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Predictive value of FDG PET/CT for pathologic axillary node involvement after neoadjuvant chemotherapy

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Abstract

Background

The purpose of this study was to determine the usefulness of sequential FDG PET/CTs for prediction of axillary lymph node (ALN) status after neoadjuvant chemotherapy (NAC).

Methods

Seventy-seven stage II or III breast cancer patients who received 3 cycles of neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this prospective study. FDG PET/CTs were acquired before chemotherapy and after the first cycle of chemotherapy for early metabolic response prediction.

Results

Patients with pN0 had significantly lower post-NAC ALN standard uptake value (SUV) than those who were pN+ (1.22 ± 1.46 in pN0 vs. 2.13 ± 1.99 in pN+, P = 0.017). Post-NAC ALN size on CT also differed according to pathologic ALN status (6.3 mm in pN0 vs. 11.1 mm in pN+, P = 0.014). When serial FDG PET/CT and chest CT were used, patients with an SUV > 1.5 and post-NAC ALN size ≥10 mm on CT did not achieve pN0 (specificity 100% and positive predictive value 100%).

Conclusions

The serial FDG PET/CT after NAC could predict the pathologic status of ALN before surgery in stage II/III breast cancer. Our findings suggest that the combined use of serial FDG PET/CTs and chest CT might provide better information regarding ALN before surgery.

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Acknowledgments

This research was supported by grants from the Priority Research Centers Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2009-0093820) and the Seoul National University Hospital research fund (03-2010-019-0).

This study was presented at the 46th American Society of Clinical Oncology Annual Meeting in Chicago, IL, USA (June 7, 2010).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, Korea

    Bhumsuk Keam, Seock-Ah Im, Youngil Koh, Sae-Won Han, Do-Youn Oh, Jee Hyun Kim, Tae-You Kim & Yung-Jue Bang

  2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Bhumsuk Keam, Seock-Ah Im, Sae-Won Han, Do-Youn Oh, Jee Hyun Kim, Keon Wook Kang, Tae-You Kim, June-Key Chung & Yung-Jue Bang

  3. Department of Radiology, Seoul National University College of Medicine, Seoul, Korea

    Nariya Cho & Woo Kyung Moon

  4. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    Wonshik Han & Dong-Young Noh

  5. Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea

    Keon Wook Kang & June-Key Chung

  6. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea

    In Ae Park

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  1. Bhumsuk Keam
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Correspondence to Seock-Ah Im.

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Keam, B., Im, SA., Koh, Y. et al. Predictive value of FDG PET/CT for pathologic axillary node involvement after neoadjuvant chemotherapy. Breast Cancer 20, 167–173 (2013). https://doi.org/10.1007/s12282-011-0323-0

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  • DOI: https://doi.org/10.1007/s12282-011-0323-0

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