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Dey P, Kc M, Proussaloglou EM, Khubchandani JA, Kim L, Zanieski G, Park T, Lynch M, Gillego A, Valero M, Schneider E, Golshan M, Greenup RA, Berger ER. Incidence of Pathologic Nodal Disease in Clinically Node-Negative, Microinvasive or T1a Breast Cancers. Ann Surg Oncol 2024:10.1245/s10434-024-16124-9. [PMID: 39240394 DOI: 10.1245/s10434-024-16124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/19/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Axillary staging in early-stage breast cancer can impact adjuvant treatment options but also has associated morbidity. The incidence of pathologic nodal positivity (pN+) in patients with microinvasive or T1a disease is poorly characterized and the value of sentinel node biopsy remains controversial. METHODS Women with cN0 and pathologic microinvasive or T1a cancer who underwent upfront surgery were identified from the National Cancer Database. Pathologic nodal stage at the time of surgery was the primary outcome. Multivariable logistic modeling was used to assess predictors of pN+. RESULTS Overall, 141,840 women were included; 139,206 had pathologic node-negative (pN0) disease and 2634 had pN+ disease. Rates of pN+ disease differed by receptor status, with the highest rates in hormone receptor-negative/human epidermal growth factor receptor 2-positive (HR-/HER2+) disease compared with triple-negative breast cancer (TNBC), HR-positive/HER2-negative (HR+/HER2-), and triple positive breast cancer. Rates of pN+ were also higher with lobular histology compared with ductal histology. Multivariable analysis demonstrated that compared with White women, Black women had higher odds of pN+ disease, and compared with women <50 years of age, women >70 years of age had higher odds of pN+ disease. Compared with women with HR+/HER2- disease, women with TNBC, triple-positive breast cancer, and HR-/HER2+ all had lower odds, and women with invasive lobular disease had higher odds compared with women with invasive ductal disease. Women with significant comorbidities also had higher odds of node positivity. CONCLUSION Over 90% of patients with clinically node-negative, microinvasive and T1a breast cancer remain pathologically node-negative following axillary staging. However, higher rates of nodal disease were found among Black patients, older patients, and patients with lobular cancer and significant comorbidities.
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Affiliation(s)
- Pranam Dey
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Madhav Kc
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Jasmine A Khubchandani
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leah Kim
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Gregory Zanieski
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Tristen Park
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Melanie Lynch
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Alyssa Gillego
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Monica Valero
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Eric Schneider
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Mehra Golshan
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Rachel A Greenup
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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Rezkallah EMN, Elsaify A, Tin SMM, Elsaify W. Diagnostic Accuracy of Ultrasonography in Axillary Staging in Breast Cancer Patients. J Med Ultrasound 2023; 31:293-297. [PMID: 38264585 PMCID: PMC10802873 DOI: 10.4103/jmu.jmu_99_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/25/2022] [Accepted: 11/30/2022] [Indexed: 01/25/2024] Open
Abstract
Background Breast cancer is the most common malignancy affecting women all over the world and represents 7% of all cancer-related deaths in the UK. One of the most crucial elements in assessing a patient's prognosis and chance of survival with breast cancer is the condition of their axillary lymph nodes. Ultrasonography (US) is now used as a routine preoperative diagnostic tool for pretherapeutic axillary evaluation. The aim of the current study is to investigate the diagnostic accuracy of US in axillary staging in breast cancer patients. Methods We carried out this retrospective study for all invasive breast cancer patients who had surgery in addition to preoperative axillary staging using US during the period from January 2020 to February 2021. The final histology results were compared with the preoperative US findings to ascertain the sensitivity, specificity, positive predictive value, and negative predictive value of AUS in axillary staging. Results One hundred and twenty-eight patients were included in our study. The average age of diagnosis was 63.9 ± 12.3 years of age. We calculated sensitivity rate of 59.6%, specificity rate of 95.1%, positive predictive value of 87.5%, and negative predictive value of 80.2% with overall diagnostic accuracy of 82.2%. Conclusion Despite the important role of preoperative US in axillary staging in breast cancer patients; it failed to detect metastatic diseases in 14.8% of our patients. These findings necessitate the routine histological evaluation of the axilla for more accurate staging of the disease.
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Affiliation(s)
| | - Andrew Elsaify
- Foundation Doctor, Misr University for Science and Technology, Giza, Egypt
| | - Su Min Min Tin
- Department of General Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Wael Elsaify
- Department of General Surgery, James Cook University Hospital, Middlesbrough, UK
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Pesapane F, Mariano L, Magnoni F, Rotili A, Pupo D, Nicosia L, Bozzini AC, Penco S, Latronico A, Pizzamiglio M, Corso G, Cassano E. Future Directions in the Assessment of Axillary Lymph Nodes in Patients with Breast Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1544. [PMID: 37763661 PMCID: PMC10534800 DOI: 10.3390/medicina59091544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Breast cancer (BC) is a leading cause of morbidity and mortality worldwide, and accurate assessment of axillary lymph nodes (ALNs) is crucial for patient management and outcomes. We aim to summarize the current state of ALN assessment techniques in BC and provide insights into future directions. Materials and Methods: This review discusses various imaging techniques used for ALN evaluation, including ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography. It highlights advancements in these techniques and their potential to improve diagnostic accuracy. The review also examines landmark clinical trials that have influenced axillary management, such as the Z0011 trial and the IBCSG 23-01 trial. The role of artificial intelligence (AI), specifically deep learning algorithms, in improving ALN assessment is examined. Results: The review outlines the key findings of these trials, which demonstrated the feasibility of avoiding axillary lymph node dissection (ALND) in certain patient populations with low sentinel lymph node (SLN) burden. It also discusses ongoing trials, including the SOUND trial, which investigates the use of axillary ultrasound to identify patients who can safely avoid sentinel lymph node biopsy (SLNB). Furthermore, the potential of emerging techniques and the integration of AI in enhancing ALN assessment accuracy are presented. Conclusions: The review concludes that advancements in ALN assessment techniques have the potential to improve patient outcomes by reducing surgical complications while maintaining accurate disease staging. However, challenges such as standardization of imaging protocols and interpretation criteria need to be addressed. Future research should focus on large-scale clinical trials to validate emerging techniques and establish their efficacy and cost-effectiveness. Over-all, this review provides valuable insights into the current status and future directions of ALN assessment in BC, highlighting opportunities for improving patient care.
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Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (A.C.B.); (S.P.); (A.L.); (M.P.); (E.C.)
| | - Luciano Mariano
- Breast Imaging Division, AOU Città della Scienza e della Salute di Torino, 10126 Turin, Italy;
| | - Francesca Magnoni
- Division of Breast Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.M.); (G.C.)
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
| | - Anna Rotili
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (A.C.B.); (S.P.); (A.L.); (M.P.); (E.C.)
| | - Davide Pupo
- Radiology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Luca Nicosia
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (A.C.B.); (S.P.); (A.L.); (M.P.); (E.C.)
| | - Anna Carla Bozzini
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (A.C.B.); (S.P.); (A.L.); (M.P.); (E.C.)
| | - Silvia Penco
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (A.C.B.); (S.P.); (A.L.); (M.P.); (E.C.)
| | - Antuono Latronico
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (A.C.B.); (S.P.); (A.L.); (M.P.); (E.C.)
| | - Maria Pizzamiglio
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (A.C.B.); (S.P.); (A.L.); (M.P.); (E.C.)
| | - Giovanni Corso
- Division of Breast Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.M.); (G.C.)
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (L.N.); (A.C.B.); (S.P.); (A.L.); (M.P.); (E.C.)
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Xu Q, Wang J, Wang J, Guo R, Qian Y, Liu F. The effectiveness of ultrasound-guided core needle biopsy in detecting lymph node metastases in the axilla in patients with breast cancer: systematic review and meta-analysis. Clinics (Sao Paulo) 2023; 78:100207. [PMID: 37141768 PMCID: PMC10176171 DOI: 10.1016/j.clinsp.2023.100207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE This study aimed to perform a meta-analysis to investigate the diagnostic safety and accuracy of Ultrasound-Guided Core Needle Biopsy (US-CNB) Axillary Lymph Nodes (ALNs) region in patients with Breast Cancer (BC). METHODS The authors searched the electronic databases PubMed, Scopus, Embase, and Web of Science for clinical trials about US-CNB for the detection of ALNs in breast cancer patients. The authors extracted and pooled raw data from the included studies and performed statistical analyses using Meta-DiSc 1.4 and Review Manager 5.3 software. A random effects model was used to calculate the data. At the same time, data from the Ultrasound-guided Fine-Needle Aspiration (US-FNA) were introduced for comparison with the US-CNB. In addition, the subgroup was performed to explore the causes of heterogeneity. (PROSPERO ID: CRD42022369491). RESULTS In total, 18 articles with 2521 patients were assessed as meeting the study criteria. The overall sensitivity was 0.90 (95% CI [Confidence Interval], 0.87‒0.91; p = 0.00), the overall specificity was 0.99 (95% CI 0.98‒1.00; p = 0.62), the overall area under the curve (AUC) was 0.98. Next, in the comparison of US-CNB and US-FNA, US-CNB is better than US-FNA in the diagnosis of ALNs metastases. The sensitivity was 0.88 (95% CI 0.84‒0.91; p = 0.12) vs. 0.73 (95% CI 0.69‒0.76; p = 0.91), the specificity was 1.00 (95% CI 0.99‒1.00; p = 1.00) vs. 0.99 (95% CI 0.67‒0.74; p = 0.92), and the AUC was 0.99 vs. 0.98. Subgroup analysis showed that heterogeneity may be related to preoperative Neoadjuvant Chemotherapy (NAC) treatment, region, size of tumor diameter, and the number of punctures. CONCLUSION US-CNB has a satisfactory diagnostic performance with good specificity and sensitivity in the preoperative diagnosis of ALNs in BC patients.
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Affiliation(s)
- Qi Xu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jiale Wang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jing Wang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Runzhao Guo
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yao Qian
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Feng Liu
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China.
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Guo Q, Dong Z, Jiang L, Zhang L, Li Z, Wang D. Assessing Whether Morphological Changes in Axillary Lymph Node Have Already Occurred Prior to Metastasis in Breast Cancer Patients by Ultrasound. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111674. [PMID: 36422213 PMCID: PMC9695007 DOI: 10.3390/medicina58111674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022]
Abstract
Background and Objectives: Whether the morphological changes in axillary lymph node (ALN) have occurred prior to metastasis remains unclear in breast cancer (BC) patients. The aim of this study is to investigate the influence of BC for the morphology of non-metastasis ALN (N−) and, further, to improve the performance of ultrasound (US) examination for metastasis ALN (N+). Materials and Methods: In this retrospective study, 653 patients with breast mass were enrolled and divided into normal group of 202 patients with benign breast tumor, N− group of 233 BC patients with negative ALN and N+ group of 218 BC patients with positive ALN. US features of ALN were evaluated and analyzed according to long (L) and short (S) diameter, the (L/S) axis ratio, cortical thickness, lymph node edge, replaced hilum and color Doppler flow imaging (CDFI). Results: ALN US features of short diameter, replaced hilum, cortical thickness and CDFI have significant statistical differences in N− group comparing with normal group and N+ group, respectively (p < 0.05). Conclusions: Therefore, BC can affect ALN and lead to US morphological changes whether lymph node metastasis is present, which reduces the sensitivity of axillary US. The combination of US and other examination methods should be applied to improve the diagnostic performance of N+.
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Affiliation(s)
- Qiang Guo
- Department of Ultrasound Medicine, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai 201700, China
- Correspondence: ; Tel.: +86-(189)-3081-7376
| | - Zhiwu Dong
- Department of Laboratory Medicine, Jinshan Branch of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 201599, China
| | - Lixin Jiang
- Department of Ultrasound in Medicine, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai 201599, China
| | - Lei Zhang
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Ziyao Li
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Dongmo Wang
- Department of Ultrasound Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
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A nomogram for predicting three or more axillary lymph node involvement before breast cancer surgery. Sci Rep 2022; 12:12141. [PMID: 35840785 PMCID: PMC9287421 DOI: 10.1038/s41598-022-16538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/18/2022] [Indexed: 11/08/2022] Open
Abstract
Based on the American College of Surgeons Oncology Group (ACOSOG)-Z0011, a useful nomogram has been constructed to identify patients who do not require intraoperative frozen sections to evaluate sentinel lymph nodes in the previous study. This study investigated the developed nomogram by ultrasonography (US) and positron emission tomography (PET)/computed tomography (CT) as a modality. In the training set, 89/1030 (8.6%) patients had three or more positive nodes. Larger tumor size, higher grade ultrasonographic ALN classification, and findings suspicious of positive ALN on PET/CT were associated in multivariate analysis. The areas under the receiver operating characteristic curve (AUC) of the nomogram were 0.856 [95% CI 0.815-0.897] in the training set. The AUC in the validation set was 0.866 [95% CI 0.799-0.934]. Application of the nomogram to 1067 patients who met the inclusion criteria of ACOSOG-Z0011 showed that 90 (8.4%) patients had scores above the cut-off and a false-negative result was 37 (3.8%) patients. And the specificity was 93.8%, and the negative predictive value was 96.4%. The upgraded nomogram improved the predictive accuracy, using only US and PET/CT. This nomogram is useful for identifying patients who do not require intraoperative analysis of sentinel lymph nodes and considering candidates for identifying neoadjuvant chemotherapy. The patients consisted of clinical T1-2 and node-negative invasive breast cancer. The training and validation set consisted of 1030 and 781 patients, respectively. A nomogram was constructed by analyzing factors related to three or more axillary lymph node metastases. The patients who matched the ACOSOG-Z0011 criteria were selected and applied to the new nomogram.
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Gao LY, Ran HT, Deng YB, Luo BM, Zhou P, Chen W, Zhang YH, Li JC, Wang HY, Jiang YX. Gail model and fifth edition of ultrasound BI-RADS help predict axillary lymph node metastasis in breast cancer-A multicenter prospective study. Asia Pac J Clin Oncol 2022; 19:e71-e79. [PMID: 35593663 DOI: 10.1111/ajco.13781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/22/2021] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES We aim to assess the performance of the Gail model and the fifth edition of ultrasound BI-RADS (Breast Imaging Reporting and Data System) in breast cancer for predicting axillary lymph node metastasis (ALNM). MATERIALS AND METHODS We prospectively studied 958 female patients with breast cancer between 2018 and 2019 from 35 hospitals in China. Based on B-mode, color Doppler, and elastography, radiologists classified the degree of suspicion based on the fifth edition of BI-RADS. Individual breast cancer risk was assessed with the Gail model. The association between the US BI-RADS category and the Gail model in terms of ALNM was analyzed. RESULTS We found that US BI-RADS category was significantly and independently associated with ALNM (P < 0.001). The sensitivity, specificity, and accuracy of BI-RADS category 5 for predicting ALNM were 63.6%, 71.6%, and 68.6%, respectively. Combining the Gail model with the BI-RADS category showed a significantly higher sensitivity than using the BI-RADS category alone (67.8% vs. 63.6%, P < 0.001). The diagnostic accuracy of the BI-RADS category combined with the Gail model was better than that of the Gail model alone (area under the curve: 0.71 vs. 0.50, P < 0.001). CONCLUSION Based on the conventional ultrasound and elastography, the fifth edition of ultrasound BI-RADS category could be used to predict the ALNM of breast cancer. ALNM was likely to occur in patients with BI-RADS category 5. The Gail model could improve the diagnostic sensitivity of the US BI-RADS category for predicting ALNM in breast cancer.
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Affiliation(s)
- Lu-Ying Gao
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Tao Ran
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - You-Bin Deng
- Department of Ultrasound, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Bao-Ming Luo
- Department of Ultrasound, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Wu Chen
- Department of Ultrasound, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yu-Hong Zhang
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jian-Chu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Yan Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Xin Jiang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhang H, Dong Y, Jia X, Zhang J, Li Z, Chuan Z, Xu Y, Hu B, Huang Y, Chang C, Xu J, Dong F, Xia X, Wu C, Hu W, Wu G, Li Q, Chen Q, Deng W, Jiang Q, Mou Y, Yan H, Xu X, Yan H, Zhou P, Shao Y, Cui L, He P, Qian L, Liu J, Shi L, Zhao Y, Xu Y, Song Y, Zhan W, Zhou J. Comprehensive Risk System Based on Shear Wave Elastography and BI-RADS Categories in Assessing Axillary Lymph Node Metastasis of Invasive Breast Cancer—A Multicenter Study. Front Oncol 2022; 12:830910. [PMID: 35359391 PMCID: PMC8960926 DOI: 10.3389/fonc.2022.830910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/14/2022] [Indexed: 12/07/2022] Open
Abstract
Purpose To develop a risk stratification system that can predict axillary lymph node (LN) metastasis in invasive breast cancer based on the combination of shear wave elastography (SWE) and conventional ultrasound. Materials and Methods A total of 619 participants pathologically diagnosed with invasive breast cancer underwent breast ultrasound examinations were recruited from a multicenter of 17 hospitals in China from August 2016 to August 2017. Conventional ultrasound and SWE features were compared between positive and negative LN metastasis groups. The regression equation, the weighting, and the counting methods were used to predict axillary LN metastasis. The sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUC) were calculated. Results A significant difference was found in the Breast Imaging Reporting and Data System (BI-RADS) category, the “stiff rim” sign, minimum elastic modulus of the internal tumor and peritumor region of 3 mm between positive and negative LN groups (p < 0.05 for all). There was no significant difference in the diagnostic performance of the regression equation, the weighting, and the counting methods (p > 0.05 for all). Using the counting method, a 0–4 grade risk stratification system based on the four characteristics was established, which yielded an AUC of 0.656 (95% CI, 0.617–0.693, p < 0.001), a sensitivity of 54.60% (95% CI, 46.9%–62.1%), and a specificity of 68.99% (95% CI, 64.5%–73.3%) in predicting axillary LN metastasis. Conclusion A 0–4 grade risk stratification system was developed based on SWE characteristics and BI-RADS categories, and this system has the potential to predict axillary LN metastases in invasive breast cancer.
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Affiliation(s)
- Huiting Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yijie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaohong Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingwen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhiyao Li
- Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhirui Chuan
- Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanjun Xu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Bin Hu
- Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai, China
| | - Yunxia Huang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, and The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, and The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Xiaona Xia
- Department of Ultrasound Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chengrong Wu
- Department of Ultrasound Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Wenjia Hu
- Department of Ultrasound, People’s Hospital of Henan Province, Zhengzhou, China
| | - Gang Wu
- Department of Ultrasound, People’s Hospital of Henan Province, Zhengzhou, China
| | - Qiaoying Li
- Department of Ultrasound Diseases, Tangdu Hospital, Four Military Medical University, Xi’an, China
| | - Qin Chen
- Department of Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wanyue Deng
- Department of Ultrasound, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiongchao Jiang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yonglin Mou
- Department of Ultrasound, General Hospital of Northern Theater Command, Shenyang, China
| | - Huannan Yan
- Department of Ultrasound, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaojing Xu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongju Yan
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yang Shao
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Ping He
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jinping Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liying Shi
- Department of Ultrasound, Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Yanan Zhao
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yongyuan Xu
- Department of Ultrasound, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yanyan Song
- Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jianqiao Zhou, ; Yanyan Song, ; Weiwei Zhan,
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jianqiao Zhou, ; Yanyan Song, ; Weiwei Zhan,
| | - Jianqiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Jianqiao Zhou, ; Yanyan Song, ; Weiwei Zhan,
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9
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Kim KE, Kim SY, Ko EY. MRI Findings Suggestive of Metastatic Axillary Lymph Nodes in Patients with Invasive Breast Cancer. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:620-631. [PMID: 36238525 PMCID: PMC9514532 DOI: 10.3348/jksr.2021.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 12/02/2022]
Abstract
Purpose This study aimed to investigate the diagnostic performance of features suggestive of nodal metastasis on preoperative MRI in patients with invasive breast cancer. Materials and Methods We retrospectively reviewed the preoperative breast MRI of 192 consecutive patients with surgically proven invasive breast cancer. We analyzed MRI findings of axillary lymph nodes with regard to the size, long/short ratio, cortical thickness, shape and margin of the cortex, loss of hilum, asymmetry, signal intensity (SI) on T2-weighted images (T2WI), degree of enhancement in the early phase, and enhancement kinetics. Receiver operating characteristic (ROC) analysis, chi-square test, t test, and McNemar’s test were used for statistical analysis. Results Increased shorter diameter, uneven cortical shape, increased cortical thickness, loss of hilum, asymmetry, irregular cortical margin, and low SI on T2WI were significantly suggestive of metastasis. ROC analysis revealed the cutoff value for the shorter diameter and cortical thickness as 8.05 mm and 2.75 mm, respectively. Increased cortical thickness (> 2.75 mm) and uneven cortical shape showed significantly higher sensitivity than other findings in McNemar’s test. Irregular cortical margins showed the highest specificity (100%). Conclusion Cortical thickness > 2.75 mm and uneven cortical shape are more sensitive parameters than other findings, and an irregular cortical margin is the most specific parameter for predicting axillary metastasis in patients with invasive breast cancer.
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Affiliation(s)
- Ka Eun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin Young Kim
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Hammond JB, Scott DW, Kosiorek HE, Parnall TH, Gray RJ, Ernst BJ, Northfelt DW, McCullough AE, Ocal IT, Pockaj BA, Cronin PA. Characterizing Occult Nodal Disease Within a Clinically Node-Negative, Neoadjuvant Breast Cancer Population. Clin Breast Cancer 2021; 22:186-190. [PMID: 34462208 DOI: 10.1016/j.clbc.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/21/2021] [Accepted: 07/10/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Neoadjuvant therapy aims to preoperatively downstage breast cancer patients. We evaluated nodal upstaging in clinically node-negative (cN0) patients receiving neoadjuvant chemotherapy (NAC) and neoadjuvant endocrine therapy (NET). METHODS cN0 patients undergoing neoadjuvant therapy from 2009 to 2018 were reviewed. Univariate and multivariate analyses evaluated rates of nodal upstaging. RESULTS A total of 228 cN0 patients with a mean age of 55 years underwent neoadjuvant therapy for Stage I-III invasive carcinoma. Subtypes included ER+/HER2- = 93 (40%), HER2+ = 61 (27%), and triple negative (TNBC) = 74 (33%). Among ER+/HER2- patients, 65 (70%) underwent NET. Overall, 49 patients (21%) were upstaged due to occult nodal disease. Factors associated with higher rates of occult nodal disease included advanced stage on initial presentation (P = .008), larger presenting tumor size (P = .009), low/intermediate tumor grade (P = .025), and ER+/HER2- subtype (P < .001); incidence of occult nodal disease by subtype included: ER+/HER2- = 37%, HER2+ = 15%, TNBC = 8%. Patients experiencing a breast pCR had a significantly lower rate of nodal upstaging compared to those with residual tumor (4% vs. 96%, P < .001). On multivariate analysis, ER+/HER- patients exhibited higher risk of occult nodal disease when compared to patients with HER2+ (odds ratio [OR] = 3.4, 95% CI, 1.2-9.8, P = .003) and TNBC (OR = 5.7, 95% CI, 1.7-19.6, P = .003). Comparing NAC vs. NET in ER+/HER2- patients showed no difference in rates of occult nodal disease (39% vs. 35%, P = .13). CONCLUSIONS ER+/HER2- subtype carries higher risk for occult nodal disease after neoadjuvant therapy; NAC versus NET in these patients does not affect nodal upstaging.
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Affiliation(s)
| | | | | | | | - Richard J Gray
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ
| | - Brenda J Ernst
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | | | - Ann E McCullough
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - Idris Tolgay Ocal
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ
| | - Barbara A Pockaj
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ
| | - Patricia A Cronin
- Division of Surgical Oncology & Endocrine Surgery, Mayo Clinic, Phoenix, AZ.
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11
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Preoperative Axillary Ultrasound Helps in the Identification of a Limited Nodal Burden in Breast Cancer Patients. Ultrasound Q 2021; 36:173-178. [PMID: 32511209 DOI: 10.1097/ruq.0000000000000495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the Z0011 trial, the clinical evaluation of axillary status has been redirected to predicting nodal tumor burden rather than nodal metastases. Our study aimed to evaluate the value of clinicopathological factors and axillary ultrasound (US) for the prediction of a high nodal burden (≥3 metastatic lymph nodes) in breast cancer patients. A total of 532 consecutive patients who underwent preoperative axillary US and subsequent surgery for clinical T1-2 breast cancer with a final pathologic analysis were included. Clinical and pathologic variables were retrospectively evaluated. Univariate and multivariate statistical analyses were performed to identify the variables that were associated with a high nodal burden. Among the 532 patients, 110 (20.7%) had a high axillary nodal burden and 422 (79.3%) had a limited nodal burden. The multivariate analysis showed that suspicious axillary US findings (P < 0.001), clinical T2 stage (P = 0.011), the presence of lymphovascular invasion (P < 0.001), and estrogen receptor positivity (P < 0.001) were significantly associated with a high nodal burden. Patients with negative axillary US findings seldom had a high nodal burden, with a negative predictive value of 93.0% (294/316). Patients with suspicious axillary US findings, clinical T2 stage, lymphovascular invasion, and estrogen receptor positivity are more likely to have a high nodal burden, which may provide additional information for the treatment plan of breast cancer patients. Preoperative axillary US helps identify a limited nodal burden in breast cancer patients and has implications for axillary lymph node dissection and adjuvant treatment.
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12
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Zeng D, Lin HY, Zhang YL, Wu JD, Lin K, Xu Y, Chen CF. A negative binomial regression model for risk estimation of 0-2 axillary lymph node metastases in breast cancer patients. Sci Rep 2020; 10:21856. [PMID: 33318591 PMCID: PMC7736885 DOI: 10.1038/s41598-020-79016-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 12/02/2020] [Indexed: 02/05/2023] Open
Abstract
Extensive clinical trials indicate that patients with negative sentinel lymph node biopsy do not need axillary lymph node dissection (ALND). However, the ACOSOG Z0011 trial indicates that patients with clinically negative axillary lymph nodes (ALNs) and 1-2 positive sentinel lymph nodes having breast conserving surgery with whole breast radiotherapy do not benefit from ALND. The aim of this study is therefore to identify those patients with 0-2 positive nodes who might avoid ALND. A total of 486 patients were eligible for the study with 212 patients in the modeling group and 274 patients in the validation group, respectively. Clinical lymph node status, histologic grade, estrogen receptor status, and human epidermal growth factor receptor 2 status were found to be significantly associated with ALN metastasis. A negative binomial regression (NBR) model was developed to predict the probability of having 0-2 ALN metastases with the area under the curve of 0.881 (95% confidence interval 0.829-0.921, P < 0.001) in the modeling group and 0.758 (95% confidence interval 0.702-0.807, P < 0.001) in the validation group. Decision curve analysis demonstrated that the model was clinically useful. The NBR model demonstrated adequate discriminative ability and clinical utility for predicting 0-2 ALN metastases.
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Affiliation(s)
- De Zeng
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, 515031, China
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and Treatment, Shantou, 515031, China
| | - Hao-Yu Lin
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Yu-Ling Zhang
- Department of Information, Cancer Hospital of Shantou University Medical College, Shantou, 515031, China
| | - Jun-Dong Wu
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and Treatment, Shantou, 515031, China
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou, 515031, China
| | - Kun Lin
- Department of Public Health and Preventive Medicine, Shantou University Medical College, Shantou, 515041, China
| | - Ya Xu
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou, 515031, China
| | - Chun-Fa Chen
- The Breast Center, Cancer Hospital of Shantou University Medical College, Shantou, 515031, China.
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13
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Murata T, Watase C, Shiino S, Jimbo K, Iwamoto E, Yoshida M, Takayama S, Suto A. Development and Validation of a Preoperative Scoring System to Distinguish Between Nonadvanced and Advanced Axillary Lymph Node Metastasis in Patients With Early-stage Breast Cancer. Clin Breast Cancer 2020; 21:e302-e311. [PMID: 33303370 DOI: 10.1016/j.clbc.2020.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND It has been determined that axillary lymph node dissection after the detection of limited axillary lymph node metastasis does not improve the prognosis of patients with breast cancer. Thus, a need exists for less-invasive axillary surgery. However, it remains unclear whether a predictive model based on preoperative data would be sufficient to accurately predict the probability of pN2-N3 (> 3 lymph node metastases). We sought to develop an easy-to-use scoring system to distinguish between pN0-N1 (0-3 lymph node metastases) and pN2-N3 using only preoperative data and validate its predictive performance. PATIENTS AND METHODS We retrospectively identified 2687 patients diagnosed with cT1-3cN0-N1 who had undergone surgery in our hospital from 2013 to 2019. We evaluated the risk factors associated with pN2-N3 by logistic regression analysis and developed a scoring system. Predictive performance was assessed by calculating the receiver operating characteristic area under the curve (AUC) and was validated using K-fold cross-validation. RESULTS We identified 1987 patients with stage pN0, 522 with pN1, and 178 with pN2-N3. Multivariate analysis revealed tumor size, number of suspicious lymph nodes on axillary ultrasound examination, histologic type, histologic grade, and receptor status were significant risk factors for pN2-N3. The AUC value was 0.87, and the mean AUC of the 10-fold cross-validation was 0.88. When the cutoff score was set at 6, the negative predictive value for excluding patients with pN2-N3 was 98.4%. CONCLUSION Our easy-to-use scoring system could be useful to preoperatively identify patients at lower risk of pN2-N3 and avoid unnecessary axillary lymph node dissection.
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Affiliation(s)
- Takeshi Murata
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan.
| | - Chikashi Watase
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Sho Shiino
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kenjiro Jimbo
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Eriko Iwamoto
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shin Takayama
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiko Suto
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
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14
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Han P, Yang H, Liu M, Cheng L, Wang S, Tong F, Liu P, Zhou B, Cao Y, Liu H, Wang C, Peng Y, Shen D, Wang S. Lymph Node Predictive Model with in Vitro Ultrasound Features for Breast Cancer Lymph Node Metastasis. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1395-1402. [PMID: 32146007 DOI: 10.1016/j.ultrasmedbio.2020.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/17/2019] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
Ultrasound diagnosis of axillary lymph nodes has the advantages of ease, convenience and low cost; however, most previous studies evaluated lymph node metastasis of the entire axilla rather than the association between the ultrasound features of a single lymph node and its pathology. This prospective study was performed to explore the ultrasound features of lymph nodes observed in bionic medium in vitro and to develop a lymph node-specific model for prediction of metastasis based on analysis of the association between the ultrasound features and pathology of each lymph node. From November 1, 2017 to December 19, 2017, 373 nodes (54 patients) were enrolled into the modeling group; from December 20, 2017 to January 12, 2018, 139 lymph nodes (22 patients) were enrolled into the validation group. Lymph nodes from sentinel lymph node biopsy or axillary lymph node dissection were enrolled. Individual lymph nodes were placed in bionic medium and observed separately using ultrasound. Traditional ultrasound features of metastatic nodes (long axis, short axis, cortical thickness and hilum loss) were recorded, and the longitudinal-to-transverse axis ratio (L/T) and cortical proportion were calculated. Pathologic results specific to each lymph node were recorded. On the basis of two-level binary logistic regression, independent predictors of lymph node metastasis in the modeling group were lymph node long axis (p = 0.004), short axis (p < 0.001), L/T (p = 0.006), cortical thickness (p = 0.001) and hilum loss (p < 0.001). When analysis was done at the node level, the areas under the curve of the modeling and validation groups were 0.97 and 0.75, respectively. When validation was done at the patient level, the areas under the curve of the modeling and validation groups were 0.96 and 0.93, respectively. The model for prediction of metastasis based on the ultrasound features and pathology of each lymph node is of good predictive value for lymph node metastasis.
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Affiliation(s)
- Pu Han
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Houpu Yang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Miao Liu
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Lin Cheng
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Siyuan Wang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Fuzhong Tong
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Peng Liu
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Bo Zhou
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Yingming Cao
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Hongjun Liu
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Chaobin Wang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Yuan Peng
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Danhua Shen
- Pathology Department, Peking University People's Hospital Beijing, China
| | - Shu Wang
- Breast Center, Peking University People's Hospital, Beijing, China.
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15
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Yang J, Xu L, Liu P, Du Z, Chen J, Liang F, Long Q, Zhang D, Zeng H, Lv Q. Accuracy of Sentinel Lymph Node Biopsy in Breast Cancer: Pitfalls in the Application of Single Tracers. Cancer Manag Res 2020; 12:3045-3051. [PMID: 32431547 PMCID: PMC7200249 DOI: 10.2147/cmar.s244806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/13/2020] [Indexed: 02/05/2023] Open
Abstract
Background Radioisotopes and blue dyes are used as dual tracers in the current gold standard procedure of sentinel lymph node (SLN) biopsy (SLNB) performed for breast cancer. However, the blue dye or the radioisotope as a single tracer is also being applied in some institutes. We aimed to explore the risk factors for the miss-detection of SLNs with the radioisotope and the blue dye and to describe the distribution of SLNs missed by each tracer. Patients and Methods Patients undergoing SLNB with radioisotope and blue dye as dual mapping agents were enrolled between August 2010 and August 2018. Radioactivity count, blue dye staining status, and size and location of each SLN were prospectively documented. Results In total, 2382 SLNs from 1010 patients were included for statistical analyses. The sentinel node identification rate was 100% for dual tracers, 99.4% for radioisotope, and 89.1% for blue dye. SLN identification using the blue dye was more likely to fail in patients undergoing breast-conserving surgery (p < 0.001) and mastectomy with reconstruction (p = 0.005). Furthermore, miss-detection was significantly more frequent in smaller and uninvolved nodes. Among all SLNs, 8.2% were located in level II and one was in level III. Notably, single tracer of blue dye tended to fail in the detection of lymph nodes in higher levels (p < 0.001). Conclusion This study explored the association between features and the incidence of the failure to detect SLNs using radioisotope and blue dye. The locations of the miss-detected SLNs are demonstrated to provide a reference for SLNBs conducted using blue dye or radioisotope as a single tracer.
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Affiliation(s)
- Jiqiao Yang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Xu
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Pengcheng Liu
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhenggui Du
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jie Chen
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Faqing Liang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Quanyi Long
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Di Zhang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Cancer Research Institute, Kanazawa University, Kanazawa, Japan
| | - Helin Zeng
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qing Lv
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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16
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Khan A, Masroor I, Khandwala K, Abbasi SUN, Tariq MU. Utility of Ultrasound and Mammography in Detection of Negative Axillary Nodal Metastasis in Breast Cancer. Cureus 2020; 12:e6691. [PMID: 32104628 PMCID: PMC7026874 DOI: 10.7759/cureus.6691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective The status of axillary lymph nodes is one of the most important prognostic factors in patients with breast cancer. A precise noninvasive evaluation of axillary lymph node status preoperatively, although challenging, is vital for optimization of the treatment plan for patients. The objective of our study was to assess the utility of ultrasound and mammography in detecting the absence of axillary lymph nodal metastasis in patients of breast cancer, taking histopathology as gold standard. Methods A cross-sectional study was conducted in the Department of Radiology, Aga Khan University Hospital, Karachi. All female patients between 20 and 95 years of age with a known diagnosis of breast cancer with mammographic and ultrasound imaging done at our institute were included. Patients with abnormal lymph nodes on mammography or on ultrasound, patients already operated for breast cancer, patients who already underwent axillary lymph node dissection and those whose histopathology reports were not available or who did not undergo surgery were excluded. Results A total of 262 women with breast carcinoma who had both ultrasound and mammography done and also had surgery performed at our institution were included. At final surgical pathology, a total of 45 of the 262 patients (17.2%) with breast carcinoma had one or more positive lymph nodes. Out of the total 262 patients, 217 patients were found to be true negatives as they had absent axillary nodal metastasis on imaging as well as on histopathology. In all, 45 out of 262 patients were found to be false negatives as they had absent axillary nodal metastasis on imaging; however, they were found to be positive for metastasis on histopathology. The negative predictive value was 82.8%. Patient age was considered as a factor that may influence the outcome of results; the patients were stratified into age ranges seven groups with the age range of 10 years, ranging from 26 to 95 years. Chi-square test showed a p-value of 0.148, which showed no significant difference in the effect of age on diagnosing the absence of metastasis by ultrasound and mammography. Conclusion Our study shows that ultrasound and mammography even when used in combination cannot safely exclude axillary metastasis and thus cannot eliminate the need for sentinel node biopsy.
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Affiliation(s)
- Anam Khan
- Radiology, Aga Khan University Hospital, Karachi, PAK
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17
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Lee HS, Kim J, Chung IY, Ko BS, Kim HJ, Lee JW, Son BH, Ahn JH, Jung KH, Kim SB, Lee HJ, Gong GY, Ahn SH, Lee SB. Is asymptomatic surveillance beneficial after standard treatment? A 10-year survival analysis of recurrent BC patients by detection method of recurrence. Breast J 2019; 26:556-559. [PMID: 31531918 DOI: 10.1111/tbj.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Han Shin Lee
- Department of Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jisun Kim
- Department of Surgery, Division of breast surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Il Yong Chung
- Department of Surgery, Division of breast surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Beom Seok Ko
- Department of Surgery, Division of breast surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Hee Jeong Kim
- Department of Surgery, Division of breast surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Division of breast surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Division of breast surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Jin-Hee Ahn
- Department of Oncology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Kyung Hae Jung
- Department of Oncology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Sung-Bae Kim
- Department of Oncology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Hee Jin Lee
- Department of Pathology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Gyung-Yub Gong
- Department of Pathology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Sei Hyun Ahn
- Department of Surgery, Division of breast surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Sae Byul Lee
- Department of Surgery, Division of breast surgery, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
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18
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Almerey T, Villacreses D, Li Z, Patel B, McDonough M, Gibson T, Maimone S, Gray R, McLaughlin SA. Value of Axillary Ultrasound after Negative Axillary MRI for Evaluating Nodal Status in High-Risk Breast Cancer. J Am Coll Surg 2019; 228:792-797. [PMID: 30797947 DOI: 10.1016/j.jamcollsurg.2019.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/31/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is assumed that axillary ultrasound (AxUS) is the best method for axillary nodal evaluation in newly diagnosed breast cancer patients. However, few have evaluated the efficacy of preoperative axillary MRI. We compared the statistical accuracy of AxUS and MRI in detecting nodal metastases among breast cancer patients who were selected for neoadjuvant chemotherapy. STUDY DESIGN We retrospectively analyzed 219 breast cancer patients undergoing neoadjuvant chemotherapy from 2007 to 2015, all of whom had AxUS and breast MRI before chemotherapy. Two breast radiologists, blinded to clinical, pathologic, and AxUS findings, re-reviewed all breast MRIs, specifically focusing on axillary nodal characteristics. We correlated clinico-pathologic characteristics, AxUS, and MRI findings, and quantified predictive values of both imaging modalities. RESULTS Overall, 101 of 219 (47%) patients had T2 tumors. The most common abnormal nodal finding was size >10 mm. Axillary ultrasound and MRI agreed on nodal status in 192 of 219 patients (87.6%). When correlated with pre-chemotherapy needle biopsy in 129 patients, AxUS and axillary MRI performed similarly (sensitivity of 99.1% vs 97.4% and specificity 15.4% vs 15.4%, respectively). Only 4 of 129 (3.1%) patients had a negative MRI and positive AxUS; 3 of 4 of these patients (75%) had a positive biopsy and 2 of 3 had positive lymph nodes on final pathology, therefore suggesting MRI missed clinically significant disease in only 2 of 129 (1.5%) patients. CONCLUSIONS In a high-risk patient population, AxUS and MRI have similar statistical profiles in evaluating axillary nodal status. Routine use of AxUS after a normal axillary MRI is not warranted.
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Affiliation(s)
- Tariq Almerey
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL
| | | | - Zhuo Li
- Department of Health Sciences Research and Biostatistics, Mayo Clinic Florida, Jacksonville, FL
| | - Bhavika Patel
- Department of Diagnostic Radiology, Mayo Clinic Arizona, Phoenix, AZ
| | | | - Tammeza Gibson
- Department of Surgery, Mayo Clinic Florida, Jacksonville, FL
| | - Santo Maimone
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL
| | - Richard Gray
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
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19
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Boudier J, Oldrini G, Barlier C, Lesur A. L’exploration axillaire en pratique quotidienne dans le parcours diagnostique d’un cancer du sein. ONCOLOGIE 2019. [DOI: 10.3166/onco-2019-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lors de la découverte d’un cancer du sein, la qualité du bilan préthérapeutique est essentielle afin d’orienter la décision thérapeutique. L’exploration axillaire est primordiale, car elle évalue l’extension régionale de la maladie, ce qui en fait un des facteurs pronostiques majeurs. Différents examens d’imagerie préopératoires peuvent révéler une atteinte de ces ganglions axillaires. Cependant, l’imagerie de référence reste l’échographie axillaire, qui permet également de guider des prélèvements. Depuis l’étude ACOSOGZ0011, nous sommes face à une désescalade thérapeutique de la chirurgie axillaire. Selon des résultats récents, on constate que la place de l’imagerie axillaire est encore plus importante. Le but de l’échographie est d’éviter un curage en deux temps après un ganglion sentinelle positif lorsque les critères de l’ACOSOG-Z0011 ne sont pas remplis.
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Yoo J, Kim BS, Yoon HJ. Predictive value of primary tumor parameters using 18F-FDG PET/CT for occult lymph node metastasis in breast cancer with clinically negative axillary lymph node. Ann Nucl Med 2018; 32:642-648. [PMID: 30094546 DOI: 10.1007/s12149-018-1288-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/20/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to demonstrate the clinical significance of total lesion glycolysis (TLG) of primary breast cancer using 18F-FDG PET/CT to predict axillary lymph node (ALN) metastasis in invasive ductal breast cancer (IDC) with a clinically negative axillary lymph node (cN-ALN). METHODS 135 patients, newly diagnosed with IDC with CN-ALN between July 2016 and October 2017, were retrospectively enrolled. We estimated primary tumor PET/CT parameters including the maximum standard uptake value (SUVmax), metabolic tumor volume (MTV), and TLG, as well as clinicopathologic findings. All patients received breast surgery followed by pathologic axillary lymph node examination. RESULTS Of the 135 patients, 31 (23.0%) were diagnosed with pathologically proven metastatic ALN. In univariate analysis, SUVmax, MTV, and TLG of the primary breast tumor were correlated with metastatic ALN along with tumor size, lymphovascular invasion, CD34, and D2-40. On multivariate analysis, TLG (> 5.74, p = 0.009) had independent significance for predicting ALN metastasis in IDC with cN-ALN. CONCLUSION We demonstrated that TLG of primary tumors can be useful in predicting pathologic ALN metastasis in IDC patients with cN-ALN.
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Affiliation(s)
- Jang Yoo
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Bom Sahn Kim
- Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea.
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea
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21
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Xu Y, Bai X, Chen Y, Jiang L, Hu B, Hu B, Yu L. Application of Real-time Elastography Ultrasound in the Diagnosis of Axillary Lymph Node Metastasis in Breast Cancer Patients. Sci Rep 2018; 8:10234. [PMID: 29980694 PMCID: PMC6035225 DOI: 10.1038/s41598-018-28474-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/19/2018] [Indexed: 12/15/2022] Open
Abstract
The pathological status of axillary lymph nodes (ALN) plays a critical role in the staging and treatment of patients with breast cancer. Therefore, differential diagnosis of metastatic ALN is highly desirable in the clinic. We used real-time elastography (RTE) and gray-scale ultrasound to generate a new scoring system for determining ALN status and estimate their performance of this system. Ninety-seven ALNs were examined by both gray-scale ultrasound and RTE. The performance of gray-scale ultrasound was evaluated by the sum of scores according to its features. RTE images were determined by a modulated scoring system based on the percentage and distribution of hypoechoic cortex regions in the ALNs. Strain ratio was also calculated. Diagnostic performance was obtained by receiver operating characteristic curve analysis with pathologic findings used as the reference standard. The sensitivity, specificity and accuracy were 92%, 73% and 83%, respectively, for gray-scale ultrasound; 78%, 93%, 86%, respectively, for RTE; 88%, 96% and 92%, respectively, for the combined evaluation (AUC = 0.963), and 87%, 76% and 81%, respectively, for strain ratio. Gray-scale ultrasonography had a better sensitivity than RTE (92% vs 78%, P = 0.039), while the specificity for RTE was superior to that of gray-scale ultrasonography (93% vs 73%, P = 0.012). In conclusion, RTE showed a high specificity for evaluating the ALN status and may improve the diagnostic accuracy when combined with gray-scale ultrasound.
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Affiliation(s)
- Yanjun Xu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, China
| | - Xiaojun Bai
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, China
| | - Yini Chen
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, China
| | - Lixin Jiang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, China
| | - Bin Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, China.
| | - Li Yu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, China.
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Guo Q, Dong Z, Zhang L, Ning C, Li Z, Wang D, Liu C, Zhao M, Tian J. Ultrasound Features of Breast Cancer for Predicting Axillary Lymph Node Metastasis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1354-1353. [PMID: 29119589 DOI: 10.1002/jum.14469] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/19/2017] [Accepted: 08/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the clinical value of ultrasound (US) features of breast lesions for predicting the risk of axillary lymph node metastasis in patients with breast cancer. METHODS In this retrospective study, 425 patients with breast cancer were recruited, and their preoperative US features and postoperative pathologic results were collected. The association of these US features of breast cancer with axillary lymph node metastasis was determined by univariate and multivariate analyses. RESULTS Among the 425 patients, 200 (47.1%) had axillary lymph node metastasis, and 225 (52.9%) did not. The parameters of tumor shape, color Doppler flow imaging grades, histologic grade, and E-cadherin level were significantly and independently associated with axillary lymph node metastasis (P < .05 for all). CONCLUSIONS Axillary lymph node metastasis was prone to happen in patients with US features of an irregular tumor shape and higher color Doppler flow imaging grades. Ultrasound imaging provides a promising tool for predicting axillary lymph node metastasis in patients with breast cancer.
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Affiliation(s)
- Qiang Guo
- Department of Ultrasound Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Departments of Ultrasound Medicine, Jinshan Branch of Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Zhiwu Dong
- Departments of Laboratory Medicine, Jinshan Branch of Shanghai Sixth People's Hospital affiliated with Shanghai Jiaotong University, Shanghai, China
| | - Lei Zhang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunping Ning
- Department of Ultrasound, Affiliated Hospital of Qingdao University, Medical College, Qingdao, China
| | - Ziyao Li
- Department of Ultrasound Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongmo Wang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chong Liu
- Department of Ultrasound Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ming Zhao
- Department of Ultrasound Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiawei Tian
- Department of Ultrasound Medicine, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Yu X, Hao X, Wan J, Wang Y, Yu L, Liu B. Correlation between Ultrasound Appearance of Small Breast Cancer and Axillary Lymph Node Metastasis. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:342-349. [PMID: 29150365 DOI: 10.1016/j.ultrasmedbio.2017.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/24/2017] [Accepted: 09/26/2017] [Indexed: 06/07/2023]
Abstract
To study the correlation of ultrasonographic signs of small breast cancer (maximum diameter ≤2.0 cm) with axillary lymph node metastasis, pre-operative ultrasonographic images of 153 small breast malignant neoplasms in 143 breast cancer patients were analyzed according to their pathologic features. Of the small breast tumors included, 47 showed axillary lymph node metastasis. Diagnosis of all patients was obtained with radical axillary surgery or a sentinel lymph node biopsy procedure. Ultrasonographic signs included irregular shape, microlobulated contour, spiculation, microcalcification, posterior echo attenuation, blood-flow grade, perforating vessels, changes in fascia or cooper's ligament and maximum cortical thickness of lymph nodes. The relationship between ultrasonographic features and axillary lymph node metastasis was analyzed using a chi-square test for univariate distributions and logistic regression for multivariate analysis. A logistic regression model was established by taking the pathologic diagnosis of lymph node metastasis as the dependent variable and the ultrasonographic signs of each small breast cancer as independent variables. In small breast cancer, characteristics such as perforating vessels and maximum cortical thickness of lymph nodes >3.0 mm correlated well with axillary lymph node metastasis as determined by univariate analysis (χ2 = 13.945, 51.276, respectively, p <0.05) and multivariate analysis (OR = 48.783, 46.754, respectively, p <0.05).
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Affiliation(s)
- Xiaoqin Yu
- Department of Ultrasound, Longgang District Central Hospital of Shenzhen, Shenzhen, China.
| | - Xiaoyan Hao
- Department of Thyroid, Breast and Vascular Surgery, Longgang District Central Hospital of Shenzhen, Shenzhen, China
| | - Jing Wan
- Department of Ultrasound, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yingying Wang
- Department of Ultrasound, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Lan Yu
- Department of Ultrasound, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Binyue Liu
- Department of Ultrasound, Longgang District Central Hospital of Shenzhen, Shenzhen, China
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Biganzoli L, Marotti L, Hart CD, Cataliotti L, Cutuli B, Kühn T, Mansel RE, Ponti A, Poortmans P, Regitnig P, van der Hage JA, Wengström Y, Rosselli Del Turco M. Quality indicators in breast cancer care: An update from the EUSOMA working group. Eur J Cancer 2017; 86:59-81. [DOI: 10.1016/j.ejca.2017.08.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/07/2017] [Accepted: 08/11/2017] [Indexed: 02/07/2023]
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Elastosonography and two-dimensional ultrasonography in diagnosis of axillary lymph node metastasis in breast cancer. Clin Radiol 2017; 73:312-318. [PMID: 29111238 DOI: 10.1016/j.crad.2017.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/19/2017] [Accepted: 09/26/2017] [Indexed: 01/12/2023]
Abstract
AIM To compare diagnostic value of two-dimensional (2D) ultrasonography and elastosonography for suspected axillary lymph node metastasis of breast cancer. MATERIALS AND METHODS Elastosonography and 2D ultrasonography were performed on 78 axillary lymph nodes of 78 patients with suspected breast cancer. Scores of shape, long- to short-axis ratio, cortical thickness, and lymph node hilum were summed as the score of each lymph node at 2D ultrasonography, while a four-point scale was adopted for elasticity scoring. The combined score of each lymph node was obtained by summing the score at 2D ultrasonography and that at elasticity scoring. The strain ratio was calculated by comparison of the average strain of the lymph node with that of the subcutaneous tissue. Diagnostic efficacies of 2D ultrasonography, elasticity scoring, and the combined method were compared. RESULTS There were 78 axillary lymph nodes, including 34 non-metastatic and 44 metastatic nodes. The elasticity scores of non-metastatic and metastatic axillary lymph nodes were 1.44±0.82 and 3.11±0.75, respectively (p<0.05). The difference in area under the operating characteristic curve (AUC) was statistically significant between 2D ultrasonography and the combined method (p<0.05). The sensitivity, specificity, and accuracy of 2D ultrasonography and elasticity scoring were 77.3% versus 86.4%, 76.5% versus 85.3%, and 76.9% versus 85.9%, respectively (all p>0.05), and those of the combined method were 93.2%, 73.5%, and 84.6%, respectively. There was a significant difference in sensitivity between 2D ultrasonography and the combined method (p<0.05). CONCLUSIONS Combined application of 2D ultrasonography with elastosonography can improve the diagnostic capability for metastatic axillary lymph node characterisation in breast cancer.
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van Roozendaal LM, Vane MLG, van Dalen T, van der Hage JA, Strobbe LJA, Boersma LJ, Linn SC, Lobbes MBI, Poortmans PMP, Tjan-Heijnen VCG, Van de Vijver KKBT, de Vries J, Westenberg AH, Kessels AGH, de Wilt JHW, Smidt ML. Clinically node negative breast cancer patients undergoing breast conserving therapy, sentinel lymph node procedure versus follow-up: a Dutch randomized controlled multicentre trial (BOOG 2013-08). BMC Cancer 2017; 17:459. [PMID: 28668073 PMCID: PMC5494134 DOI: 10.1186/s12885-017-3443-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/22/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies showed that axillary lymph node dissection can be safely omitted in presence of positive sentinel lymph node(s) in breast cancer patients treated with breast conserving therapy. Since the outcome of the sentinel lymph node biopsy has no clinical consequence, the value of the procedure itself is being questioned. The aim of the BOOG 2013-08 trial is to investigate whether the sentinel lymph node biopsy can be safely omitted in clinically node negative breast cancer patients treated with breast conserving therapy. METHODS The BOOG 2013-08 is a Dutch prospective non-inferiority randomized multicentre trial. Women with pathologically confirmed clinically node negative T1-2 invasive breast cancer undergoing breast conserving therapy will be randomized for sentinel lymph node biopsy versus no sentinel lymph node biopsy. Endpoints include regional recurrence after 5 (primary endpoint) and 10 years of follow-up, distant-disease free and overall survival, quality of life, morbidity and cost-effectiveness. Previous data indicate a 5-year regional recurrence free survival rate of 99% for the control arm and 96% for the study arm. In combination with a non-inferiority limit of 5% and probability of 0.8, this result in a sample size of 1.644 patients including a lost to follow-up rate of 10%. Primary and secondary endpoints will be reported after 5 and 10 years of follow-up. DISCUSSION If the sentinel lymph node biopsy can be safely omitted in clinically node negative breast cancer patients undergoing breast conserving therapy, this study will cost-effectively lead to a decreased axillary morbidity rate and thereby improved quality of life with non-inferior regional control, distant-disease free survival and overall survival. TRIAL REGISTRATION The BOOG 2013-08 study is registered in ClinicalTrials.gov since October 20, 2014, Identifier: NCT02271828. https://clinicaltrials.gov/ct2/show/NCT02271828.
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Affiliation(s)
- L M van Roozendaal
- Division of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M L G Vane
- Division of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. .,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - T van Dalen
- Division of Surgical Oncology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - J A van der Hage
- Division of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - L J A Strobbe
- Division of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - L J Boersma
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Radiation Oncology, Maastricht University Medical Centre (MAASTRO clinic), Maastricht, the Netherlands
| | - S C Linn
- Division of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - M B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - P M P Poortmans
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - V C G Tjan-Heijnen
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Division of Medical Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - K K B T Van de Vijver
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - J de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - A H Westenberg
- Radiation Oncology, Radiotherapy group, Arnhem, the Netherlands
| | - A G H Kessels
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J H W de Wilt
- Division of Surgical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M L Smidt
- Division of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Zhang J, Li X, Huang R, Feng WL, Kong YN, Xu F, Zhao L, Song QK, Li J, Zhang BN, Fan JH, Qiao YL, Xie XM, Zheng S, He JJ, Wang K. A nomogram to predict the probability of axillary lymph node metastasis in female patients with breast cancer in China: A nationwide, multicenter, 10-year epidemiological study. Oncotarget 2017; 8:35311-35325. [PMID: 27852049 PMCID: PMC5471057 DOI: 10.18632/oncotarget.13330] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/26/2016] [Indexed: 01/17/2023] Open
Abstract
Axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) alone may lead to postoperative complications. Among patients with positive ALN in the preoperative examination, approximately 40% patients do not have SLN metastasis. Herein, we aimed to develop a model to predict the probability of ALN metastasis as a preoperative tool to support clinical decision-making. We retrospectively analyzed the clinicopathological features of 4211 female patients with breast cancer who were diagnosed in seven breast cancer centers representing entire China, over 10 years (1999-2008). The patients were randomly categorized into a training cohort or validation cohort (3:1 ratio). Multivariate logistic regression analysis was performed for 1869 patients with complete information on the study variables. Age at diagnosis, tumor size, tumor quadrant, clinical nodal status, local invasion status, pathological type, and molecular subtypes were the independent predictors of ALN metastasis. The nomogram was then developed using the seven variables. Further, it was subsequently validated in 642 patients with complete data on variables in the validation cohort. Coefficient of determination (R²) and the area under the receiver-operating characteristic (ROC) curve (AUC) were calculated to be 0.979 and 0.7007, showing good calibration and discrimination of the model, respectively. The false-negative rates of the nomogram were 0 and 6.9% for the predicted risk cut-off values of 14.03% and 20%, respectively. Therefore, when the predicted risk is less than 20%, SLNB may be avoided. After further validation in various patient populations, this model may support increasingly limited axillary surgery in breast cancer.
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Affiliation(s)
- Jian Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Xiao Li
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Rong Huang
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Wei-Liang Feng
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, P.R. China
| | - Ya-Nan Kong
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - Feng Xu
- Department of Breast-thyroid Surgery, Xiangya Second Hospital, Central South University, Changsha, P.R. China
| | - Lin Zhao
- Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, P.R. China
| | - Qing-Kun Song
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Jing Li
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Bao-Ning Zhang
- Center of Breast Disease, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Jin-Hu Fan
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Xiao-Ming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - Shan Zheng
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Jian-Jun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
| | - Ke Wang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
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Ahn SK, Kim MK, Kim J, Lee E, Yoo TK, Lee HB, Kang YJ, Kim J, Moon HG, Chang JM, Cho N, Moon WK, Park IA, Noh DY, Han W. Can We Skip Intraoperative Evaluation of Sentinel Lymph Nodes? Nomogram Predicting Involvement of Three or More Axillary Lymph Nodes before Breast Cancer Surgery. Cancer Res Treat 2017; 49:1088-1096. [PMID: 28161935 PMCID: PMC5654155 DOI: 10.4143/crt.2016.473] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/17/2017] [Indexed: 01/21/2023] Open
Abstract
Purpose The American College of Surgeons Oncology Group Z0011 trial reported that complete dissection of axillary lymph nodes (ALNs) may not be warranted in women with clinical T1-T2 tumors and one or two involved ALNs who were undergoing lumpectomy plus radiation followed by systemic therapy. The present study was conducted to identify preoperative imaging predictors of ≥ 3 ALNs. Materials and Methods The training set consisted of 1,917 patients with clinical T1-T2 and node negative invasive breast cancer. Factors associated with ≥ 3 involved ALNs were evaluated by logistic regression analysis. The validation set consisted of 378 independent patients. The nomogram was applied prospectively to 512 patients who met the Z0011 criteria. Results Of the 1,917 patients, 204 (10.6%) had ≥ 3 positive nodes. Multivariate analysis showed that involvement of ≥ 3 nodes was significantly associated with ultrasonographic and chest computed tomography findings of suspicious ALNs (p < 0.001 each). These two imaging criteria, plus patient age, were used to develop a nomogram calculating the probability of involvement of ≥ 3 ALNs. The areas under the receiver operating characteristic curve of the nomogram were 0.852 (95% confidence interval [CI], 0.820 to 0.883) for the training set and 0.896 (95% CI, 0.836 to 0.957) for the validation set. Prospective application of the nomogram showed that 60 of 512 patients (11.7%) had scores above the cut-off. Application of the nomogram reduced operation time and cost, with a very low re-operation rate (1.6%). Conclusion Patients likely to have ≥ 3 positive ALNs could be identified by preoperative imaging. The nomogram was helpful in selective intraoperative examination of sentinel lymph nodes.
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Affiliation(s)
- Soo Kyung Ahn
- Department of Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Min Kyoon Kim
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jongjin Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Eunshin Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Kyung Yoo
- Department of Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joon Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Chang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Nariya Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Kyung Moon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - In Ae Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Barco I, Chabrera C, García-Fernández A, Fraile M, González S, Canales L, Lain JM, González C, Vidal MC, Vallejo E, Deu J, Pessarrodona A, Giménez N, García Font M. Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients. Clin Transl Oncol 2016; 19:704-710. [PMID: 27896640 DOI: 10.1007/s12094-016-1589-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/18/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE Roughly two-thirds of early breast cancer cases are associated with negative axillary nodes and do not benefit from axillary surgery at all. Accordingly, there is an ongoing search for non-surgical staging procedures to avoid lymph-node dissection or sentinel node biopsy (SNB). Non-invasive imaging techniques with very high sensitivity (Se) and negative predictive value (NPV) could eventually replace SNB. We aimed to establish the role of axillary US and MRI, alone or in combination, associated with ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in the prediction of axillary node involvement. METHODS/PATIENTS Between January 2003 and September 2015, we included 1505 of the 1538 breast cancer patients attending our centres. All patients had been referred from a single geographical area. Axillary US, magnetic resonance imaging and ultrasound-guided fine-needle aspiration biopsy (US-FNAB) were performed if required. RESULTS 1533 axillary US examinations and 1351 axillary MRI studies were analyzed. For axillary US, Se, Specificity (Sp), Positive Predictive Value (PPV), and NPV were 47.5, 93.6, 82.5, and 73.8%, respectively. For axillary MRI, corresponding values were 29.8, 96.6, 84.9, and 68.4%. When both tests were combined, Sp and PPV slightly improved over individual tests alone. US-FNAB showed a 100% Sp and PPV, with a Se of 80%. CONCLUSION We may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients.
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Affiliation(s)
- I Barco
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/Sant Antoni, 21, 08221, Terrassa, Spain
| | - C Chabrera
- Department of Nursing, School of Health Science, TecnoCampus Mataró-Maresme, Barcelona, Spain
| | - A García-Fernández
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/Sant Antoni, 21, 08221, Terrassa, Spain.
| | - M Fraile
- Nuclear Medicine Department, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - S González
- Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - L Canales
- Breast Unit, Department of Radiology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - J M Lain
- Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Terrassa, Spain
| | - C González
- Department of Pathology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - M C Vidal
- Department of Nursing, Promotion and Supporting Program, Institut Català de la Salut, ASSIR Mollet, Barcelona, Spain
| | - E Vallejo
- Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - J Deu
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/Sant Antoni, 21, 08221, Terrassa, Spain
| | - A Pessarrodona
- Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - N Giménez
- University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.,Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M García Font
- University International of Catalunya, Barcelona, Spain
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Hoen N, Pral L, Golfier F. [Value of intraoperative frozen section of sentinel lymph node in breast cancer. Retrospective study about 293 patients]. ACTA ACUST UNITED AC 2016; 44:274-9. [PMID: 27118121 DOI: 10.1016/j.gyobfe.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/07/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Intraoperative positive frozen section of sentinel axillary lymph node in breast cancer allows the full node dissection at the same time of the breast surgery and the enhancement of adjuvant therapies with no delay. The low frequency of node involvement and the high rate of false-negative, make consider the value of intraoperative frozen section. The aim of this study was to analyze the potential advantage of intraoperative frozen section performed routinely. METHODS Retrospective monocentric study of 293 patients, operated on for stage pT1 or pT2 breast cancer with a sentinel node biopsy (SNB). RESULTS A total of 289 patients had an intraoperative frozen section of the SNB. A sentinel node was identified in 98.6% of the cases. On intraoperative section, sentinel node was negative, positive or was not performed in 252 (86%), 37 (12.6%) and 4 (1.4%) cases respectively. In total, ibtraoperative frozen sections identified 48.7% of the metastatic SNB (37/76). The metastatic lymph node distribution, after final histological analysis, was as follows: 17% macro metastasis, 5.8% micro metastasis and 3% isolated tumor cells. The false-negatives rate was 13.5%. Fifty-eight patients (19.8%) underwent axillary full lymph node dissection: 39 during a primary surgery and 19 during a secondary one. Histological analysis of the lymph nodes was totally negative in 62% of cases. Intraoperative frozen sections benefited to 12.8% of the patients who had their full lymph node dissection at the same surgery. CONCLUSION The intraoperative frozen section of SNB benefits to a limited number of patients, due to its high rate of false-negatives. Sensitivity of frozen sections could be lowered if the preoperative axillary ultrasound examination becomes a routine, which would question its value.
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Affiliation(s)
- N Hoen
- Service de chirurgie gynécologique et oncologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - L Pral
- Service de chirurgie gynécologique et oncologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - F Golfier
- Service de chirurgie gynécologique et oncologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Qiu SQ, Zeng HC, Zhang F, Chen C, Huang WH, Pleijhuis RG, Wu JD, van Dam GM, Zhang GJ. A nomogram to predict the probability of axillary lymph node metastasis in early breast cancer patients with positive axillary ultrasound. Sci Rep 2016; 6:21196. [PMID: 26875677 PMCID: PMC4753408 DOI: 10.1038/srep21196] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
Among patients with a preoperative positive axillary ultrasound, around 40% of them are pathologically proved to be free from axillary lymph node (ALN) metastasis. We aimed to develop and validate a model to predict the probability of ALN metastasis as a preoperative tool to support clinical decision-making. Clinicopathological features of 322 early breast cancer patients with positive axillary ultrasound findings were analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of ALN metastasis. A model was created from the logistic regression analysis, comprising lymph node transverse diameter, cortex thickness, hilum status, clinical tumour size, histological grade and estrogen receptor, and it was subsequently validated in another 234 patients. Coefficient of determination (R(2)) and the area under the ROC curve (AUC) were calculated to be 0.9375 and 0.864, showing good calibration and discrimination of the model, respectively. The false-negative rates of the model were 0% and 5.3% for the predicted probability cut-off points of 7.1% and 13.8%, respectively. This means that omission of axillary surgery may be safe for patients with a predictive probability of less than 13.8%. After further validation in clinical practice, this model may support increasingly limited surgical approaches to the axilla in breast cancer.
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Affiliation(s)
- Si-Qi Qiu
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Huan-Cheng Zeng
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Fan Zhang
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Cong Chen
- Department of Ultrasound Diagnosis, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Wen-He Huang
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Rick G. Pleijhuis
- Department of Internal Medicine, Medical Spectrum Twente, Enschede, The Netherlands
| | - Jun-Dong Wu
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Gooitzen M. van Dam
- Department of Surgery, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Guo-Jun Zhang
- The Breast Center, Cancer Hospital of Shantou University Medical College, Guangdong, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Guangdong, China
- Cancer Research Center, Shantou University Medical College, Guangdong, China
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Pilewskie M, Jochelson M, Gooch JC, Patil S, Stempel M, Morrow M. Is Preoperative Axillary Imaging Beneficial in Identifying Clinically Node-Negative Patients Requiring Axillary Lymph Node Dissection? J Am Coll Surg 2015; 222:138-45. [PMID: 26711795 DOI: 10.1016/j.jamcollsurg.2015.11.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND American College of Surgeons Oncology Group (ACOSOG) Z0011 results support the omission of axillary lymph node dissection (ALND) in women with less than 3 positive sentinel lymph nodes (SLNs) undergoing breast-conserving surgery (BCS) and radiation therapy. We sought to determine if abnormal axillary imaging is predictive of the need for ALND in this population. STUDY DESIGN Patients with cT1-2N0 breast cancer by physical examination undergoing BCS were managed according to Z0011 criteria independent of axillary imaging. Patient characteristics and rates of ALND were compared among those with and without abnormal lymph nodes (LNs) detected by mammogram, ultrasound (US), or MRI. All available axillary imaging was reviewed by 1 breast radiologist. RESULTS Between August 2010 and December 2013, 3,253 breast cancer patients were treated with BCS and SLN biopsy; 425 patients met Z0011 criteria (cT1-2N0) and had nodal metastasis on SLN biopsy. Clinicopathologic features were median patient age, 58 years; median tumor size, 1.8 cm; 85% ductal histology; and 89% estrogen receptor positive. All women had a mammogram, 242 had axillary US, 172 had MRI. Abnormal LNs were seen on 7%, 25%, and 30% of mammograms, US, and MRIs, respectively. Although abnormal LNs on mammogram or US were associated with a significant increase in ALND and a non-significant trend was seen with MRI, 68% to 73% of women with abnormal axillary imaging did not require ALND. CONCLUSIONS Among clinically node-negative patients with abnormal axillary imaging, 71% did not meet criteria for ALND and were spared further surgical morbidity. Abnormal nodes on US, MRI, or mammogram in clinically node-negative patients are not reliable indicators of the need for ALND.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maxine Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica C Gooch
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Predictors of false negative axillary ultrasound in breast cancer. J Surg Res 2015; 198:351-4. [DOI: 10.1016/j.jss.2015.03.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/08/2015] [Accepted: 03/19/2015] [Indexed: 02/05/2023]
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You S, Kang DK, Jung YS, An YS, Jeon GS, Kim TH. Evaluation of lymph node status after neoadjuvant chemotherapy in breast cancer patients: comparison of diagnostic performance of ultrasound, MRI and ¹⁸F-FDG PET/CT. Br J Radiol 2015; 88:20150143. [PMID: 26110204 PMCID: PMC4651396 DOI: 10.1259/bjr.20150143] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To evaluate the diagnostic performance of ultrasound, MRI and fluorine-18 fludeoxyglucose positron emission tomography (18F-FDG PET)/CT for the diagnosis of metastatic axillary lymph node (ALN) after neoadjuvant chemotherapy (NAC) and to find out histopathological factors affecting the diagnostic performance of these imaging modalities. Methods: From January 2012 to November 2014, 191 consecutive patients with breast cancer who underwent NAC before surgery were retrospectively reviewed. We included 139 patients with ALN metastasis that was confirmed on fine needle aspiration or core needle biopsy at initial diagnosis. Results: After NAC, 39 (28%) patients showed negative conversion of ALN on surgical specimens of sentinel lymph node (LN) or ALN. The sensitivity of ultrasound, MRI and PET/CT was 50% (48/96), 72% (70/97) and 22% (16/73), respectively. The specificity of ultrasound, MRI and PET/CT was 77% (30/39), 54% (21/39) and 85% (22/26), respectively. The Az value of combination of ultrasound and PET/CT was the highest (0.634) followed by ultrasound (0.626) and combination of ultrasound, MRI and PET/CT (0.617). The size of tumour deposit in LN and oestrogen receptor was significantly associated with the diagnostic performance of ultrasound (p < 0.001 and p = 0.009, respectively) and MRI (p = 0.045 and p = 0.036, respectively). The percentage diameter decrease, size of tumour deposit in LN, progesterone receptor, HER2 and histological grade were significantly associated with the diagnostic performance of PET/CT (p = 0.023, p = 0.002, p = 0.036, p = 0.044 and p = 0.008, respectively). On multivariate logistic regression analysis, size of tumour deposit within LN was identified as being independently associated with diagnostic performance of ultrasound [odds ratio, 13.07; 95% confidence interval (CI), 2.95–57.96] and PET/CT (odds ratio, 6.47; 95% CI, 1.407–29.737). Conclusion: Combination of three imaging modalities showed the highest sensitivity, and PET/CT showed the highest specificity for the evaluation of ALN metastasis after NAC. Ultrasound alone or combination of ultrasound and PET/CT showed the highest positive-predictive value. The size of tumour deposit within ALN was significantly associated with diagnostic performance of ultrasound and PET/CT. Advances in knowledge: This study is about the diagnostic performance of ultrasound, MRI, PET/CT and combination of each imaging modality for the evaluation of metastatic ALN after NAC. Of many histopathological factors, only the size of tumour deposit within ALN was an independent factor associated with the diagnostic performance of ultrasound and PET/CT.
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Affiliation(s)
- S You
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - D K Kang
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Y S Jung
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Y-S An
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - G S Jeon
- Department of Radiology, CHA Bundang Medical Center, CHA University, College of Medicine, Seongnam, Republic of Korea
| | - T H Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
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Locoregional Recurrence Risk in Breast Cancer Patients with Estrogen Receptor Positive Tumors and Residual Nodal Disease following Neoadjuvant Chemotherapy and Mastectomy without Radiation Therapy. Int J Breast Cancer 2015; 2015:147476. [PMID: 26266050 PMCID: PMC4523670 DOI: 10.1155/2015/147476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/01/2015] [Indexed: 11/24/2022] Open
Abstract
Among breast cancer patients treated with neoadjuvant chemotherapy (NAC) and mastectomy, locoregional recurrence (LRR) rates are unclear in women with ER+ tumors treated with adjuvant endocrine therapy without postmastectomy radiation (PMRT). To determine if PMRT is needed in these patients, we compared LRR rates of patients with ER+ tumors (treated with adjuvant endocrine therapy) with women who have non-ER+ tumors. 85 consecutive breast cancer patients (87 breast tumors) treated with NAC and mastectomy without PMRT were reviewed. Patients were divided by residual nodal disease (ypN) status (ypN+ versus ypN0) and then stratified by receptor subtype. Among ypN+ patients (n = 35), five-year LRR risk in patients with ER+, Her2+, and triple negative tumors was 5%, 33%, and 37%, respectively (p = 0.02). Among ypN+/ER+ patients, lymphovascular invasion and grade three disease increased the five-year LRR risk to 13% and 11%, respectively. Among ypN0 patients (n = 52), five-year LRR risk in patients with ER+, Her2+, and triple negative tumors was 7%, 22%, and 6%, respectively (p = 0.71). In women with ER+ tumors and residual nodal disease, endocrine therapy may be sufficient adjuvant treatment, except in patients with lymphovascular invasion or grade three tumors where PMRT may still be indicated.
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Breast Cancer Molecular Subtype as a Predictor of the Utility of Preoperative MRI. AJR Am J Roentgenol 2015; 204:1354-60. [DOI: 10.2214/ajr.14.13666] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Jankowski C, Hudry D, Vaillant D, Varbedian O, Mejean N, Guy F, Feutray S, Coutant C. Evaluation of axillary involvement by ultrasound-guided lymph node biopsy: A prospective study. ACTA ACUST UNITED AC 2015; 43:431-6. [DOI: 10.1016/j.gyobfe.2015.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/17/2015] [Indexed: 01/28/2023]
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Yu YH, Mo QG, Zhu X, Gao LQ, Liang C, Huang Z, Qin QH, Wei W, Jiang Y, Bu KP, Wei CY. Axillary fine needle aspiration cytology is a sensitive and highly specific technique for the detection of axillary lymph node metastasis: a meta-analysis and systematic review. Cytopathology 2014; 27:59-69. [DOI: 10.1111/cyt.12224] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Y.-H. Yu
- Department of Breast Surgery; Guangxi Cancer Hospital & Affiliated Cancer Hospital of Guangxi Medical University
| | - Q.-G. Mo
- Department of Breast Surgery; Guangxi Cancer Hospital & Affiliated Cancer Hospital of Guangxi Medical University
| | - X. Zhu
- Department of Breast Surgery; Guangxi Cancer Hospital & Affiliated Cancer Hospital of Guangxi Medical University
| | - L.-Q. Gao
- Department of Microbiology; Guangxi Medical University
| | - C. Liang
- Department of Surgery; The Third Affiliated Hospital of Guangxi Medical University
| | - Z. Huang
- Department of Breast Surgery; Guangxi Cancer Hospital & Affiliated Cancer Hospital of Guangxi Medical University
| | - Q.-H. Qin
- Department of Breast Surgery; Guangxi Cancer Hospital & Affiliated Cancer Hospital of Guangxi Medical University
| | - W. Wei
- Department of Breast Surgery; Guangxi Cancer Hospital & Affiliated Cancer Hospital of Guangxi Medical University
| | - Y. Jiang
- Department of Breast Surgery; Guangxi Cancer Hospital & Affiliated Cancer Hospital of Guangxi Medical University
| | - K.-P. Bu
- Department of Breast Surgery; Guangxi Cancer Hospital & Affiliated Cancer Hospital of Guangxi Medical University
| | - C.-Y. Wei
- Department of Breast Surgery; Guangxi Cancer Hospital & Affiliated Cancer Hospital of Guangxi Medical University
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van Wely BJ, de Wilt JHW, Francissen C, Teerenstra S, Strobbe LJA. Meta-analysis of ultrasound-guided biopsy of suspicious axillary lymph nodes in the selection of patients with extensive axillary tumour burden in breast cancer. Br J Surg 2014; 102:159-68. [DOI: 10.1002/bjs.9663] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/15/2014] [Accepted: 09/01/2014] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Recent studies show that not all patients with breast cancer and positive axillary lymph nodes need additional axillary surgery. A systematic review and meta-analysis of the literature was performed to test the hypothesis that ultrasound-guided biopsy of suspicious nodes can be a useful tool to identify patients with extensive axillary tumour burden.
Methods
PubMed and Embase were searched to identify articles reporting on ultrasound-guided techniques to stage the axilla of patients with breast cancer. The emphasis was to study the number of positive nodes found after axillary lymph node dissection (ALND) following a positive ultrasound-guided biopsy or a positive sentinel lymph node biopsy (SLNB). Information regarding the number of positive nodes thus had to be available. Results were tested for heterogeneity and a meta-analysis was performed.
Results
A total of 894 articles were identified, and 115 were selected based on title and abstract information by two independent reviewers. After extensive review, 18 articles were eligible for analysis. Eight studies reported sufficient data to perform a meta-analysis comparing 532 patients with a positive ultrasound-guided biopsy with 248 patients with a negative ultrasound-guided biopsy but a positive SLNB. The number of involved nodes was significantly higher in patients in whom axillary metastasis was detected by ultrasound-guided biopsy (P < 0·001). No heterogeneity in the observed effect was found (I2 = 22 per cent, P = 0·26).
Conclusion
Patients with breast cancer in whom axillary metastases are detected by ultrasound-guided biopsy have significantly more involved nodes than SLNB-positive patients. This finding enables further preoperative tailoring of axillary treatment in breast cancer.
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Affiliation(s)
- B J van Wely
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Francissen
- Department of Surgery, Geldersche Vallei Hospital, Ede, The Netherlands
| | - S Teerenstra
- Section of Biostatistics, Department of Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L J A Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Sankaye P, Chhatani S, Porter G, Steel J, Doyle S. Is axillary sonographic staging less accurate in invasive lobular breast cancer than in ductal breast cancer? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1805-1810. [PMID: 25253827 DOI: 10.7863/ultra.33.10.1805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether axillary sonography is less accurate in invasive lobular breast cancer than in ductal breast cancer. METHODS Patients with invasive breast cancer were retrospectively identified from histologic records from 2010 to 2012. Staging axillary sonograms from 96 patients with primary breast cancer in each of 2 subgroups, invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC), were reviewed. Preoperative sonographically guided 14-gauge core biopsy was performed on morphologically abnormal lymph nodes. RESULTS Thirty-one of 96 patients (32%) in each subgroup were node positive on final postoperative histopathologic analysis. Axillary staging sensitivity was 17 of 31 patients (54%) in the IDC subgroup and 15 of 31(48%) in the ILC subgroup. Further analysis of the data showed no statistically significant differences between these subgroups. CONCLUSIONS We found that there was no statistically significant difference in the accuracy of axillary sonographic staging between ILC and IDC.
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Affiliation(s)
- Prashant Sankaye
- Plymouth Hospitals NHS Trust and Peninsula Radiology Academy, Plymouth, England.
| | - Sharmila Chhatani
- Plymouth Hospitals NHS Trust and Peninsula Radiology Academy, Plymouth, England
| | - Gareth Porter
- Plymouth Hospitals NHS Trust and Peninsula Radiology Academy, Plymouth, England
| | - Jim Steel
- Plymouth Hospitals NHS Trust and Peninsula Radiology Academy, Plymouth, England
| | - Sarah Doyle
- Plymouth Hospitals NHS Trust and Peninsula Radiology Academy, Plymouth, England
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Chung J, Youk JH, Kim JA, Gweon HM, Kim EK, Ryu YH, Son EJ. Role of diffusion-weighted MRI: predicting axillary lymph node metastases in breast cancer. Acta Radiol 2014; 55:909-16. [PMID: 24234236 DOI: 10.1177/0284185113509094] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ultrasound (US) is probably the standard imaging procedure in most centers, and US-guided fine needle aspiration can be added if suspicious lymph nodes are found. However, US-guided fine needle aspiration is an invasive method to diagnose a metastasis and has showed relatively low sensitivity. In general, diffusion-weighted (DW) magnetic resonance imaging (MRI) has become an emerging technique for discriminating benign from malignant breast lesions in a short imaging acquisition time. PURPOSE To evaluate the potential for using DW MRI with an apparent diffusion coefficient (ADC) value to predict axillary lymph node metastases in patients with invasive breast cancer. MATERIAL AND METHODS This study enrolled 110 axillary lymph nodes from 110 consecutive women who were diagnosed with invasive breast cancer for preoperative breast MRI and US. The largest enhancing ipsilateral axillary lymph nodes were included in this study, and benign and metastatic axillary lymph nodes were compared according to the pathologic reports. The cut-off ADC value to differentiate between benign and metastatic axillary lymph nodes was evaluated with receiver-operating characteristic curve analysis. Diagnostic performance of ultrasound and DW MRI was calculated for enhancing lymph node in dynamic contrast-enhanced MRI. RESULTS Nodal metastases were documented in 68 (62%) axillary lymph nodes. The mean size of metastatic axillary lymph nodes was larger than that of benign axillary lymph nodes (15.5 mm vs. 10.9 mm, P < 0.001). The mean ADC value (0.69 × 10(-3 )mm(2)/s) of the metastases was significantly lower than that of the benign axillary lymph nodes (1.04 × 10(-3 )mm(2)/s) (P < 0.001). The ADC value cut-off between metastatic and benign axillary lymph nodes was 0.90 × 10(-3 )mm(2)/s. Using ADC cut-off, sensitivity, specificity, and accuracy of DW MRI were 100%, 83.3%, and 93.6%, respectively. The sensitivity, specificity, and accuracy of US showed 94.1%, 54.8%, and 79.1%, respectively. CONCLUSION DW MRI of axillary lymph nodes can provide reliable information for the differentiation of benign from metastatic axillary lymph nodes in invasive breast cancer patients.
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Affiliation(s)
- Jin Chung
- Department of Radiology, Ewha Womans University, School of Medicine, Seoul, Republic of Korea
- Department of Radiology, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ah Kim
- Department of Radiology, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Hye Mi Gweon
- Department of Radiology, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Son
- Department of Radiology, Yonsei University, College of Medicine, Seoul, Republic of Korea
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Should Ultrasound be a Standard Preoperative Tool in Surgical Planning? CURRENT BREAST CANCER REPORTS 2014. [DOI: 10.1007/s12609-013-0133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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An YS, Lee DH, Yoon JK, Lee SJ, Kim TH, Kang DK, Kim KS, Jung YS, Yim H. Diagnostic performance of 18F-FDG PET/CT, ultrasonography and MRI. Detection of axillary lymph node metastasis in breast cancer patients. Nuklearmedizin 2013; 53:89-94. [PMID: 24220324 DOI: 10.3413/nukmed-0605-13-06] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 08/26/2013] [Indexed: 12/13/2022]
Abstract
UNLABELLED The aim of this study was to evaluate the diagnostic abilities of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography(PET/CT) compared with those of ultrasonography and magnetic resonance imaging (MRI) for axillary lymph node staging in breast cancer patients. PATIENTS, METHODS Preoperative 18F-FDG PET/non-contrast CT, ultrasonography and MRI were performed in 215 women with breast cancer. Axillary lymph node dissection was performed in all patients and the diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. ROC curves were compared to evaluate the diagnostic ability of several imaging modalities (i. e., ultrasonography, MRI and 18F-FDG PET/CT). RESULTS In total, 132 patients (61.4%) had axillary lymph node metastasis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of axillary lymph node metastasis were 72.3%, 77.3%, 66.7%, 81.6%, 75.3% for ultrasonography, 67.5%, 78.0%, 65.9%, 79.2%, 74.0% for MRI, and 62.7%, 88.6%, 77.6%, 79.1%, 78.6% for 18F-FDG PET/CT, respectively. There was no significant difference in diagnostic ability among the imaging modalities (i.e., ultrasonography, MRI and 18F-FDG PET/CT). The diagnostic ability of 18F-FDG PET/CT was significantly improved by combination with MRI (p = 0.0002) or ultrasonography (p < 0.0001). The combination of 18F-FDG PET/CT with ultrasonography had a similar diagnostic ability to that of all three modalities combined (18F-FDG PET/CT+ultrasonography+MRI, p = 0.05). CONCLUSION The diagnostic performance of 18F-FDG PET/CT for detection of axillary node metastasis was not significantly different from that of ultrasonography or MRI in breast cancer patients. Combining 18F-FDG PET/CT with ultrasonography or MRI could improve the diagnostic performance compared to 18F-FDG PET/CT alone.
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Affiliation(s)
- Y-S An
- Young-Sil An, M.D., Ph.D., Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Ajou University, Woncheon-dong, Yeongtong-gu, Gyeonggi-do, Suwon, Korea 443-749, Tel. +82/31/219 59 48; Fax +82/31/219 59 50, E-mail:
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Sutcliffe J, Hardman RL, Dornbluth NC, Kist KA. A novel technique for teaching challenging ultrasound-guided breast procedures to radiology residents. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1845-1854. [PMID: 24065266 DOI: 10.7863/ultra.32.10.1845] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Ultrasound-guided breast interventions (core biopsies, needle-wire localizations, and fine-needle cyst aspirations) are common procedures performed by radiologists. Residents must gain competency in these interventions during training. Phantoms and simulations have been advocated for teaching interventions, and various systems are available for standard breast interventions. However, simulations for difficult/high-risk interventions are not readily available. We describe an inexpensive method for simulating difficult ultrasound-guided breast procedures, including masses over breast implants, deep masses along the chest wall, and lymph nodes adjacent to axillary vessels.
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Affiliation(s)
- Joseph Sutcliffe
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78229 USA.
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Axillary ultrasound in patients with clinically node-negative breast cancer: which features are predictive of disease? J Surg Res 2013; 184:234-40. [DOI: 10.1016/j.jss.2013.03.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/17/2013] [Accepted: 03/20/2013] [Indexed: 02/05/2023]
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Giard S, Cutuli B, Antoine M, Barreau B, Besnard S, Bonneterre J, Campone M, Ceugnard L, Classe JM, Cohen M, Dohoullou N, Fourquet A, Guinebretière JM, Hennequin C, Leblanc-Onfroy M, Levy L, Mazeau-Woynar V, Mouret Reynier MA, Rousseau C, Verdoni L. Les recommandations nationales françaises de prise en charge du cancer du sein infiltrant. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2296-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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The clinical value of tumor FDG uptake for predicting axillary lymph node metastasis in breast cancer with clinically negative axillary lymph nodes. Ann Nucl Med 2013; 27:546-53. [DOI: 10.1007/s12149-013-0720-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
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48
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Noninvasive Nodal Staging in Patients With Breast Cancer Using Gadofosveset-Enhanced Magnetic Resonance Imaging. Invest Radiol 2013; 48:134-9. [DOI: 10.1097/rli.0b013e318277f056] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wojcinski S, Dupont J, Schmidt W, Cassel M, Hillemanns P. Real-time ultrasound elastography in 180 axillary lymph nodes: elasticity distribution in healthy lymph nodes and prediction of breast cancer metastases. BMC Med Imaging 2012; 12:35. [PMID: 23253859 PMCID: PMC3536617 DOI: 10.1186/1471-2342-12-35] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 12/18/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To determine the general appearance of normal axillary lymph nodes (LNs) in real-time tissue sonoelastography and to explore the method's potential value in the prediction of LN metastases. METHODS Axillary LNs in healthy probands (n=165) and metastatic LNs in breast cancer patients (n=15) were examined with palpation, B-mode ultrasound, Doppler and sonoelastography (assessment of the elasticity of the cortex and the medulla). The elasticity distributions were compared and sensitivity (SE) and specificity (SP) were calculated. In an exploratory analysis, positive and negative predictive values (PPV, NPV) were calculated based upon the estimated prevalence of LN metastases in different risk groups. RESULTS In the elastogram, the LN cortex was significantly harder than the medulla in both healthy (p=0.004) and metastatic LNs (p=0.005). Comparing healthy and metastatic LNs, there was no difference in the elasticity distribution of the medulla (p=0.281), but we found a significantly harder cortex in metastatic LNs (p=0.006). The SE of clinical examination, B-mode ultrasound, Doppler ultrasound and sonoelastography was revealed to be 13.3%, 40.0%, 14.3% and 60.0%, respectively, and SP was 88.4%, 96.8%, 95.6% and 79.6%, respectively. The highest SE was achieved by the disjunctive combination of B-mode and elastographic features (cortex >3mm in B-mode or blue cortex in the elastogram, SE=73.3%). The highest SP was achieved by the conjunctive combination of B-mode ultrasound and elastography (cortex >3mm in B-mode and blue cortex in the elastogram, SP=99.3%). CONCLUSIONS Sonoelastography is a feasible method to visualize the elasticity distribution of LNs. Moreover, sonoelastography is capable of detecting elasticity differences between the cortex and medulla, and between metastatic and healthy LNs. Therefore, sonoelastography yields additional information about axillary LN status and can improve the PPV, although this method is still experimental.
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Affiliation(s)
- Sebastian Wojcinski
- Hannover Medical School, Department for Obstetrics and Gynecology, OE 6410, Carl-Neuberg-Straße 1, Hannover 30625, Germany
| | - Jennifer Dupont
- Main-Taunus-Kreis Hospital, Department for Obstetrics and Gynecology, Bad Soden, Germany
| | - Werner Schmidt
- University Hospital of Saarland, Department for Obstetrics and Gynecology, Homburg/Saar, Germany
| | - Michael Cassel
- University of Potsdam, Center for Sports Medicine, Recreational and High Performance Sports, Potsdam, Germany
| | - Peter Hillemanns
- Hannover Medical School, Department for Obstetrics and Gynecology, OE 6410, Carl-Neuberg-Straße 1, Hannover 30625, Germany
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McDermott S, Hedgire SS, Hahn PF, Mueller PR, Harisinghani MG. Image-guided Biopsy of Suspicious Lymph Nodes in Patients with Known Primary Malignancies. J Vasc Interv Radiol 2012; 23:371-6. [DOI: 10.1016/j.jvir.2011.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/21/2011] [Accepted: 11/24/2011] [Indexed: 11/25/2022] Open
Affiliation(s)
- Shaunagh McDermott
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
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