Prediction of Sentinel Lymph Node Biopsy Status in Breast Cancers with PET/CT Negative Axilla

Abstract

Background and Aim Prior knowledge of axillary node status can spare a lot of patients with early breast cancer morbidity due to an unnecessary axillary dissection. Our study compared various metabolic and pathological features that can predict the sentinel lymph node biopsy (SLNB) status in patients with positron emission tomography/computed tomography (PET/CT) negative axilla.

Patients and Methods All consecutive patients with early breast cancers (< 5 cm) with PET/CT negative axilla who underwent breast surgery and SLNB from November 2016 to February 2020 were included. Various primary tumor (PT) pathological variables and metabolic variables on PET/CT such as maximum standardized uptake value (PT-SUV_max), metabolic tumor volume (PT-MTV), and total lesion glycolysis (PT-TLG) were compared using univariate and multivariate analyses for prediction of SLNB status.

Results Overall 70 patients, all female, with mean age 55.6 years (range: 33–77) and mean tumor size 2.2 cm (range: 0.7–4.5), were included. SLNB was positive in 20% of patients (n = 14) with nonsentinel nodes positive in 4% (n = 3) patients. Comparing SLNB positive and negative groups, univariate analysis showed significant association of SLNB with low tumor grade, positive lymphovascular invasion (LVI), positive estrogen receptor (ER) status with lower mean K_i-67 index (34.41 vs. 52.02%; p = 0.02), PT-SUV_max (5.40 vs. 8.68; p = 0.036), PT-MTV (4.71 cc vs. 7.46 cc; p = 0.05), and PT-TLG (15.12 g/mL.cc vs. 37.10 g/mL.cc; p = 0.006). On multivariate analysis, only LVI status was a significant independent predictor of SLNB status (odds ratio = 6.23; 95% confidence interval: 1.15–33.6; p = 0.033).

Conclusion SLNB is positive in approximately 20% of early breast cancers with PET/CT negative axilla and SLNB status appears to be independent of PT size. SLNB+ PTs were more likely to be LVI+ and ER + ve, with lower grade/K_i-67/metabolic activity (SUV_max/MTV/TLG) compared with SLNB–ve tumors. Logistic regression analysis revealed LVI status as the only significant independent predictor of sentinel lymph node status.

Keywords

sentinel lymph node biopsy - breast cancers - PET/CT negative axilla - prediction

Publikationsverlauf

Artikel online veröffentlicht:
28. Juni 2022

• References

• 1 Dar M, Sharma K. Burden of cancer in India: GLOBOCAN 2018 Estimates Incidence, Mortality, prevalence and future projections of cancer in India. Burden Cancer India 2019
• 2 Fisher B, Bauer M, Margolese R. et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985; 312 (11) 665-673
• 3 Lyman GH, Giuliano AE, Somerfield MR. et al; American Society of Clinical Oncology. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005; 23 (30) 7703-7720
• 4 Ahmed M, Purushotham AD, Douek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol 2014; 15 (08) e351-e362
• 5 Veronesi U, Viale G, Paganelli G. et al. Sentinel lymph node biopsy in breast cancer: ten-year results of a randomized controlled study. Ann Surg 2010; 251 (04) 595-600
• 6 Park KU, Caudle A. Management of the axilla in the patient with breast cancer. Surgical Clinics, 2018 surgical.theclinics.com
• 7 Martelli G, Boracchi P, De Palo M. et al. A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: results after 5 years of follow-up. Ann Surg 2005; 242 (01) 1-6 , discussion 7–9
• 8 Chandra P, Ravichander SK, Babu SM, Jain D, Nath S. Evaluation of diagnostic accuracy and impact of preoperative positron emission tomography/computed tomography in the management of early operable breast cancers. Indian J Nucl Med 2020; 35 (01) 40-47
• 9 Parmar V, Hawaldar R, Nair NS. et al. Sentinel node biopsy versus low axillary sampling in women with clinically node negative operable breast cancer. Breast 2013; 22 (06) 1081-1086
• 10 Cools-Lartigue J, Sinclair A, Trabulsi N. et al. Preoperative axillary ultrasound and fine-needle aspiration biopsy in the diagnosis of axillary metastases in patients with breast cancer: predictors of accuracy and future implications. Ann Surg Oncol 2013; 20 (03) 819-827
• 11 Veronesi U, De Cicco C, Galimberti VE. et al. A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol 2007; 18 (03) 473-478
• 12 Chen M, Palleschi S, Khoynezhad A, Gecelter G, Marini CP, Simms HH. Role of primary breast cancer characteristics in predicting positive sentinel lymph node biopsy results: a multivariate analysis. Arch Surg 2002; 137 (05) 606-609 , discussion 609–610
• 13 Ozmen V, Karanlik H, Cabioglu N. et al. Factors predicting the sentinel and non-sentinel lymph node metastases in breast cancer. Breast Cancer Res Treat 2006; 95 (01) 1-6
• 14 Postacı H, Zengel B, Yararbaş U. et al. Sentinel lymph node biopsy in breast cancer: predictors of axillary and non-sentinel lymph node involvement. Balkan Med J 2013; 30 (04) 415-421
• 15 Capdet J, Martel P, Charitansky H. et al. Factors predicting the sentinel node metastases in T1 breast cancer tumor: an analysis of 1416 cases. Eur J Surg Oncol 2009; 35 (12) 1245-1249
• 16 Viale G, Zurrida S, Maiorano E. et al. Predicting the status of axillary sentinel lymph nodes in 4351 patients with invasive breast carcinoma treated in a single institution. Cancer 2005; 103 (03) 492-500
• 17 Majid S, Rydén L, Manjer J. Predictive factors for sentinel node metastases in primary invasive breast cancer: a population-based cohort study of 2552 consecutive patients. World J Surg Oncol 2018; 16 (01) 54
• 18 Ding J, Jiang L, Wu W. Predictive value of clinicopathological characteristics for sentinel lymph node metastasis in early breast cancer. Med Sci Monit 2017; 23: 4102-4108
• 19 Mao F, Yao R, Peng L, Zhao J-L, Liang Z-Y, Sun Q. Predictive clinicopathological characteristics affecting sentinel lymph node metastasis in early breast cancer patients. Med Sci Monit 2017; 6 (05) 968-975
• 20 Reyal F, Rouzier R, Depont-Hazelzet B. et al. The molecular subtype classification is a determinant of sentinel node positivity in early breast carcinoma. PLoS One 2011; 6 (05) e20297
• 21 Bertucci F, Finetti P, Birnbaum D. Basal breast cancer: a complex and deadly molecular subtype. Curr Mol Med 2012; 12 (01) 96-110
• 22 Groheux D, Giacchetti S, Moretti JL. et al. Correlation of high 18F-FDG uptake to clinical, pathological and biological prognostic factors in breast cancer. Eur J Nucl Med Mol Imaging 2011; 38 (03) 426-435
• 23 Song BI, Kim HW, Won KS. Predictive value of ¹⁸F-FDG PET/CT for axillary lymph node metastasis in invasive ductal breast cancer. Ann Surg Oncol 2017; 24 (08) 2174-2181
• 24 Sun WY, Choi YJ, Song Y-J. Prediction of axillary nodal status according to the axillary lymph node to primary breast tumor maximum standardized uptake value ratio on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. J Breast Dis 2016; 4 (02) 92-99