Selective Sentinel Node Plus Additional Non-Sentinel Node Biopsy Based on an FDG-PET/CT Scan in Early Breast Cancer Patients: Single Institutional Experience

World J Surg. 2009 May;33(5):943-9. doi: 10.1007/s00268-009-9955-z.


Background: This study was designed to determine whether a preoperative fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) (FDG-PET/CT) could be used as a guide for axillary node dissection (AND) or sentinel lymph node biopsy (SNB) in breast cancer patients.

Methods: Between February 2007 and April 2008, we performed FDG-PET/CT scans in 137 biopsy-proven breast cancer patients planning to have an SNB to select patients for either AND (PET/CT N+) or SNB (PET/CT N0). In performing SNB, we also performed additional non-SNB (ADD), which was enlarged at the lower axilla.

Results: Twenty-seven patients with positive scans underwent complete AND as a primary procedure, and 110 patients with negative scans underwent SNB + ADD. There were 8 cases of false negative scans, and no case of false positive scan. The overall sensitivity, specificity, positive predictive value, and overall accuracy of FDG-PET/CT in predicting axillary metastasis were 77.1%, 100%, 100%, and 94.2%, respectively. In a subset of 110 patients with SNB + ADD, 104 patients had histologically negative SN, and 6 patients had positive SN in frozen section. Among 110 SNB + ADD cases, there were only 8 cases (7.3%) of positive axillary basins in permanent biopsy, including two cases of late positives that had micrometastases in the SN only. Through selective SNB + ADD based on an FDG-PET/CT, we have spared 27 unnecessary SNBs (true positive scans).

Conclusions: FDG-PET/CT is a specific imaging modality for predicting axillary node metastasis, and allows for a selective approach to either AND or SNB. A selective SNB + ADD based on an FDG-PET/CT reduced both unnecessary SNBs and positive axillary basins, enhancing the identification rates of SN and the accuracy of SNB.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Axilla / diagnostic imaging
  • Axilla / surgery
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery*
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology
  • Lymph Nodes / surgery
  • Lymphatic Metastasis / diagnostic imaging
  • Male
  • Middle Aged
  • Neoplasm Staging / methods
  • Positron-Emission Tomography / methods*
  • Predictive Value of Tests
  • Prospective Studies
  • Radiopharmaceuticals
  • Reproducibility of Results
  • Sentinel Lymph Node Biopsy / methods*
  • Tomography, X-Ray Computed / methods*


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18