The Relation Between Tumor and Axillary Lymph Node SUV Values with the Presence of Distant Metastases in Staging F18 FDG PET/CT in Breast Cancer

INTRODUCTION: We aimed to investigate the relationship between primary tumor and axillary lymph node maximum standardized uptake values (SUVmax) with the presence of distant metastases at initial staging of breast cancer.
METHODS: Fifty-seven women who were referred to our clinic for staging positron emission tomography/computed tomography (PET/CT) with diagnosis of breast cancer were included in the study. Immunohistochemical (IHC) features of the primary tumor [hormone receptor (HR), human epidermal growth factor receptor type-2 (HER2), Ki67 index] were reviewed retrospectively. All patients’ HR status was positive and HER2 status was negative. Primary tumor SUVmax (Tmax) and axillary lymph node SUVmax (Nmax) values and primary tumor-to-axillary lymph node (T/N) ratios were calculated in PET/CT. Patients were divided into two groups as metastatic and non-metastatic according to PET/CT findings. The differences between groups in terms of age, Ki67 index and SUV values were statistically analyzed.
RESULTS: The mean age of the patients was 52±14.4 (range 25-79 years). According to PET/CT findings, the patients were divided in two groups, 57% metastatic (n = 33) and 43% non-metastatic (n = 24). While no statistically significant difference was observed between the two groups in terms of age, Ki67 index and Tmax averages, statistically significant differences were found between Nmax values (p <0.001) and T/N ratios (p=0.001). Cut-off value in association with distant metastasis was 7,8 for Nmax value and 8,5 for T/N ratio on ROC curve analysis.
DISCUSSION AND CONCLUSION: Accurate staging is important in terms of treatment plan and prediction of disease prognosis in breast cancer. In our study, it was thought that the difference in Nmax values and T/N ratios, independent of Tmax values, could be a determinant in terms of the overlooked and possible early metastatic disease indicator in the patient group without known distant metastasis.

Meme Kanserinde Evreleme F18 FDG PET/BT Ýncelemesinde Tümör ve Aksiller Lenf Nodu SUV Deðerlerinin Uzak Metastaz ile Ýliþkisi

GÝRÝÞ ve AMAÇ: Meme kanseri evrelemesinde primer tümor ve aksiller lenf nodu SUVmax parametrelerinin uzak metastaz varlýðý ile iliþkisini araþtýrmak amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmaya kliniðimize meme kanseri tanýsý ile evreleme amaçlý positron emisyon tomografi /bilgisayarlý tomografi (PET/BT) incelemesi için refere edilen 57 kadýn hasta dahil edildi. Hastalarýn immünohistokimyasal özellikleri [hormonreseptörü (HR), human epidermal büyüme factor reseptörü tip-2 (HER2), Ki67 indeksi] geriye dönük olarak tarandý. Hastalarýn tümü HR-pozitif,HER2-negatif idi. PET/BT’de primer tümör SUVmax(Tmax), aksiller lenf nodu SUVmax (Nmax) deðerleri ve tümör/aksiller lenf nodu SUVmax (T/N) oranlarý hesaplandý. Hastalar PET/BT bulgularýna göre metastatik ve non-metastatik olarak iki gruba ayrýldý. Gruplar arasý yaþ, Ki67 indeksi ve SUV deðerleri açýsýndan farklýlýk istatistiksel analizi yapýldý.
BULGULAR: Hastalarýn yaþ ortalamasý 52 ± 14.4 (aralýk 25-79) idi. PET/BT bulgularýna göre hastalar %57’si metastatik (n=33), %43’ü non-metastatik (n=24) olmak üzere iki grupta izlendi. Ýki grup arasýnda yaþ, Ki67 indeksi ve Tmax ortalamalarý açýsýndan istatistiksel olarak anlamlý fark izlenmezken ortalama Nmax deðerleri ve T/N oranlarý arasýnda istatistiksel olarak anlamlý fark bulundu (sýrasýyla p<0.001, p=0.001). Uzak metastaz varlýðý açýsýndan ROC analizde Nmax için kesme deðeri 7.8,T/N oraný için 8.5 olarak bulundu.
TARTIÞMA ve SONUÇ: Meme kanserinde tedavi planý, hastalýk prognozu açýsýndan evrelemenin doðru þekilde yapýlmasý önem arzetmektedir. Çalýþmamýzda Nmax deðerinin ve T/N oranýnýn, Tmax deðerlerinden baðýmsýz olarak farklýlýk göstermesi, uzak metastaz saptanamayan hasta grubunda gözden kaçan ve olasý erken metastatik hastalýk göstergesi açýsýndan belirleyici olabileceði düþünülmüþtür.