A Quantitative review of the use of FDG-PET in the axillary staging of breast cancer

Breast cancer is the most frequent type of cancer in women and is the second leading cause of cancer death in Canadian women. It is an important source of morbidity and mortality in today's society and confers risk to the patient both in terms of the disease itself and the treatment of the disease. Axillary lymph node status is the most important prognostic factor for determining breast cancer survival and it guides the treatment of the disease based on the disease stage. The aim of this study is to assess the diagnostic value of positron emission tomography (PET) utilizing [F-18]2-fluoro-2-deoxy-D-glucose (FDG) in the axillary staging of breast cancer. A systematic literature search was carried out in the Medline, Embase and Cochrane databases. Seventy one original studies were identified, 20 of which evaluated the axillary status of women. The studies were graded based on recommended procedures from similar studies. Aggregate sensitivities and specificities were calculated for various levels of quality for all included studies. Recommendations for future studies were made based on patient positioning, acquisition time, attenuation correction, fasting state, and image interpretation. A large variation in the sensitivity and specificity of large diagnostic trials of similar quality was noted. We concluded that PET has promise for the axillary staging of breast cancer once the variability of sensitivity and specificity in these large trials is addressed.