FDG-guided excision of peripheral non-palpable lymph nodes in the axilla with suspected malignancy Excision guidée par FDG des ganglions lymphatiques non palpables de l'aisselle avec suspicion de malignité


İLHAN M. B., Kut A., BADEMLER S., KILIÇ B., Yanar F., KARANLIK H.

Medecine Nucleaire, vol.48, no.1, pp.1-7, 2024 (SCI-Expanded) identifier

  • Publication Type: Article / Article
  • Volume: 48 Issue: 1
  • Publication Date: 2024
  • Doi Number: 10.1016/j.mednuc.2023.08.002
  • Journal Name: Medecine Nucleaire
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.1-7
  • Keywords: FDG uptake, Lympadenectomy, Radioguided biopsy, Ultrasound
  • Istanbul University Affiliated: Yes

Abstract

Objective: To define the feasibility of 18F-fluorodeoxyglucose (FDG) uptake tracing in the excision of potentially malignant non-palpable lymph nodes (NLN), especially in the axilla. Materials and methods: Findings of 493 peripheral lymph node (LN) excisions were examined in the study. Three hundred seventy-eight LNs were palpable and the remaining 115 LNs were non-palpable. The excised NLNs were analyzed in two groups, NLNs excised based on the anatomical descriptions of imaging methods (n = 62), image-guided NLN excisions (n = 53). Among the image-guided excisions, 27 NLNs were excised using real-time ultrasound (US) guidance, and 26 NLNs were excised using FDG uptake tracing. Results: Image-guided excisions provided better diagnostic accuracy for potentially malignant NLNs compared with excisions made located based on imaging descriptions (P = 0.029). In these image-guided NLN excisions, the FDG uptake-trace method combined with positron emission tomography-computed tomography (PET-CT) was more successful in detecting malignant NLNs compared with US guidance (P = 0.04). NLN excisions based on FDG uptake were completed in a shorter time than both excisions with US guidance (P = 0.006) and excisions made locating based on imaging definitions (P = 0.001). Conclusion: Potentially malignant NLN excisions can be challenging for surgeons, and can result in prolonged surgical time. It may be extrapolated from our study that anatomy and metabolism-based LN excision guidance using information obtained in PET-CT and following FDG uptake tracing may improve the accuracy of histologic examinations, and thus increase the probability of achieving a correct diagnosis.