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Research ArticleOriginal Article

Feasibility of sentinel lymph node biopsy omission after integration of 18F-FDG dedicated lymph node PET in early breast cancer: a prospective phase II trial

Junjie Li, Jingyi Cheng, Guangyu Liu, Yifeng Hou, Genghong Di, Benglong Yang, Yizhou Jiang, Liang Huang, Feilin Qu, Sheng Chen, Yan Wang, Keda Yu and Zhimin Shao
Cancer Biology & Medicine July 2022, 19 (7) 1100-1108; DOI: https://doi.org/10.20892/j.issn.2095-3941.2022.0085
Junjie Li
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Jingyi Cheng
3Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Guangyu Liu
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Yifeng Hou
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Genghong Di
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Benglong Yang
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Yizhou Jiang
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Liang Huang
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Feilin Qu
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Sheng Chen
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Yan Wang
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Keda Yu
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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Zhimin Shao
1Department of Breast Surgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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  • ORCID record for Zhimin Shao
  • For correspondence: [email protected]
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    Figure 1

    CONSORT diagram of patient disposition. *cN+: patients with a positive axillary physical examination.

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    Table 1

    Patient demographics and clinical characteristics

    Characteristicsn (%)
    Age (years)49.9 (28–75)
     <5097 (51.3)
     ≥5092 (48.7)
    Operation type
     Breast-conserving surgery68 (36)
     Mastectomy121 (64)
    Axillary evaluation
     SLNB133 (70.4)
     SLNB, then AD40 (21.2)
     AD16 (8.4)
    Pathologic node stage
     N0133 (70.3)
     N1mic16 (8.5)
     N132 (17)
     N27 (3.7)
     N31 (0.5)
    T stage
     T1a19 (10.1)
     T1b11 (5.8)
     T1c64 (33.9)
     T289 (47.1)
     Unknown6 (3.1)
    Histology
     IDC180 (95.2)
     ILC9 (4.8)
    Grade
     I25 (13.2)
     II96 (50.8)
     III68 (36)
    Subtype
     HR positive and HER2 negative120 (63.5)
     HR positive and HER2 positive23 (12.2)
     HR negative and HER2 positive27 (14.3)
     HR negative and HER2 negative19 (10)
     Ki67 ≥30%+78 (41.3)
     LVI positive61 (32.3)

    AD, axillary dissection; HER2, human epidermal growth factor receptor 2; HR, hormone receptor; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; LVI, lymphovascular invasion; SLNB, sentinel lymph node biopsy.

      • View popup
      Table 2

      Diagnostic performance of LymphPET and ultrasound in axillary staging

      Axillary imaging assessmentnMacrometastasesMicrometastasesNon-metastasesSensitivitySpecificityNPV
      Ultrasound‡4016
      US-neg12417129557.571.886.3
      US-det4614428
      US-met199010
      LymphPET†
      Negative13116111046077.287.8
      Positive5824529
      Combination*
      Negative100998277.561.191
      Positive8931751

      ‡US-neg, no lymph nodes detected by ultrasound; US-det, lymph nodes detected by ultrasound; US-met, suspected metastatic lymph nodes detected by ultrasound.

      †maxLUV of LymphPET was set at 0.27 (negative < 0.27, positive ≥0.27).

      *Negative, no lymph nodes detected by ultrasound and maxLUV in LymphPET < 0.27; positive, lymph nodes detected by ultrasound and/or maxLUV in LymphPET ≥0.27.

      Sensitivity, specificity, and NVP were calculated according to lymph node macrometastases.

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        Table 3

        Clinical characteristics of patients with a false-negative axillary node evaluation by LymphPET and ultrasound

        Patient IDAge (years)SideOperationMGLocationSize cmHistologyGradeLVER%PR%HER2Ki67No SLN removedNo. lymph node macrometastases AD
        5744RightMMassCenter1.5IDCIII+8060+15410/19
        7667RightBCSMCOuter upper3.7IDCII–8010+20310/12
        8341RightMMCOuter upper1.5IDCII+8080–15520/15
        11667RightMMCOuter upper2.8IDCII+8080–10630/12
        11741RightBCSMassOuter upper3IDCII+8080–30322/20
        12869RightMMassInner upper2ILCII–8020–30326/24
        12947LeftMMassOuter2.2IDCII+8080–10420/25
        14457LeftMMassOuter lower3.5IDCII+8080–30311/22
        14761RightMMassOuter upper1.2IDCII–00–80410/8

        AD, axillary dissection; BCS, breast-conserving surgery; ER, estrogen receptor; PR, progesterone receptor; HER2, human epidermal growth factor receptor 2; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; LV, lymphovascular invasion; M, mastectomy; MC, mass with calcification; MG, mammography.

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        Cancer Biology & Medicine: 19 (7)
        Cancer Biology & Medicine
        Vol. 19, Issue 7
        15 Jul 2022
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        Feasibility of sentinel lymph node biopsy omission after integration of 18F-FDG dedicated lymph node PET in early breast cancer: a prospective phase II trial
        Junjie Li, Jingyi Cheng, Guangyu Liu, Yifeng Hou, Genghong Di, Benglong Yang, Yizhou Jiang, Liang Huang, Feilin Qu, Sheng Chen, Yan Wang, Keda Yu, Zhimin Shao
        Cancer Biology & Medicine Jul 2022, 19 (7) 1100-1108; DOI: 10.20892/j.issn.2095-3941.2022.0085

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        Feasibility of sentinel lymph node biopsy omission after integration of 18F-FDG dedicated lymph node PET in early breast cancer: a prospective phase II trial
        Junjie Li, Jingyi Cheng, Guangyu Liu, Yifeng Hou, Genghong Di, Benglong Yang, Yizhou Jiang, Liang Huang, Feilin Qu, Sheng Chen, Yan Wang, Keda Yu, Zhimin Shao
        Cancer Biology & Medicine Jul 2022, 19 (7) 1100-1108; DOI: 10.20892/j.issn.2095-3941.2022.0085
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        Keywords

        • breast cancer
        • sentinel lymph node biopsy
        • 18F-fluorodeoxyglucose
        • LymphPET
        • negative predictive value

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