1. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society Semih Gorgulu, MD Gulhane Military Medical Academy, Dept. of Surgery Ankara, TURKEY Ankara, TURKEY FDG-PET WITH SENTINEL LYMPH NODE BIOPSY FOR EVALUATION OF AXİLLARY INVOLVEMENT IN BREAST CANCER

2. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society Breast Cancer Jemal, A et al CA Cancer J Clin 2006;56:106-130

3. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society The single most powerful independent predictor of recurrence and survival Clinical examination and currently available imaging techniques are inaccurate for axillary staging The best procedure examining the axillary lymph nodes is still standard axillary lymph node dissection and pathological node examination Significant short & long term sequelae Lymheodema Restriction of arm and shoulder movement Numbness of upper arm skin Provides staging & prognostic information

4. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society Axillary staging through a minimally invasive and less morbid surgical approach More precise and consistent identification of the node with highest pathological yield A reliable axillary staging technique, although a limited number of false negative results are a feature of all published experience But still involves a surgical procedure

5. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society Positron Emission Tomography (PET) Nuclear medicine imaging modality Biochemical & physiologic activity Anatomic image Malignant cells exhibit increased glycolitic activity Radio labeled glucose analog [F-18] Fluorodeoxyglucose (FDG)

6. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society Analyze the value of FDG PET scanning in detecting axillary lymph node involvement in women with primary breast cancer undergoing sentinel lymph node (SN) biopsy 24 women with newly diagnosed invasive breast cancer underwent FDG-PET. İmages were blindly interpreted by two experienced readers for abnormally increased axillary FDG uptake. After SN biopsy all patients underwent complete axillary lymph node dissection

7. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society CharacteristicTotal No.% Age (Years) ≤ 50833.3 ≥ 511666.6 Histologic type Ductal1979.1 Lobular416.6 Mixed14.1 Tumor grade I416.6 II937.5 III1145.8

8. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society CharacteristicsTotal No.% Tumor size (cm) ≤ 0.514.1 0.5-1.0416.6 1.1-2.01354.1 2.0-5.0625 > 5.0-- ER-PR receptor status Positive1770.8 Negative729.1

9. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society 11 patients (45.8 %) Metastatic SLN FDG-PET 3 patients Tumor size in PET (-) patients 8-34 mm No false positive findings with FDG-PET Sensitivity27.2 % Specificity100 % Positive predictive value100 % Negative predictive value61.9 %

10. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society AuthorsYearCases Sensitivity (%) Specificity (%) Avril1996517996 Utech199612410075 Adler1997529566 Crippa1998688591 Smithe1998509091 Schirrmeister20011177992 Zornosa20032008497 Barranger20033220100 Fehr2004242093 Wahl20043606180 Gorgulu20062427100

11. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society After the promising initial results, more recent studies showed that FDG-PET is not yet sufficiently sensitive in detection of lymph node metastases This limitation has become particularly clear since the introduction of aggressive pathological examination Currently FDG-PET cannot be routinely used for axillary staging of operable breast cancer CONCLUSIONS

12. 11th Biennial Meeting of the International Gynecologic Cancer Society 11th Biennial Meeting of the International Gynecologic Cancer Society Gulhane Military Medical Academy Ankara TURKEY