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

Breast Cancer. 2013 Apr;20(2):167-73. doi: 10.1007/s12282-011-0323-0. Epub 2012 Feb 7.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / drug therapy
  • Breast Neoplasms / pathology
  • Carcinoma, Ductal, Breast / diagnostic imaging*
  • Carcinoma, Ductal, Breast / drug therapy
  • Carcinoma, Ductal, Breast / secondary
  • Docetaxel
  • Doxorubicin / administration & dosage
  • Female
  • Fluorodeoxyglucose F18*
  • Follow-Up Studies
  • Humans
  • Lymph Nodes / diagnostic imaging
  • Lymphatic Metastasis
  • Middle Aged
  • Multimodal Imaging*
  • Neoadjuvant Therapy*
  • Neoplasm Staging
  • Positron-Emission Tomography*
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Radiopharmaceuticals*
  • Sentinel Lymph Node Biopsy
  • Taxoids / administration & dosage
  • Tomography, X-Ray Computed*


  • Radiopharmaceuticals
  • Taxoids
  • Fluorodeoxyglucose F18
  • Docetaxel
  • Doxorubicin