Imaging technique helps predict breast cancer spread before surgery

August 21, 2006

Whole-body positron emission tomography (PET) scans could help physicians determine whether breast cancer has spread to the lymph nodes in the armpit prior to surgery, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.

Breast cancer is the most common type of malignant cancer in U.S. women, according to background information in the article. The most reliable way for physicians to determine the prognosis of women with the disease is to determine whether cancer has spread to the axillary lymph nodes, small oval structures in or near the armpits. In procedures known as dissection or biopsy, physicians remove all or part of the lymph nodes nearest the breast to determine whether the cancer has metastasized (spread). "A technique to identify positive lymph nodes before surgery would have several advantages," the authors write.

Alice Chung, M.D., and colleagues at the Cedars-Sinai Medical Center, Los Angeles, evaluated such a technique in 51 women (average age 54 years) who had 54 cases of invasive breast cancer as determined by biopsies. Before their surgeries or chemotherapy, the women had all had PET scans, in which a material similar to glucose (fludeoxyglucose F 18, or FDG) was injected into the body along with a chemical tracer. Because cancer cells use more glucose, they absorb more of the FDG. The researchers analyzed the scans to determine the standardized uptake value for each patient, a number that indicated how much of the FDG was absorbed in reference to how much was injected.

The PET scans indicated activity in the axillary area for 32 (59 percent) of the breast cancer cases. The standard uptake value ranged from .7 to 11; 20 tumors had a value of 2.3 or greater, while 34 had a value of less than 2.3. For further analysis, the researchers set the standard uptake value threshold at 2.3, meaning that cancers with a higher value were considered to have spread to the lymph nodes. Using this threshold, the scans were 72 percent accurate; had a sensitivity of 60 percent, meaning that 60 percent of those with axillary metastases were identified; a specificity of 100 percent, meaning that no one without metastases was identified as having metastases; and a positive predictive value--or proportion of patients with a positive result who are accurately diagnosed--of 100 percent.

Physicians should not necessarily replace other methods with PET scans, but if the scans are already performed before surgery, calculating a standard update value for axillary activity will help them determine if the lymph nodes are involved, the authors write. Technical and calibration factors cause variations in readings, therefore, "each PET center needs to develop its reference values," they continue. "However, if a PET standardized uptake value is validated and can predict node positivity with 100 percent specificity, chemotherapy can be initiated or a surgeon can proceed directly to axillary lymph node dissection for locoregional control."
(Arch Surg. 2006;141:783-789. Available pre-embargo to the media at http://www.jamamedia.org.)
-end-
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

The JAMA Network Journals

Related Breast Cancer Articles from Brightsurf:

Oncotarget: IGF2 expression in breast cancer tumors and in breast cancer cells
The Oncotarget authors propose that methylation of DVDMR represents a novel epigenetic biomarker that determines the levels of IGF2 protein expression in breast cancer.

Breast cancer: AI predicts which pre-malignant breast lesions will progress to advanced cancer
New research at Case Western Reserve University in Cleveland, Ohio, could help better determine which patients diagnosed with the pre-malignant breast cancer commonly as stage 0 are likely to progress to invasive breast cancer and therefore might benefit from additional therapy over and above surgery alone.

Partial breast irradiation effective treatment option for low-risk breast cancer
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast irradiation for many women with low-risk, early stage breast cancer, according to new clinical data from a national clinical trial involving researchers from The Ohio State University Comprehensive Cancer Center - Arthur G.

Breast screening linked to 60 per cent lower risk of breast cancer death in first 10 years
Women who take part in breast screening have a significantly greater benefit from treatments than those who are not screened, according to a study of more than 50,000 women.

More clues revealed in link between normal breast changes and invasive breast cancer
A research team, led by investigators from Georgetown Lombardi Comprehensive Cancer Center, details how a natural and dramatic process -- changes in mammary glands to accommodate breastfeeding -- uses a molecular process believed to contribute to survival of pre-malignant breast cells.

Breast tissue tumor suppressor PTEN: A potential Achilles heel for breast cancer cells
A highly collaborative team of researchers at the Medical University of South Carolina and Ohio State University report in Nature Communications that they have identified a novel pathway for connective tissue PTEN in breast cancer cell response to radiotherapy.

Computers equal radiologists in assessing breast density and associated breast cancer risk
Automated breast-density evaluation was just as accurate in predicting women's risk of breast cancer, found and not found by mammography, as subjective evaluation done by radiologists, in a study led by researchers at UC San Francisco and Mayo Clinic.

Blood test can effectively rule out breast cancer, regardless of breast density
A new study published in PLOS ONE demonstrates that Videssa® Breast, a multi-protein biomarker blood test for breast cancer, is unaffected by breast density and can reliably rule out breast cancer in women with both dense and non-dense breast tissue.

Study shows influence of surgeons on likelihood of removal of healthy breast after breast cancer dia
Attending surgeons can have a strong influence on whether a patient undergoes contralateral prophylactic mastectomy after a diagnosis of breast cancer, according to a study published by JAMA Surgery.

Young breast cancer patients undergoing breast conserving surgery see improved prognosis
A new analysis indicates that breast cancer prognoses have improved over time in young women treated with breast conserving surgery.

Read More: Breast Cancer News and Breast Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.