Axillary Ultrasound for Breast Cancer Staging: an Attempt to Identify Clinical/Histopathological Factors Impacting Diagnostic Performance

Abstract

Aim:To assess the diagnostic value of pre-surgery axillary ultrasound for nodal staging in patients with primary breast cancer and to identify clinical/histopathological factors impacting diagnostic performance.Study design:Single-center, retrospective chart analysis. We assessed sensitivity, specificity, and positive and negative predictive value of clinical examination as well as axillary ultrasound vs. clinical examination alone. The histopathological results were the standard of truth. In addition, we analyzed clinical and histopathological factors regarding their potential to impact sensitivity and specificity.Results:We enrolled a total of 172 women in the study. Sensitivity of clinical examination plus ultrasound was significantly higher than for clinical examination alone (58% vs. 31.6%). Specificity and positive predictive value were similar while the negative predictive value increased from 63.4% to 73% when additionally applying ultrasound. Sensitivity and specificity of axillary ultrasound were impacted by tumor size (P = 0.2/0.04), suspicious axillary palpation (P < 0.01/<0.01), number of affected lymph nodes (P < 0.01/−) and distant metastases (P = 0.04/<0.01). All other factors had no impact.Conclusion:Since pre-surgery axillary nodal staging is currently used to determine disease management, axillary ultrasound is a useful add-on tool in the diagnostic armamentarium for breast cancer patients. Tumor size, suspicious axillary palpation, number of affected lymph nodes and distant metastases increase diagnostic performance of this diagnostic modality.

Clinicopathological Factors Associated With Positive Preoperative Axillary Ultrasound Scanning in Breast Cancer Patients

“…Moreover, PAUS-positive patients have more macrometastases and more lymph nodes involved than those who have metastases identified by SLNB alone. These results are consistent with those of Wely et al [11] and others [12,13], who also showed that patients with ultrasound-positive lymph nodes often have more extensive lymph node involvement and unfavourable disease characteristics. In particular, in their consideration of the impact of the Z0011 trial, Verheuvel et al found that the PAUS-positive group also had unfavourable disease characteristics and a worse prognosis than SLNB positive pa-tients.…”

“…It is likely to have been due to the lymph node burden resulting in marked morphological changes in the involved nodes that were readily detected by the radiologist at the time of presentation. These findings are consistent with those of Wely et al [11] and Ertan et al [12], who also showed that patients with ultrasoundpositive lymph nodes often have more extensive lymph node involvement. The overall PAUS positive detection rate in our unit was 50.5%.…”

Diagnostic Accuracy of Fine-Needle Aspiration Cytology and Core-Needle Biopsy in the Assessment of the Axillary Lymph Nodes in Breast Cancer—A Meta-Analysis

“…AUS is a basic and initial diagnostic tool used for patients with breast cancer [ 70 , 71 ]. Although the ability of AUS to provide high-quality images has gradually improved, the appearance of ALNs with normal-appearing morphology ranges between 26% and 52% [ 8 , 11 , 59 , 72 , 73 , 74 , 75 ]. The diagnostic accuracy of AUS can be affected by various factors, including the operator’s skill and experience and the ultrasound equipment used.…”

Axillary Ultrasound Identifies Residual Nodal Disease After Chemotherapy: Results From the American College of Surgeons Oncology Group Z1071 Trial (Alliance)

“…The positive predictive value for nodal metastases was reported as 93.1% for nodal ultrasound with core biopsy in a retrospective study of 662 patients with newly suspected breast cancer [14]. It has been suggested that the absence of a fatty hilum on imaging be an indicator for performing biopsy [17, 18]. …”