DOI: 10.1093/qjmed/hcad069.707 ISSN:

Role of Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) of Main Tumor in Breast Cancer in Prediction of Occult Axillary Lymph Node Metastasis

Amir Tarek Borham Kora, Amal Ibrahim Ahmed Othman, Aya Yassin Ahmed Mohamed
  • General Medicine


In breast cancer, the axillary lymph node (ALN) status has been well established to be a significant prognostic factor and essential for treatment decisions that consider systemic and locoregional approaches. Axillary lymph node dissection (ALND) was performed to examine pathologic information regarding axillary lymph node during breast surgery (e.g. breast conserving surgery or mastectomy), which may cause critical complications such as lymphedema, pain, and movement restriction.

Aim of the Work

To assess the clinical significance of total lesion glycolysis (TLG) and metabolic tumor volume (MTV) of primary breast cancer using 18F-FDG PET/CT. To predict positive axillary lymph node metastasis in clinically negative axillary lymph nodes in breast cancer patients.


Between November 2020 and May 2021, The study was carried out on 40 female breast cancer patients with clinically negative axillary lymph nodes who had undergone surgical resection of the primary breast tumor followed by sentinel lymph node biopsy only or axillary lymph node dissection along with sentinel lymph node biopsy.


We found that, 10 (25.0%) of total 40 patients were proven to have ALN metastasis based on the final pathology. A primary breast tumor with TLG > 6.2 &MTV > 4 was associated with a significantly higher prevalence of ALN metastasis than tumors with TLG ≤ 6.2& MTV ≤ 4.


We suggest that the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary breast tumor were independent predictive factors for ALN metastasis. Since the incidence of pathologic ALN metastasis in breast cancer with cN-ALN is not negligible, volume-based PET/CT parameters of primary breast tumors upon preoperative workup may be potentially helpful to enhance the negative predictive value for occult ALN metastasis and to determine patient selection for surgical procedures.

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