Ur Metser, Seyed Ali Mirshahvalad, Vanessa Murad, Patrick Veit-Haibach, Ezra Han
LSCLNM was identified in a minority of patients with breast cancer undergoing staging with [18F]FDG-PET/CT, but its likelihood increased substantially with more extensive regional nodal disease. Specialists reporting PET scans should be aware of the clinical implications of this finding and ensure to report the nodal spread in detail. Our data suggest that in patients with PET-positive high-level nodal disease, inclusion of the LSCLN should be considered, based on individual risk features including tumor location and primary tumor burden.
PURPOSE: There is variability in the coverage of the lateral supraclavicular fossa in adjuvant radiotherapy targets in breast cancer patients. The purpose of this study was to evaluate the prevalence and predictors of lateral supraclavicular lymph node metastasis (LSCLNM) in patients with advanced or multifocal breast cancer on [18F]FDG-PET/CT.
MATERIALS AND METHODS: Invasive ductal breast carcinoma patients who were referred for [18F]FDG-PET/CT were included. Primary tumor location, [18F]FDG-PET parameters, extent of regional nodal disease (including presence or absence of LSCLNM), and distant metastasis status were recorded. Associations between these parameters and presence of LSCLNM were tested.
RESULTS: There were 243 patients evaluated, of whom 23 had bilateral disease. Of the 266 primary breast tumors evaluated, 19 (7.1%) cases had ipsilateral LSCLNM. None of the patients with locoregional nodal metastasis limited to axillary levels 1-2 had LSCLNM, whereas 8.7%, 12.8% and 52.2% of cases with axillary nodal metastasis up to level III, axillary nodal plus internal mammary nodal metastases, and medial supraclavicular lymph node metastasis (MSCLNM) showed LSCLNM, respectively. Further associations with LSCLNM included metabolic tumor volume (MTV), tumor location in the upper outer quadrant and presence of distant metastasis. Following multivariate analysis, only MTV and the presence of axillary level III nodal metastasis and MSCLNM remained statistically significant (p of 0.043, 0.011 and <0.001, respectively), suggesting their independence.
CONCLUSIONS: LSCLNM was identified in a minority of patients with breast cancer undergoing staging with [18F]FDG-PET/CT, but its likelihood increased substantially with more extensive regional nodal disease. Specialists reporting PET scans should be aware of the clinical implications of this finding and ensure to report the nodal spread in detail. Our data suggest that in patients with PET-positive high-level nodal disease, inclusion of the LSCLN should be considered, based on individual risk features including tumor location and primary tumor burden.