Source:European Journal of Surgical Oncology (EJSO), Volume 43, Issue 4
Author(s): S.C. Teixeira, B.B. Koolen, P.H.M. Elkhuizen, M.-J.T.F.D. Vrancken Peeters, M.P.M. Stokkel, S. Rodenhuis, V. van der Noort, E.J.T. Rutgers, R.A. Valdés Olmos
Introduction18F-FDG PET/CT has high positive predictive value for the detection of avid lymph node metastases in breast cancer patients. We analysed the effect of upstaging lymph nodes by PET/CT on short-term outcome in stage II/III breast cancer patients.Patients and methodsA total of 278 stage II/III primary breast cancer patients (mean age 48.9 years, range 19–75 years) were re-staged with 18F-FDG PET/CT before start of pre-operative systemic treatment (PST). Patients were divided in three groups based on risk for local recurrence: a low – (T2N0), intermediate – (T0-2N1 and T3N0) and a high-risk group (T0-3N2–3, T3N1 and T4). Within these groups we looked at local recurrence-free survival (LRFS), recurrence-free survival (RFS) and overall survival (OS) within the first 3 years of follow-up.ResultsWith a median follow-up (FU) of 50 months the RFS, LRFS and OS were 87%, 88% and 92% respectively for the whole group. PET/CT upstaged 43 patients from the low- and intermediate risk group to the high-risk group, based on detection of ≥4 avid axillary nodes or occult N2/3-disease. Patients upstaged with PET/CT had more events for all three analyses compared to the original risk groups, which resulted in a significantly worse RFS (69.8%; p = 0.03) a nearly significantly worse LRFS (p = 0.052) and no effect in OS (p = 0.433).DiscussionAdditional PET/CT staging allows breast cancer patients to be treated according to the true stage, still stage II/III breast cancer patients upstaged to N2/3 by PET/CT have worse short-term outcome, despite adjustment of treatment, than patients staged high-risk with conventional imaging.
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