Analysis Of Positive Axillary Lymph Nodes Displayed Negative On ¹⁸F-FDG PET/CT About Breast Carcinoma

Objective:To analyze the influencing factors of positive axillary lymph nodes which are negative on ¹⁸F-FDG PET/CT about early breast carcinoma,according to the patient’s medical history,pathological diagnosis,and the results of ¹⁸F-FDG PET/CT inspection.To improve the accuracy of diagnosis of ¹⁸F-FDG PET/CT inspection about metastatic axillary lymph nodes from breast cancer,and reduce the misdiagnosis rate of ¹⁸F-FDG PET/CT inspection,finally,to help clinical evaluation.Methods:In this study,the early breast cancer female patients were selected,who were treated in the Breast Surgery at the China-Japan Union Hospital of Jilin University from September 2018 to August 2021.In the ¹⁸F-FDG PET/CT negative group,there were 48 cases,whose axillary lymph nodes were diagnosed as malignant by pathology,but they displayed negative on ¹⁸F-FDG PET/CT examination.On the other way,the¹⁸F-FDG PET/CT positive group included 72 patients with early breast cancer who were diagnosed with positive axillary lymph nodes by both pathology and ¹⁸F-FDG PET/CT inspection during the same period of previous group.The clinical data of 120patients were collected,including the patient’s medical history,physical examination,the result of ¹⁸F-FDG PET/CT,and pathological reports.SPSS25.0 software was used for statistical analysis,and Mann-Whitney U test and Chi-Squared test were uesd to analyze the relevant factors,which were about positive axillary lymph nodes of breast cancer being negative on ¹⁸F-FDG PET/CT.Independent influencing factors were determined according to multivariate Logistic regression analysis.It was statistical significance when P<0.05.Results:1.In the ¹⁸F-FDG PET/CT negative group,the age range of patients was between26 and 74 years old,with an average age of 51.77 years old.The weight of patients ranged from 47.00 kg to 85.00 kg,with an average age of 61.06 kg.The women who were premenopausal accounted for 64.58%and postmenopausal group accounted for35.42%.37 patients（77.08%）had fasting blood glucose≤6.1 mmol/L,however,11patients（22.92%）had fasting blood glucose>6.1 mmol/L but≤11.1 mmol/L.In the¹⁸F-FDG PET/CT positive group,the age of patients was from 36 to 78 years old,with the average of 54.43 years old.The weight range of patients was between 45 kg and89 kg,with an average weight of 62.88 kg.Premenopausal cases accounted for33.33%and postmenopausal cases accounted for 66.67%.52 patients（72.22%）had fasting blood glucose≤6.1 mmol/L and 20 patients（27.78%）had fasting blood glucose>6.1 mmol/L but≤11.1 mmol/L.2.The histological grading of I in both groups were 0 cases.There were 43 cases（89.58%）of histological grade II in the ¹⁸F-FDG PET/CT negative group,5 cases（10.42%）of gradeⅢ.Primary tumor diameter ranged from 0.92 to 9.25 cm,with a mean diameter of 2.26 cm.Patients with vascular involvement of the primary tumor accounted for 43.75%and those without vascular involvement accounted for 56.25%.Nerve involvement occurred in 27.08%of patients and no nerve involvement was seen in 72.92%of patients.The diameter of metastatic axillary lymph nodes ranged from 0.50 to 11.00 mm,with an average diameter of 4.40 mm.The number of metastatic axillary lymph nodes,which were detected,ranged from 1 to 15,with the median of 2.In the ¹⁸F-FDG PET/CT positive group,the histological grade II had 45cases（62.50%）and III had 27 cases（37.50%）.The primary foci were 1.06～5.51 cm in diameter,with the mean diameter of 2.39 cm.The patients with vascular involvement in the primary tumor accounted for 66.67%,while without nerve involvement accounted for 33.33%.31.94%of patients were found nerve involvement,whereas68.06%were not found.The diameter of metastatic lymph nodes ranged from 0.30 to55.00 mm,with the mean diameter of 15.59 mm.The number of positive lymph nodes detected in the axilla ranged from 1 to 28,with the median of 3.3.There were 43 cases（89.58%）with positive ER and 5 cases（10.42%）with negative ER in the ¹⁸F-FDG PET/CT negative group.PR was positive in 37 cases（77.08%）and negative in 11 cases（22.92%）.HER-2 was positive in 5 cases（10.42%）and negative in 43 cases（89.58%）.There were 11 cases（22.92%）with low expression of Ki67 and 37 cases（77.08%）with high expression.In ¹⁸F-FDG PET/CT positive group,there were 49 cases（68.06%）with positive ER and 23 cases（31.94%）with negative ER.PR was positive in 41 cases（56.94%）and negative in 31 cases（43.06%）.HER-2 was positive in 22 cases（30.56%）and negative in 50 cases（69.44%）.There were 7 cases（9.72%）with low expression of Ki-67 and 65 cases（90.28%）with high expression.4.The SUVmax _BCof patients in the ¹⁸F-FDG PET/CT negative group ranged from 2.11 to 37.30,with the mean value of 9.45;the MTV_BCranged from 3.04 to159.07,with the mean value of 25.18;the range of TLG_BCwas 5.30 to 193.45,with the mean value of 43.24;the SUVmax _LNof patients ranged from 0.20 to 14.38,with the average of 1.46.In the positive group of ¹⁸F-FDG PET/CT,the SUVmax _BCof patients ranged from 3.18 to 35.48,with the mean value of 11.83;the MTV_BCranged from 3.00 to 92.79,with the mean value of 13.66;the TLG_BCranged from 5.97 to413.40,with the mean value of 39.85;the range of SUVmax _LNwas 1.50 to 50.75,with the average of 9.01.5.The result of univariate analysis showed that menstrual status,primary tumor diameter,histological grade,vascular involvement,ER and PR status,HER-2 status,the index of Ki-67,metastatic axillary lymph nodes’diameter,the quantity of metastatic axillary lymph nodes,SUVmax _BCand SUVmax _LNwere all statistically significant factors that influence the positive axillary lymph nodes present negative on¹⁸F-FDG PET/CT imaging in breast cancer,P<0.05.6.Multivariate Logistic regression analysis showed that menstrual status,primary tumor’s diameter,metastatic axillary lymph nodes’diameter and SUVmax _LNwere independent influencing factors for positive axillary lymph nodes presented negative on ¹⁸F-FDG PET/CT in breast cancer,P<0.05.Conclusions:1.Low histological grade,no vascular involvement,ER positive,PR positive,HER-2 negative,low expression of Ki-67,less axillary lymph node metastasis number,and lower the value of SUVmax _BCare all the influencing factors which caused the positive axillary lymph nodes of breast cancer to be negative on ¹⁸F-FDG PET/CT imaging.2.Premenopausal status,the smaller primary tumor diameter and axillary lymph node metastases diameter,and the lower value of SUVmax _LNare independent influencing factors which caused the positive axillary lymph nodes of breast cancer to be negative on ¹⁸F-FDG PET/CT imaging.3.Age,body mass number,fasting glucose,nerve involvement,MTV_BCand TLG_BCdon’t have an effect on the phenomenon of positive axillary lymph nodes presented negative on ¹⁸F-FDG PET/CT in breast cancer.