الفهرس 
Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the second most frequently diagnosed malignancy in the world after lung cancer; and more than two million new cases are seen each year. It is the leading cause of death in women around the world.
FDG-PET/CT is used in the early stage, estimation of the therapeutic response, revelation of recurrent disease, and distal metastasis. There is a general agreement about the high diagnostic specificity of FDG-PET, despite the well-known occurrence of false-positive results in diagnostic oncology with FDG-PET owing to concomitant inflammatory alteration. Nearly all recent investigations report a false-positive rate ranging from 0–6%, and this is one of the reasons why several authors suggest that patients with FDG positive uptake should avoid sentinel lymph node biopsy (SLNB) , and they should be directly addressed to ALND. In this case, FDG PET can represent an alternative to SLNB.
But current technology available now does not allow FDG-PET/CT to replace SLNB in the staging of the axilla in breast cancer, although this may change in the future with advancing technology. At present FDG-PET/CT may have a role to play in pre-selecting candidates for SLNB or ALND and thus avoid unnecessary surgery and potential morbidity.
Therefore, this study aimed to assess to what extent PET CT can be used in the assessment of negative axillary lymph nodes in breast cancer and determine if pathological variability can affect the result of the PET CT.
This prospective study carried on 50 female patients with locally advanced breast cancer and with negative PET CT scans for active axillary lymph nodes. All studied cases underwent postoperative pathological examination to be compared with preoperative PET CT results.
Summary of our results:
• According to demographic data of the studied cases, the mean age of the patients was 48.6 years with a standard deviation of 10.8 years. Approximately 48% of the cases were postmenopausal, while 52% were premenopausal.
• According to clinical staging, the majority of cases (88%) were classified as stage II, stage I represented only 2% of the cases, while 10% were classified as stage III.
• Lesions were bilateral in 6% of cases while in 94% of the cases were unilateral. Regarding the site of the primary lesion, 44% have lesions located in the upper outer quadrant (UOQ), making it the most common location. Other sites include the lower outer quadrant (LOQ) with 24%, the central region with 12%, the lower inner quadrant (LIQ) with 10%, and the upper inner quadrant (UIQ) with 10%.T1 tumors accounted for 12% of the cases, T2 tumors represented 60%, T3 tumors were 20%, and T4 tumors 8% of the cases.
• The mean size of the primary lesion was 3.7 cm with a standard deviation of 1.2 cm. The mean size of the axillary lymph nodes was 1.6 cm with a standard deviation of 0.3 cm.
• In terms of pathology, 80% of the cases were classified as invasive ductal carcinoma (IDC), while 20% were invasive lobular carcinoma (ILC). Regarding the pathological tumor grade, 14% of cases were classified as grade I (GI), 52% as grade II (GII), and 34% as grade III (GIII). For estrogen receptor (ER) expression, 46% of cases were negative, and 54% were positive. In terms of progesterone receptor (PR) expression, 48% of cases were negative, and 52% were positive. Regarding HER2 neu expression, 74% of cases were negative, while 26% were positive. In terms of molecular subtypes, 18% of cases exhibited HER2 neo-overexpression, 36% were classified as luminal A, 16% as luminal B, and 30% as triple negative.
• Among the studied cases, 84% have negative axillary lymph node status, indicating the absence of cancerous involvement in the axillary lymph nodes. On the other hand, 16% of the cases showed positive cancerous involvement in axillary lymph node histology.
• Logistic regression analysis was conducted for the prediction positive lymph nodes using age, menopause, laterality, size of lesion, size of lymph node and tumor stage. Bilateral lesion, large sized lesions and high tumor T stage (3-4) were associated with positive lymph nodes in univariate analysis. High T stage was associated with risk of positive lymph node in multivariate analysis.