Download Axillary Lymph Node Involvement with FDG PET/CT In Patients With

Axillary Lymph Node Involvement with FDG PET/CT In
Patients With Lung Cancer
Poster No.:
P-0031
Congress:
ESTI 2014
Type:
Scientific Poster
Authors:
C. Goktan, O. K. Celik, F. Aras, P. Celik; Manisa/TR
Keywords:
Metastases, Cancer, Diagnostic procedure, Biopsy, Ultrasound,
PET-CT, CT, Thorax, Oncology, Lymph nodes
DOI:
10.1594/esti2014/P-0031
Any information contained in this pdf file is automatically generated from digital material
submitted to EPOS by third parties in the form of scientific presentations. References
to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in
any way constitute or imply ECR's endorsement, sponsorship or recommendation of the
third party, information, product or service. ECR is not responsible for the content of
these pages and does not make any representations regarding the content or accuracy
of material in this file.
As per copyright regulations, any unauthorised use of the material or parts thereof as
well as commercial reproduction or multiple distribution by any traditional or electronically
based reproduction/publication method ist strictly prohibited.
You agree to defend, indemnify, and hold ECR harmless from and against any and all
claims, damages, costs, and expenses, including attorneys' fees, arising from or related
to your use of these pages.
Please note: Links to movies, ppt slideshows and any other multimedia files are not
available in the pdf version of presentations.
www.myESR.org
Page 1 of 6
Purpose
Involvement of the axilla in patients with lung cancer is rare. The aim of this study is to
discuss the possible ways of axillary lymph node involvement (ALNI) and to emphasize
its prognostic value.
Materials and Methods
We retrospectively evaluated 546 patients with lung cancer who underwent FDG PET/
CT (Philips Medical Systems), between January 2012 and December 2013 to assess the
incidence of ALNI. The 6 patients with ALNI were re-evaluted in detail with their diagnostic
CT's, axillary USG and clinicopathological findings. Five of 6 patients were stage IV
due to systemic disease independent of the ALNI. In these five patients, ALNI was
considered as positive according to the FDG PET/CT findings, ultrasonography, clinical
and radiological findings. One patient with isolated ALNI (no cervical or supraclaviculary
involvement) underwent to FNAB and pathology revealed malignant cytology. This
patient considered as stage IV due to ALNI. When assessing treatment response in the
axillary region, dimentional and metabolic changes observed in PET/CT images were
taking into consideration.
Results
There were 4 patients with squamous cell histopathology and 2 patients with
adenocarcinoma. Five of 6 patients were stage IV due to systemic disease independent
of the ALNI and one patient was stage IV due to isolated ALNI. (figüre-1) ALNI was in
contralateral side in 1 patient (Figüre-2) and ipsilateral side in 5 patients. Primary tumor
localization was upper lobe in 4 patients and hilar in 2 patients. The median tumor length
was 20 mm (range, 13-52 mm). Lymphatic metastasis to mediastinum was evident in all
patients.Three patients with upper lobe tumor had also pleural invasion. Nodal stage was
N2 in 4 patients and N3 in 2 patients. The diameter of the positive axillary lymph nodes
were measured between 7 and 35 mm (median:15 mm). A metabolic regression was
observed in all patients in the chemotherapy response evaluation time using PET/CT.
Images for this section:
Page 2 of 6
Fig. 1: PET - CT showing uptake in the upper lobe lesion (30 x 40 mm in diameter and
SUV max:8,7) along with the mediastinum and axillary lymph nodes (10,7mm x 16.5 mm
in diameter and SUV max: 2.2).
Page 3 of 6
Fig. 2: Whole body PET image showing uptake in the upper lobe tumor (SUV max: 30)
with pleural invasion and left axillary node (26X 35 mm in diameter, SUV max: 24,3).
Page 4 of 6
Conclusions
Axillary lymph nodes does not receive lymphatic drainage from the lung directly. For
this reason metastasis of lung cancer to ALNI is rare. However, Riquet et al. reported
that ALNI were encountered in 9 of 1,486 (0.61%) of postoperative cases with lung
cancer. In this series of lung cancer patients, the prevalence of ALNI from lung cancers
was 0.75% (10 of 1,340 patients). (1) There have been many hypothesis to explain the
unusual pattern of ALNI from lung cancer. Marcantonio and Libshitz(2) believed that lung
cancers involve ipsilateral ALN through either chest wall invasion or retrograde spread
from supraclavicular lymph nodes . Another hypothesis suggesting that ALNI happens
through newly formed lymphatic channels arising in chest wall or a pleural adhesion
has been described. A other pathway of ALNI is involvement of intercostal lymphatics
via the mediastinal lymph nodes.(1,3,4 ) The forth suggested mechanism involves the
systemic vascular route, considering the fact that there are no channels of lymphatic
communication from the lungs to the ALNI.(4)
When evaluating the patients for staging and therapeutic response purposes using PET /
CT exams the patients who have upper lobe tumor, pleural invasion and advanced nodal
stage should be examined more carefully in terms of ALNI. Isolated ALNI involvement is
very rare situation and these patients deserves more attention as treatment options may
be altered due to upstaging. (5)
References
1.Riquet M. Anatomic Basis of Lymphatic Spread From Carcinoma of the Lung to the
Mediastinum: Surgical and Prognosis Implications. Surg Radiol Anat; 1993;15:273-7
2. Marcantonio DR, Libshitz HI. Axillary Lymph Node Metastases of Bronchogenic
Carcinoma. Cancer;1995;76:803-6
3. Satoh H, Ishikawa H, Kagohashi K, Kurishima K, Sekizawa K. Axillary Lymph Node
Metastasis in Lung Cancer. Med Oncol;2009;26:147-50
4. Riquet M, Le Pimpec-Barthes F, Danel C. Axillary Lymph Node Metastases from
Bronchogenic Carcinoma. Ann Thorac Surg;1998;66:920-2
5. Krishnamurthy A, Neelakantan V. Isolated Axillary Lymph Node Metastasis at
Presentation in Bronchogenic Carcinoma. J Cancer Res Ther; 2012;8(1):161-2
Page 5 of 6
Personal Information
Page 6 of 6