Accuracy of axillary ultrasound in preoperative nodal staging of breast cancer - size of metastases as limiting factor

Abstract

Since the performance of surgical procedures of the axilla in the treatment of early breast cancer is decreasing, the role of axillary ultrasound (AUS) as staging procedere has newly to be addressed. The aim of this study was to determine which patient or histopathological characteristics are related to false-negative AUS. In a retrospective study design data of 470 women with primary breast cancer were collected from patient charts and imaging and pathology records were reviewed. True positive and false negative axillary ultrasound groups were compared in terms of tumor size, histological subtype, grade, estrogen receptor (ER) and HER2 status, proliferation index, number and size of nodal metastases, extracapsular extension (ECE) and lymphovascular invasion (LVI). Of 470 patients, 166 (35%) were node positive, 79 of them with suspicious AUS. Factors associated with false negative AUS by univariate analysis were included in a multivariate model. By multivariate analysis, only size of nodal metastases was an independent factor for false negative AUS. In the sentinel lymph node biopsy (SLNB) subgroup, 45% of patients had nodal metastasis size less than or equal to 5 mm. In conclusion, AUS in preoperative staging of early stage breast cancer is limited by small size of metastases in a substantial number of patients. Prospective studies have to show whether small metastatic deposits leaving in patients in case of no axillary surgery have no negative effect on disease free and overall survival.

Local Treatment of the Axilla in Early Breast Cancer: Concepts from the National Surgical Adjuvant Breast and Bowel Project B-04 to the Planned Intergroup Sentinel Mamma Trial

“…All of these patients at the Mayo Clinic Rochester were clinically node-negative by preoperative axillary ultrasound (AUS) with or without fine-needle aspiration (FNA) biopsy. Recently, we have published our data from the University Hospital Rostock with an SLN-positive rate of 21.1% [14].…”

“…With regard to the higher costs and possible side effects, PET/CT and MRI do not have a place in routine axillary staging. Finally, we have to take into account that exclusion of nodal metastatic infiltration is impossible with any imaging technique in about 25% of nodal metastases due to a size of ≤ 5 mm, which is below the reliability for detection [14].…”

Evaluation of Sentinel Lymph Node Biopsy and Axillary Lymph Node Dissection for Breast Cancer Treatment Concepts - a Retrospective Study of 1,214 Breast Cancer Patients

“…Other groups reported lower rates of between 13% [27] and 17.6% [28]; however, another German group recently published a comparable SLN-positive rate of 21.1% [29]. The rate of positive SLN is expected to decrease in the era of breast cancer screening.…”

“…Therefore, not only the role of ALND but also that of SLNB itself is under discussion. Increasingly precise and efficient preoperative axillary imaging still misses about 25% of axillary metastatic disease -especially in cases with metastases of 5 mm and thus below the level of detection [29]. Wang et al [30] recently published a meta-analysis that not only reported SLNB false-negative rates of up to 22.9%, but also failed to find significantly different rates in overall survival, disease-free survival and local axillary recurrence with SLNB alone versus ALND.…”

Accuracy of ultrasound scan guided needle biopsy in preoperative diagnosis of metastatic axillary lymphadenopathy in patients with breast cancer

“…A positive correlation doi: 10.7243/2057-1631-4-1 has been reported between the preoperative USB diagnosis of metastatic disease and the underlying prevalence of ALN metastases [9]. Further studies have also confirmed that the sensitivity of US and USB depends on the extent of axillary tumor burden [10][11][12]. Meta-analysis studies have reported that preoperative USB of the axilla is accurate for initial staging of women with invasive breast cancer [9] and is a useful step in the process of axillary staging [13].…”