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


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


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.