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New objective criteria improve PET scan reliability in detecting breast cancer metastasis

LOS ANGELES To begin to standardize PET scanning techniques to detect the spread of breast cancer to the lymph nodes, researchers at the Saul and Joyce Brandman Breast Center at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center have developed objective criteria that can be used to complement clinical observations. The group's findings and recommendations appear in the August issue of Archives of Surgery.

The spread of breast cancer cells to lymph nodes under the arm is a significant indication of the stage of the disease and the patient's prognosis, and lymph node biopsies or even surgical removal often are needed to determine whether metastasis has occurred.

In an effort to develop noninvasive options to assess lymph node involvement, PET scans (positron emission tomography) and other technologies are being refined and studied for their ability to detect breast cancer cells in lymph nodes. But while noninvasive imaging procedures offer reduced discomfort and risk, scans may be open to interpretation when analyzed visually.

PET scans for invasive breast cancers and their metastases are performed after injection of a glucose-like substance called fludeoxyglucose F 18 (FDG) and a radioactive tracer. Because malignant cells use more glucose than normal cells, FDG accumulates in them and the tracer makes them visible on the PET scan.

The key to accurate diagnosis, according to the article, is the amount of tracer uptake a "standardized uptake value" (SUV). At Cedars-Sinai, axillary nodes with SUVs of 2.3 or greater were 15 times more likely to contain metastasis than nodes with SUVs less than 2.3. In fact, with the SUV threshold set at 2.3, 60 percent of those with axillary metastases were identified (60 percent sensitivity), there were no false positive readings (100 percent specificity) and all those with a positive result were accurately diagnosed (100 percent positive predictive value). Acc
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Contact: Sandy Van
sandy@prpacific.com
800-880-2397
Cedars-Sinai Medical Center
21-Aug-2006


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