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18F-Alfatide II for the evaluation of axillary lymph nodes in breast cancer patients: comparison with 18F-FDG

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

18F-Alfatide II has been translated into clinical use and been proven to have good performance in identifying breast cancer. In this study, we investigated 18F-Alfatide II for evaluation of axillary lymph nodes (ALN) in breast cancer patients and compared the performance with 18F-FDG.

Methods

A total of 44 female patients with clinically suspected breast cancer were enrolled and underwent 18F-Alfatide II and 18F-FDG PET/CT within a week. Tracer uptakes in ALN were evaluated by visual analysis, semi-quantitative analysis with maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and SUVmax ratio of target/non-target (T/NT).

Results

Among 44 patients, 37 patients were pathologically diagnosed with breast cancer with metastatic (17 cases) or non-metastatic (20 cases) ALN. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of visual analysis were 70.6%, 90%, 81.1%, 85.7%, and 78.3% for 18F-Alfatide II, 64.7%, 90%, 78.4%, 84.6%, and 75% for 18F-FDG, respectively. By combining 18F-Alfatide II and 18F-FDG, the sensitivity significantly increased to 82.4%, the specificity was 85%, the accuracy increased to 83.8%, the PPV was 82.4%, and the NPV significantly increased to 85.0%. Three cases of luminal B subtype were false negative for both 18F-Alfatide II and 18F-FDG. The other 2 false negative cases of 18F-Alfatide II were triple-negative subtype and 3 false negative cases of 18F-FDG were luminal B subtype too. The AUCs of three semi-quantitative parameters (SUVmax, SUVmean, T/NT) for 18F-Alfatide II were between 0.8 and 0.9, whereas those for 18F-FDG were more than 0.9. 18F-Alfatide II T/NT had the highest Youden index (76.5%), specificity (100%), accuracy (89.2%), and PPV (100%) among these semi-quantitative parameters. 18F-Alfatide II uptake as well as 18F-FDG uptake in metastatic axillary lymph nodes (MALN) was significantly higher than that in benign axillary lymph nodes (BALN). Both 18F-Alfatide II and 18F-FDG did not show difference in primary tumor uptake irrespective of ALN status.

Conclusion

18F-Alfatide II can be used in breast cancer patients to detect metastatic ALN, however, like 18F-FDG, with high specificity but relatively low sensitivity. The combination of 18F-Alfatide II and 18F-FDG can significantly improve sensitivity and NPV. 18F-Alfatide II T/NT may serve as the most important semi-quantitative parameter to evaluate ALN.

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Funding

This work was supported by the National Key Basic Research Program of China (973 program, 2014CB744504), the National Natural Science Foundation of China (81971675), the Natural Science Foundation of Jiangsu Province (BK20160610), Jiangsu Province Social Development Program (BE2017772), Jiangsu Planned Projects for Postdoctoral Research Funds (1601090C), and the National University of Singapore Start-up Fund (R-180-000-017-133, R-180-000-017-733, R-180-000-017-731).

Author information

Author notes

  1. Jiang Wu and Jihong Tian contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Jinling Hospital, Medical School, Nanjing University, Nanjing, China

    Jiang Wu, Hengshan Ji, Jingjing Sun, Xingang Wang, Chuanjin Sun & Hong Zhu

  2. Department of Radiotherapy, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Jihong Tian

  3. Department of Cardiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China

    Yiyan Zhang

  4. Jiangsu Xinrui Pharmaceutical Co., Ltd., Nantong, China

    Li Wang

  5. Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials, Jiangsu National Synergetic Innovation Centre for Advanced Materials, Nanjing University of Posts & Telecommunications, Nanjing, China

    Zhaogang Teng

  6. Department of Medical Imaging, Jinling Hospital, Medical School, Nanjing University, Nanjing, China

    Guangming Lu

  7. Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Lower Kent Ridge Rd, Singapore, Singapore

    Xiaoyuan Chen

  8. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Lower Kent Ridge Rd, Singapore, Singapore

    Xiaoyuan Chen

  9. Department of Chemical and Biomolecular Engineering, National University of Singapore, Lower Kent Ridge Rd, Singapore, Singapore

    Xiaoyuan Chen

  10. Department of Biomedical Engineering, National University of Singapore, Lower Kent Ridge Rd, Singapore, Singapore

    Xiaoyuan Chen

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  1. Jiang Wu
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Corresponding authors

Correspondence to Zhaogang Teng, Guangming Lu, Hong Zhu or Xiaoyuan Chen.

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Wu, J., Tian, J., Zhang, Y. et al. 18F-Alfatide II for the evaluation of axillary lymph nodes in breast cancer patients: comparison with 18F-FDG. Eur J Nucl Med Mol Imaging 49, 2869–2876 (2022). https://doi.org/10.1007/s00259-021-05333-z

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