Is 18 F-fluorodeoxyglucose-positron emission tomography or computed tomography scan a triaging technique for axillary dissection in breast cancer?


  • Uma Krishnaswamy Department of Breast and Oncoplastic Surgery, Apollo (Main) Hospital, Chennai, Tamil Nadu, India
  • Sai Sampath Kumar Vasantham Department of General Surgery, Apollo (Main) Hospital, Chennai, Tamil Nadu, India
  • Yasvanth Kumar Department of CTVS, Apollo (Main) Hospital, Chennai, Tamil Nadu, India



PET CT, Breast cancer, Axillary lymph node, US guided FNAC, ALND, SLNB


Background: To determine if fluorodeoxyglucose-positron emission tomography/ computed tomography (FDG PET/CT) scan identifies axillary nodal disease in conjunction with ultrasound (US) guided fine needle aspiration cytology (FNAC) of suspicious axillary nodes in breast cancer. To determine if this will enable axillary node dissection upfront, avoiding sentinel lymph node biopsy (SLNB).

Methods: Study was performed in Apollo main hospital, Off Greams-lane, Greams road, Chennai IRB approval was obtained from institutional ethical committee-bio medical research-Apollo hospitals, (IEC application number: AMH-C-S-029/04-23). Informed consent was obtained from all the patients who met the inclusion criteria. The 61 patients with cT1-T3, N0-N1, and M0 disease underwent 18F-FDG-PET/CT scans after mammographic evaluation and an US guided FNAC of nodes which were seen to be suspicious in the mammogram and correlated US of the Axilla. All patients underwent axillary lymph node dissection (ALND levels 1 and 2) without a SLNB.

Results: Out of 61 patients, 40 (65.6%) had axillary node uptake on PET/CT scan. But, after ALND, only 32 patients were found to have metastatic nodes on the histopathological examination (HPE) of the operative specimen. Out of these 32 patients, results for axillary metastasis had been noted on PET/CT, US, and guided FNAC in 18 patients (56.3%). Discordant results were noted in 14 (43.8%) patients, 29 patients had no metastasis on HPE. Negative results for axillary metastasis were noted on PET/CT, US and guided FNAC in 26 patients (89.7%). The results were discordant in 3 (10.3%) patients.

Conclusions: An expanded preoperative axillary assessment does not have sufficient reliability to serve as a reliable triaging technique in axillary management. Concordant positive results may permit directly proceeding to ALND without resorting to SLNB. Concordant negative results may similarly permit avoiding axillary surgery. But discordant results warrant SLNB for assessment of axilla.

Author Biographies

Uma Krishnaswamy, Department of Breast and Oncoplastic Surgery, Apollo (Main) Hospital, Chennai, Tamil Nadu, India



Sai Sampath Kumar Vasantham, Department of General Surgery, Apollo (Main) Hospital, Chennai, Tamil Nadu, India



Yasvanth Kumar, Department of CTVS, Apollo (Main) Hospital, Chennai, Tamil Nadu, India




Kumar R, Chauhan A, Zhuang H. Clinicopathologic factors associated with false negative FDG–PET in primary breast cancer. Breast Cancer Res Treat. 2006;98:267-74.

Podoloff DA, Advani RH, Allred C, Benson AB, Brown E, Burstein HJ et al. NCCN Task Force report: Positron Emission Tomography (PET)/Computed Tomography (CT) scanning in cancer. J National Comprehensive Cancer Network. 2006;5(1):S1-22.

Rosen EL, Eubank WB, Mankoff DA. FDG PET, PET/CT, and breast cancer imaging. Radiographics. 2007;27(1):S215-29.

Oz A, Demirkazik FB, Akpinar MG, Soygur I, Baykal A, Onder SC et al. Efficiency of ultrasound and ultrasound-guided fine needle aspiration cytology in preoperative assessment of axillary lymph node metastases in breast cancer. J Breast Cancer. 2012;15(2):211-7.

Wahl RL. Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. J Clin Oncol. 2004;22(2):277-85.

Fehr MK, Hornung R, Varga Z, Burger D, Hess T, Haller U et al. Axillary staging using positron emission tomography in breast cancer patients qualifying for sentinel lymph node biopsy. Breast J. 2004;10:89-93.

Veronesi U, De Cicco C, Galimberti VE, Fernandez JR, Rotmensz N, Viale G et al. A comparative study on the value of FDG-PET and sentinel node biopsy to identify occult axillary metastases. Ann Oncol. 2007;18(3):473-8.

Sohn YM, Hong IK, Han K. Role of [18F] fluorodeoxyglucose positron emission tomography-computed tomography, sonography, and sonographically guided fine-needle aspiration biopsy in the diagnosis of axillary lymph nodes in patients with breast cancer: comparison of diagnostic performance. J Ultrasound Med. 2014;33(6):1013-21.

Gil-Rendo A, Zornoza G, García-Velloso MJ, Regueira FM, Beorlegui C, Cervera M. Fluorodeoxyglucose positron emission tomography with sentinel lymph node biopsy for evaluation of axillary involvement in breast cancer. Br J Surg. 2006;93(6):707-12.

Ulaner GA. PET/CT for Patients with Breast Cancer: Where Is the Clinical Impact? AJR Am J Roentgenol. 2019;213(2):254-65.






Original Research Articles