The Role of Axillary SUVmax in 18F-FDG PET/CT in Predicting the Number of Axillary Metastases of Breast Cancer.

OBJECTIVE: To investigate the role of positron emission tomography/computed tomography (PET-CT) in determining the maximum number of axillary lymph node metastasis (ALNM) detectable in sentinel lymph node biopsy (SLNB). STUDY DESIGN: Observational study. Place and Duration of the Study: Sivas Cumhuriyet University Faculty of Medicine, Turkiye, from January 2015 to August 2021. METHODOLOGY: A total of 104 breast cancer patients who underwent surgery after a PET-CT scan were examined. A receiver operating characteristic (ROC) analysis was utilised to determine optimal cut-off values for the standardised uptake values of the primary tumour (pSUVmax) and axillary lymph nodes (nSUVmax) in the presence of ALNM and the presence of more than two ALNMs. RESULTS: The presence of more than two ALNMs was associated with pSUVmax, nSUVmax, LVI, and the number of LNs detected on PET-CT. In the ROC analysis, for the ability to predict more than two ALNMs in SLNB/axillary lymph node dissection (ALND), cut-offvalues were calculated as 4.65 for pSUVmax (AUC=0.669, sensitivity=66.7%, specificity=62%, PPV=0.482, NPV=0.800, p=0.006) and 1.75 for nSUVmax (AUC=0.838, sensitivity=81.8%, specificity=88.7%, PPV= 0.676, NPV=0.913, p<0.001). CONCLUSION: Low sensitivity, NPV, and accuracy values that limit the use of PET-CT in preoperative axillary evaluation can be increased by targeting the criterion of more than two ALNMs. Thus, PET-CT can be used more effectively in axilla management. KEY WORDS: Breast cancer, Positron emission tomography, SUVmax values, Axillary lymph node, ACOSOG Z0011.

Metaplastic Breast Cancer.

Metaplastic Breast Cancer (MBC) is a term referring to a heterogeneous group with malignant epithelial and mesenchymal tissue components. MBC is a rare disease, accounting for 0.2% of all breast cancers. Most MBC are triple negative cancers with poor prognosis and an aggressive clinical course. Herein, we aimed to present a 74-year-old patient with metaplastic breast cancer along with clinical, radiologic and pathologic properties.

Gestational Gigantomastia.

Gestational gigantomastia is a rare condition characterized by fast, disproportionate and excessive breast growth, decreased quality of life in pregnancy, and presence of psychologic as well as physical complications. The etiology is not fully understood, although hormonal changes in pregnancy are considered responsible. Prolactin is the most important hormone. To date, 125 cases of gigantomastia have been reported in the literature. In this case presentation, we report a pregnant woman aged 26 years with a 22-week gestational age with gestational gigantomastia and review the diagnosis and treatment of this rare disease in relation with the literature.