Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients

Eur J Nucl Med Mol Imaging. 2009 Oct;36(10):1543-50. doi: 10.1007/s00259-009-1145-6. Epub 2009 May 5.


Purpose: The aims of this study were (1) to evaluate FDG PET/CT and CT for the detection of axillary lymph node metastases in breast cancer (BC) patients and (2) to evaluate FDG PET/CT as a pre-test for the triage to sentinel lymph node biopsy (SLNB) versus axillary lymph node dissection (ALND).

Methods: The sensitivity, specificity, positive and negative predictive value (PPV, NPV), and accuracy of FDG PET/CT and CT for axillary lymph node metastases were determined in 61 patients (gold standard: histopathology). According to the equation "NPV = specificity (1-prevalence) / [specificity (1-prevalence) + (1-sensitivity) prevalence]" FDG PET/CT was evaluated as a triage tool for SLNB versus ALND.

Results: The sensitivity, specificity, PPV, NPV and accuracy of FDG PET/CT was 58, 92, 82, 77 and 79% and of CT 46, 89, 72, 71 and 72%, respectively. Patients with an up to approximately 60% risk for axillary lymph node metastases appear to be candidates for SLNB provided that the axilla is unremarkable on FDG PET/CT.

Conclusion: FDG PET/CT cannot replace invasive approaches for axillary staging but may extend the indication for SLNB.

MeSH terms

  • Adult
  • Aged
  • Axilla
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology
  • Female
  • Fluorine Radioisotopes
  • Fluorodeoxyglucose F18*
  • Humans
  • Lymph Node Excision
  • Lymphatic Metastasis / diagnostic imaging*
  • Lymphatic Metastasis / pathology
  • Middle Aged
  • Neoplasm Staging / methods*
  • Neoplasm Staging / statistics & numerical data
  • Positron-Emission Tomography
  • Radiopharmaceuticals*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Sentinel Lymph Node Biopsy
  • Tomography, X-Ray Computed


  • Fluorine Radioisotopes
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18