Original article Fluorodeoxyglucose positron emission tomography with sentinel lymph node biopsy for evaluation of axillary involvement in breast cancer A. Gil-Rendo 1 , G. Zornoza 1 , M. J. Garc´ ıa-Velloso 2 , F. M. Regueira 1 , C. Beorlegui 1 and M. Cervera 1 1 Department of General Surgery and 2 Department of Nuclear Medicine, Clinica Universitaria of Navarra, C/P´ ıo XII 36, 31008 Pamplona, Navarra, Spain Correspondence to: Dr A. Gil-Rendo (e-mail: agilrendo@telefonica.net) Background: This study analysed the value of [ 18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting axillary lymph node involvement in women with breast cancer. Methods: In the first 150 women in this prospective study, axillary lymph node dissection (ALND) was performed regardless of the PET results. In a second group (125 women) FDG-PET was complemented with sentinel lymph node biopsy (SLNB) only in those who did not have pathological axillary uptake. Results: The sensitivity and specificity of FDG-PET in detecting axillary involvement was 84·5 and 98·5 per cent respectively in the whole series of 275 patients, with two false-positive and 22 false- negative results. False-negative results were associated with some intrinsic tumour characteristics. In 21 women, PET revealed pathological uptake, suggesting involvement of the internal mammary lymph node chain. Whole-body PET identified a second synchronous tumour in five asymptomatic patients and haematogenous metastases in two patients. Conclusion: The high positive predictive value of PET (98·4 per cent) suggests that FDG uptake in the axilla could be an indication for full ALND without previous SLNB. Paper accepted 4 April 2006 Published online 18 April 2006 in Wiley InterScience (www.bjs.co.uk). DOI: 10.1002/bjs.5338 Introduction The most powerful predictor of recurrence and survival in women with breast cancer is axillary lymph node status 1 . Clinical examination of the axilla and currently available imaging techniques are inaccurate for axillary staging. The best procedure for examining the lymph nodes is still standard axillary lymph node dissection (ALND) and pathological node examination. However, this can result in significant short- and long-term sequelae such as lymphoedema, pain or restriction of arm and shoulder movement 2 . Sentinel lymph node biopsy (SLNB) has been adopted by many centres for axillary staging of women with clini- cally negative axillary nodes and early-stage breast cancer. Although SLNB has minimal long-term morbidity 3 , it is expensive and time consuming, and has a false-negative rate of 0–15 per cent that depends strongly on the surgeon’s experience. Positron emission tomography with [ 18 F]fluorodeoxy- glucose (FDG-PET) is an alternative non-invasive poten- tial approach to axillary staging in breast cancer. It is a radionuclear imaging technique that reflects the higher glycolytic rate of cancer cells compared with normal cells. It has advantages in detecting subclinical metastases in axil- lary lymph nodes compared with other imaging techniques based on anatomical findings. The aim of this study was to ascertain whether preoperative FDG-PET could assess axillary status accurately in clinically node-negative breast cancer. In a first group of women, FDG-PET was followed by routine ALND in order to evaluate the sensitivity and specificity of the technique. In a second group of women, FDG- PET was complemented by SLNB only when there was no pathological axillary uptake in the PET study. Factors associated with false-negative results of PET in the axilla were also analysed. Patients and methods This prospective study analysed a series of 275 women with breast cancer (suspicious mammography confirmed by core biopsy). The study was approved by the local ethics committee and all patients were asked for their informed Copyright  2006 British Journal of Surgery Society Ltd British Journal of Surgery 2006; 93: 707–712 Published by John Wiley & Sons Ltd Downloaded from https://academic.oup.com/bjs/article/93/6/707/6142353 by guest on 30 June 2022