Diagnostic Accuracy of PET Imaging for Lymph Node Detection in Breast cancer patients undergoing Upfront Surgery: A Single-Institution Analysis of Breast Cancer Patients

<ns5:p>Background The role of PET imaging in lymph node staging for breast cancer patients proceeding to upfront surgery remains incompletely characterized. We evaluated the diagnostic accuracy of PET imaging in immediate surgical patients. Methods A retrospective cohort of 70 breast cancer patients undergoing upfront surgery was analyzed. PET imaging findings were compared with histopathological examination (HPE) results. Diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated. Results Among 70 surgical patients (mean age 53.9 ± 11.5 years), 26 (37.14%) had pathologically confirmed lymph node involvement. PET imaging demonstrated sensitivity of 69.23% (95% CI: 48.27-85.67), specificity of 81.82% (95% CI: 67.27-91.60), PPV of 69.23%, and NPV of 81.82%. The test correctly identified 18 of 26 patients with nodal disease while avoiding false positives in 36 of 44 node-negative patients. Positive likelihood ratio was 3.81, and negative likelihood ratio was 0.38. The F1-score was 0.6923, indicating good balance between precision and sensitivity for surgical planning. Conclusions PET imaging demonstrated moderate sensitivity (69.23%) for detecting lymph node involvement in patients undergoing upfront surgery. Its relatively high negative predictive value (81.82%) suggests a potential role in identifying patients at lower risk of nodal disease; however, negative PET findings should be interpreted in conjunction with clinical, radiological, and pathological assessment. PET may contribute to preoperative staging and surgical planning, while positive findings may require confirmatory evaluation when management decisions depend on nodal status.</ns5:p>