastases (sensitivity=91.6%) were detected. A false-positive result, yielding a specificity of 92.3% was also obtained. A metastatic involvement of the internal mammary chain was observed. No uptake was seen in 11 benign mammary lesions or at the level of the breast and axilla when neoplastic involvement was absent. In conclusion, SMM with^99mTc-tetrofosmin is an effective technique for the evaluation of primary breast carcinomas, recurrences and lymph node metastases.     

Comparison of18FDG-PET with99mTc-HMDP scntigraphy for the detection of bone metastases in patients with breast cancer

OBJECTIVE: Bone is one of the most common sites of metastasis in breast cancer patients. Although bone scintigraphy is widely used to detect metastatic breast cancer, the usefulness of 18FDG-PET for detecting bone metastasis has not been clearly evaluated. The purpose of this study was to compare the diagnostic accuracy of 18FDG-PET with bone scintigraphy in detecting bone metastasis in breast cancer patients. METHODS: Forty-four women aged 35 to 81 years (mean, 56 years) with breast cancer were examined in this study. Both 18FDG-PET and bone scintigraphy were performed for each patient with 0-69 day intervals (mean, 11.5 days). The results of each image interpretation were compared retrospectively. Whole-body bones were classified into 9 anatomical regions. Metastases were confirmed at 45/187 regions in 14 patients by bone biopsy or clinical follow-up including other imaging techniques for a period of at least 6 months afterwards. RESULTS: On a region basis, the sensitivity, specificity, and accuracy of 18FDG-PET were 84%, 99% and 95%, respectively. Although these results were comparable to those of bone scintigraphy, the combination of 18FDG-PET and bone scintigraphy improved the sensitivity (98%) and accuracy (97%) of detection. False negative lesions of bone scintigraphy were mostly bone marrow metastases and those of 18FDG-PET were mostly osteoblastic metastases. 18FDG-PET was superior to bone scintigraphy in the detection of osteolytic lesions (92% vs. 73%), but inferior in the detection of osteoblastic lesions (74% vs. 95%). CONCLUSIONS: This study shows that 18FDG-PET tends to be superior to bone scintigraphy in the detection of osteolytic lesions, but inferior in the detection of osteoblastic lesions. 18FDG-PET should play a complementary role in detecting bone metastasis with bone scintigraphy.     

Impact of [<Superscript>18</Superscript>F]FDG-PET on the primary staging of small-cell lung cancer

Purpose The purpose of this study was to evaluate the impact of [¹⁸F]fluorodeoxy-d-glucose positron emission tomography (FDG-PET) on the primary staging of patients with small-cell lung cancer (SCLC).Methods FDG-PET was performed in 120 consecutive patients with SCLC during primary staging. In addition, brain examinations with both FDG-PET and cranial magnetic resonance imaging (MRI) or computed tomography (CT) were performed in 91 patients. Results of FDG-PET were compared with those of conventional staging procedures. FDG-PET detected markedly increased FDG uptake in the primary tumours of all 120 patients (sensitivity 100%).Results Complete agreement between FDG-PET results and other staging procedures was observed in 75 patients. Differences occurred in 45 patients at 65 sites. In 47 sites the FDG-PET results were proven to be correct, and in ten, incorrect. In the remaining eight sites, the discrepancies could not be clarified. In 14/120 patients, FDG-PET caused a stage migration, correctly upstaging ten patients to extensive disease and downstaging three patients by not confirming metastases of the adrenal glands suspected on the basis of CT. Only 1/120 patients was incorrectly staged by FDG-PET, owing to failure to detect brain metastases. In all cases the stage migration led to a significant change in the treatment protocol. Sensitivity of FDG-PET was significantly superior to that of CT in the detection of extrathoracic lymph node involvement (100% vs 70%, specificity 98% vs 94%) and distant metastases except to the brain (98% vs 83%, specificity 92% vs 79%). However, FDG-PET was significantly less sensitive than cranial MRI/CT in the detection of brain metastases (46% vs 100%, specificity 97% vs 100%).Conclusion The introduction of FDG-PET in the diagnostic evaluation of SCLC will improve the staging results and affect patient management, and may reduce the number of tests and invasive procedures.     

Breast MRI for evaluating patients with metastatic axillary lymph node and initially negative mammography and sonography.

OBJECTIVE: We wanted to investigate the ability of breast MR imaging to identify the primary malignancy in patients with axillary lymph node metastases and initially negative mammography and sonography, and we correlated those results with the conventional imaging. MATERIALS AND METHODS: From September 2001 to April 2006, 12 patients with axillary lymph node metastases and initially negative mammography and sonography underwent breast MR imaging to identify occult breast carcinoma. We analyzed the findings of the MR imaging, the MR-correlated mammography and the second-look sonography. We followed up both the MR-positive and MR-negative patients. RESULTS: MR imaging detected occult breast carcinoma in 10 of 12 (83%) patients. Two MR-negative patients were free of carcinoma in the ipsilateral breast during their follow-up period (39 and 44 months, respectively). In nine out of 10 patients, the MR-correlated mammography and second-look sonography localized lesions that were not detected on the initial exam. All the non-MR-correlated sonographic abnormalities were benign. CONCLUSION: Breast MR imaging can identify otherwise occult breast cancer in patients with metastatic axillary lymph nodes. Localization of the lesions through MR-correlated mammography and second-look sonography is practically feasible in most cases.     

Detection of bone metastases in breast cancer by positron emission tomography

Positron emission tomography (PET) is able to demonstrate changes in the metabolism of malignant tumors and metastases before they become visible on anatomical imaging. The skeleton is the most common site of distant metastases of breast cancer. There is convincing evidence that FDG-PET is more sensitive in detecting osteolytic metastases than bone scintigraphy, whereas bone scintigraphy is more sensitive in detecting osteoblastic metastases. Because both types of metastases can occur in breast cancer, bone scintigraphy and FDG-PET should be considered as complementary and can currently be regarded as standard of care for staging in breast cancer patients, whereas the decision to use F-18 fluoride PET should be made individually for each patient, depending on the expected change of therapy management.     

Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer

The aim of this study was to see how effective ultrasound-guided needle biopsy was at detecting lymph node involvement in patients with early breast cancer. Patients with newly diagnosed invasive breast cancer underwent axillary ultrasound (US) where lymph node size and morphology were noted. A core biopsy (CB) was undertaken of any node greater than 5 mm in longitudinal section. Patients with benign CBs proceeded to sentinel lymph node (SLN) biopsy, whereas those with malignancy underwent axillary lymph node dissection (ALND). US and CB findings were correlated with final surgical histology in all cases. One hundred and thirty-nine patients were examined, of whom 52.5% had lymph node metastases on final histology. One hundred and twenty-one patients (87%) underwent axillary node CB. The overall sensitivity of CB for detecting lymph node metastases was 53.4% (60.3% for macrometastases; 26.7% for micrometastases). The US morphological characteristics most strongly associated with malignancy were absence of a hilum and a cortical thickness greater than 4 mm. However, one third of patients with normal lymph node morphology had nodal metastases, and only 12% of these were diagnosed on CB. CB of axillary lymph nodes can diagnose a substantial number of patients with lymph node metastases, allowing these patients to proceed directly to ALND, avoiding unnecessary SLN biopsy.     

Prospective evaluation of fluorine-18 fluorodeoxyclucose positron emission tomography in breast cancer for staging of the axilla related to surgery and immunocytochemistry

The noninvasive staging of axillary lymph nodes for metastases is investigated in patients with breast cancer prior to surgery by positron emission tomography (PET) with fluorine- l8-fluoro-2-deoxy-d-glucose (¹⁸F-FDG). In 124 patients with newly diagnosed breast cancer, whole-body PET was performed to determine the average differential uptake ratio (DUR) of¹⁸F-FDG in the axillary lymph nodes. Results were correlated with the number of the dissected lymph nodes, size of the primary tumor, tumor type, tumor grade, estrogen and progesterone receptors, DNA ploidy, and the proportion of cells in the synthetic phase of the cell cycle (S-phase). In this prospective study of 124 patients with breast carcinoma, PET correctly categorized all 44 tumor-positive axillary lymph nodes, a sensitivity of 100%. Sixty tumor-negative axillary lymph nodes were negative by PET and 20 tumor-negative axillary lymph nodes were positive by PET. No false-negative PET findings were encountered. A weak correlation was found between DUR and tumor size as well as between DUR and the S-phase of the tumor. In patients with breast carcinoma,¹⁸F-FDG PET can be of value in evaluating axillary lymph nodes for metastatic involvement prior to surgery. It is of particular importance that no false-negative PET findings were encountered, and axillary lymph node dissection might not be necessary in patients without axillary uptake by PET. The DUR of the positive axillary lymph nodes seems to bear a relationship with some of the purported prognostic parameters of the primary tumor.     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.

Abstract：

Objective To evaluate the role of breast MRI in detecting the primary malignancy in patients presenting solely with axillary lymph node metastases. Methods Thirty-three patients with axillary lynph node metastases but negative findings on either physical examination or mammography underwent breast MRI to identify occult breast carcinoma. MRI of the breast was assessed according to BI-RADS criteria. The pathologic diagnosis was made according to the standard criteria by the WHO Classification of Tumor. Results Among 33 patients presenting solely with axillary metastases, 30 patients underwent modified radical mastectomy. Primary breast carcinoma was proven in 17 patients. MRI detected lesions in 16 patients, including 10 masses and 6 non-mass lesions. Size of the masses ranged from 0. 5 to 2. 6 cm (mean 1.5 cm). Six lesions were smaller than 1.5 cm in size. Non-mass lesions showed ductal enhancement in 4 cases and segmental enhancement in 2 cases. One patient with tumor detected by histopathology showed no abnormal enhancement on MRI. No tumor was found at mastectomy in the other 13 womeu, and negative MR findings were revealed in 9. Four cases with suspicious enhancement on MRI had no corresponding primary foci on pathology. Three patients didn't undergo surgical procedure. The sensitivity, specificity, and accuracy of MRI in the diagnosis of the primary malignancy were 94. 1%,69. 2%, and 83.3%, respectively. Conclusions Small size of mass and ductal or segmental enhancement of non-mass lesion were common MR features of occult malignancy. MRI showed high sensitivity and accuracy in diagnosing occult breast carcinoma. Breast MRI should be taken in search of occult malignancy in patients with axillary metastases.     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.     

乳腺MRI在X线检查乳腺阴性腋淋巴结转移癌阳性患者中的应用价值

目的 探讨乳腺MR检查对临床乳腺触诊和X线检查均为阴性的腋淋巴结转移癌患者寻找其乳腺内原发病灶的应用价值.方法 分析33例以腋淋巴结转移癌为首诊表现(临床乳腺触诊和X线检查均为阴性)患者的乳腺MR影像资料,依据美国放射学会的乳腺影像报告和数据系统MRI标准对所有病变进行分析,并将MRI诊断结果与病理进行对照.结果 33例腋淋巴结转移癌患者中,30例临床行乳腺根治术,其中17例经病理证实为乳腺癌,乳腺MRI检出其中的16例,包括10例肿块性病变和6例非肿块性病变,肿块性病变直径0.5～2.6 cm(平均1.5 cm),直径≤1.5 cm者6例;非肿块性病变包括4例导管性强化和2例段性强化;另1例病理切片发现乳腺癌但乳腺MRI为阴性.其余13例行乳腺根治术患者病理检查未发现乳腺癌灶,其中9例乳腺MRI亦呈阴性表现,另4例MRI提示可疑癌灶.余3例临床未行手术治疗的患者,乳腺MRI亦为阴性.以病理诊断为金标准,MR检出乳腺原发癌灶的敏感度、特异度和准确度分别为94.1%、69.2%和83.3%.结论 相对于一般乳腺癌而言,隐匿性乳腺癌MRI表现更以小灶性的肿块性病变和导管或段性强化的非肿块性病变为常见表现类型.乳腺MR检查对隐匿性乳腺癌的检出具有较高的敏感度和准确度,应作为这类患者的常规检查手段.